Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Br J Hosp Med (Lond). 2024 Jul 30;85(7):1-8. doi: 10.12968/hmed.2024.0048. Epub 2024 Jul 24.
Vasopressor medications for circulatory shock have historically been administered through central venous catheters due to concern for extravasation injury when given peripherally. However, recent studies have demonstrated the safety of peripheral administration of vasopressor medications at lower doses and for a limited duration. Peripheral use of vasopressors is appealing to both patients and providers, as obtaining central access is an invasive procedure associated with the risk of pneumothorax, bleeding, and infection. Furthermore, waiting to initiate these medications until central access is obtained can lead to delays in care. Conversely, valid concerns remain regarding the risk of tissue extravasation associated with peripheral vasopressors, which can be life and limb threatening. We discuss the guidelines and data for optimal dose, duration, intravenous line (IV) size, IV location, and nursing IV site monitoring for peripheral vasopressors. We then explore adverse events associated with peripheral vasopressors. Finally, we describe how this practice change may impact hospital medicine providers.
血管加压药物历来通过中心静脉导管用于循环休克，因为担心外周给予时会发生外渗损伤。然而，最近的研究表明，在较低剂量和有限时间内外周给予血管加压药物是安全的。血管加压剂的外周使用对患者和提供者都具有吸引力，因为获得中心通路是一种有创程序，与气胸、出血和感染的风险相关。此外，等待获得中心通路再开始使用这些药物可能会导致治疗延迟。相反，外周血管加压剂与组织外渗相关的风险仍然存在合理的担忧，这可能会危及生命和肢体。我们讨论了外周血管加压剂的最佳剂量、持续时间、静脉输液（IV）管大小、IV 位置和护理 IV 部位监测的指南和数据。然后，我们探讨了与外周血管加压剂相关的不良事件。最后，我们描述了这种实践改变可能如何影响医院医学提供者。
