Authors (including presenting author) :
Chan HT, Chan CW, Tsui CW, Wong N, Wu ML, Yuen HK, Wong SK, Lai CKP, Chan MH, Ngai CW
Affiliation :
Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
Vasopressors are an integral component in the management of shock and are traditionally given through a central venous catheter (CVC). Prompt initiation of vasopressors is crucial for stabilization of patient condition. Research has demonstrated that vasopressor administration through peripheral venous catheter is a feasible and safe alternative when a CVC is not available.
Objectives :
This project aims at standardizing the practice of peripheral vasopressor administration and to develop strategies to enhance related drug administration safety in a local adult intensive care unit (AICU).
Methodology :
A guideline on vasopressor administration was formulated in March 2024. Staff concerns were addressed with group interviews and individual briefing. Practice on the administration of noradrenaline, adrenaline, phenylephrine and dopamine through peripheral venous catheters in AICU patients was audited by retrospective chart review (March – December 2024).
Result & Outcome :
100 patients received peripheral vasopressors via peripheral venous catheters. The mean of maximum dosage of noradrenaline, phenylephrine and dopamine are 0.101 ± 0.071 mcg/kg/min, 0.718 ± 0.495 mcg/kg/min and 8.517 ± 6.847 mcg/kg/min respectively, while no patient received adrenaline via peripheral venous catheter. 58 patients (58%) were stabilized with peripheral vasopressor without the need for central venous catheter (CVC) insertion. 42 patients (42%) required escalation of drug which necessitate CVC insertion. Mean length of stay of patients in peripheral and central vasopressor group were 4.43 ± 2.96 days and 7.26 ± 6.31 days respectively (p = 0.003). Survival to ICU discharge in peripheral vasopressor group was 96.6% (n=56). Extravasation occurred in 6 patients (6%). No major complication such as tissue necrosis was observed. Guideline-driven peripheral administration of vasopressors in an ICU setting is safe and feasible.
