Tian David H, Smyth Claire, Keijzers Gerben, Macdonald Stephen Pj, Peake Sandra, Udy Andrew, Delaney Anthony
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Emerg Med Australas. 2020 Apr;32(2):220-227. doi: 10.1111/1742-6723.13406. Epub 2019 Nov 7.
Vasopressor medications have traditionally been administered via central venous catheters (CVCs), primarily due to concerns of peripheral extravasation of vasoconstrictive medications. Recent studies have suggested that vasopressor administration via peripheral intravenous catheters (PiVCs) may be a feasible and safe alternative. This systematic review evaluates the safety of delivering vasopressor medications via PiVCs.
We performed a systematic review to assess the frequency of complications associated with the delivery of vasopressors via PiVCs. A literature search for prospective and retrospective studies of vasopressor infusions in adults was performed. We included studies of continuous infusions of vasopressor medications (noradrenaline, adrenaline, metaraminol, phenylephrine, dopamine and vasopressin) delivered via a PiVCs that included at least 20 patients. Data on patient factors, cannulation approach, monitoring protocols, vasopressor dosing and dilutions and adverse events were collected and summarised.
Seven studies were identified that fulfilled the inclusion criteria, including 1382 patients. No study fulfilled all of the validity criteria. Noradrenaline was the most commonly administered agent (n = 702 episodes of administration), followed by phenylephrine (n = 546), dopamine (n = 108), metaraminol (n = 74) and vasopressin and adrenaline (<5 patients). Mean duration of infusion was 22 h (95% confidence interval [CI] 8-36 h). Extravasation occurred in 3.4% (95% CI 2.5-4.7%) of patients. There were no reported episodes of tissue necrosis or limb ischaemia. All extravasation events were successfully managed conservatively or with vasodilatory medications.
Reports of the administration of vasopressors via PiVCs, when given for a limited duration, under close observation, suggest that extravasation is uncommon and is unlikely to lead to major complications.
血管升压药物传统上通过中心静脉导管（CVC）给药，主要是因为担心血管收缩药物外周渗漏。最近的研究表明，通过外周静脉导管（PiVC）给药血管升压药物可能是一种可行且安全的替代方法。本系统评价评估了通过PiVC给药血管升压药物的安全性。
我们进行了一项系统评价，以评估与通过PiVC给药血管升压药物相关的并发症发生率。对成人血管升压药物输注的前瞻性和回顾性研究进行了文献检索。我们纳入了至少20例患者通过PiVC持续输注血管升压药物（去甲肾上腺素、肾上腺素、间羟胺、去氧肾上腺素、多巴胺和血管加压素）的研究。收集并汇总了患者因素、置管方法、监测方案、血管升压药物剂量和稀释以及不良事件的数据。
确定了7项符合纳入标准的研究，包括1382例患者。没有一项研究符合所有有效性标准。去甲肾上腺素是最常用的药物（给药702例次），其次是去氧肾上腺素（546例次）、多巴胺（108例次）、间羟胺（74例次）以及血管加压素和肾上腺素（<5例患者）。平均输注时间为22小时（95%置信区间[CI]8 - 36小时）。3.4%（95%CI 2.5 - 4.7%）的患者发生了渗漏。没有报告组织坏死或肢体缺血的病例。所有渗漏事件均通过保守治疗或使用血管扩张药物成功处理。
关于在密切观察下通过PiVC给药血管升压药物且持续时间有限的报告表明，渗漏并不常见，且不太可能导致严重并发症。
