title: Safety of peripheral intravenous administration of vasoactive medication.
abstract: BACKGROUND
  Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access.
  
  
  METHODS
  Over a 20-month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18-bed medical intensive care unit. Norepinephrine, dopamine, and phenylephrine were all approved for use through peripheral intravenous access.
  
  
  RESULTS
  A total of 734 patients (age 72 ± 15 years, male/female 398/336, SAPS II score 75 ± 15) received vasoactive medication via peripheral intravenous access 783 times. Vasoactive medication used was norepinephrine (n = 506), dopamine (n = 101), and phenylephrine (n = 176). The duration of vasoactive medication via peripheral intravenous access was 49 ± 22 hours. Extravasation of the peripheral intravenous access during administration of vasoactive medication occurred in 19 patients (2%) without any tissue injury following treatment, with local phentolamine injection and application of local nitroglycerin paste. There were 95 patients (13%) receiving vasoactive medication through peripheral intravenous access who eventually required central intravenous access.
  
  
  CONCLUSIONS
  Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York.
authors.forename: Jose
authors.initials: J
authors.lastname: Cardenas-Garcia
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York.
authors.forename: Karen F
authors.initials: KF
authors.lastname: Schaub
authors.affiliation: Clinical Pharmacy Services, Department of Pharmacy, Westchester Medical Center, Valhalla, New York.
authors.forename: Yuly G
authors.initials: YG
authors.lastname: Belchikov
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York.
authors.forename: Mangala
authors.initials: M
authors.lastname: Narasimhan
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York.
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Koenig
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Mayo
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002406:Catheterization, Peripheral / Q000379:methods*; D004298:Dopamine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D061214:Patient Safety; D010656:Phenylephrine / Q000008:administration & dosage; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004298:Dopamine; D009638:Norepinephrine