Turner David A, Kleinman Monica E
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, NC 27710, USA.
Pediatr Emerg Care. 2010 Aug;26(8):563-6. doi: 10.1097/PEC.0b013e3181ea71e1.
Many experts recommend that vasoactive agents be infused via a central venous line (CVL) because of the potential risk of infiltration, but CVL placement in pediatric patients is often challenging. We hypothesized that it is safe to administer vasoactive infusions via peripheral intravenous (PIV) line in critically ill infants and children during interhospital transport.
We retrospectively reviewed the medical records of 1133 neonatal and pediatric patients transported to the intensive care units at Children's Hospital Boston from May 2004 through June 2006 to identify patients treated with vasoactive medications via PIV line. Mann-Whitney U analysis was used to identify variables associated with complications of peripheral vasoactive infusion.
Seventy-three (6%) of the 1133 patients were treated during transport with vasoactive agents via PIV line. No complications occurred during transport, but 11 (15%) of 73 patients developed intravenous (IV) infiltrates related to vasoactive infusion at a mean of 7 hours after arrival to the receiving facility (range, 2-24 hours). Compared with patients with IV infiltrations, those without IV infiltrates had significantly lower median duration of vasoactive infusion and median maximum medication dose (256 vs 810 minutes and 10 vs 15 microg/kg per minute, respectively; P < 0.05). There were no significant differences between any other variables tested, and all infiltrates resolved without significant intervention or lasting injury.
Results from our series suggest that administration of vasoactive medications via PIV line during transport of critically ill infants and children is safe. The risk for complications increased with higher infusion rates and longer duration of therapy. Prompt transitioning of vasoactive infusions to a CVL may lead to fewer complications but does not seem to be necessary before transport.
由于存在渗漏的潜在风险，许多专家建议通过中心静脉导管（CVL）输注血管活性药物，但在儿科患者中放置CVL往往具有挑战性。我们推测，在院际转运期间，通过外周静脉（PIV）导管为重症婴幼儿和儿童输注血管活性药物是安全的。
我们回顾性分析了2004年5月至2006年6月间转运至波士顿儿童医院重症监护病房的1133例新生儿和儿科患者的病历，以确定通过PIV导管接受血管活性药物治疗的患者。采用曼-惠特尼U分析来确定与外周血管活性输注并发症相关的变量。
1133例患者中有73例（6%）在转运期间通过PIV导管接受了血管活性药物治疗。转运期间未发生并发症，但73例患者中有11例（15%）在抵达接收机构后平均7小时（范围2 - 24小时）出现了与血管活性输注相关的静脉（IV）渗漏。与发生IV渗漏的患者相比，未发生IV渗漏的患者血管活性输注的中位持续时间和最大药物剂量中位数显著更低（分别为256分钟对810分钟和10微克/千克每分钟对15微克/千克每分钟；P < 0.05）。所测试的任何其他变量之间均无显著差异，所有渗漏均在未进行重大干预或未造成持久损伤的情况下得到解决。
我们系列研究的结果表明，在重症婴幼儿和儿童转运期间通过PIV导管给予血管活性药物是安全的。并发症风险随着输注速率的提高和治疗持续时间的延长而增加。将血管活性输注迅速转换为CVL可能会减少并发症，但在转运前似乎并非必要。
