Overview of Peripheral Vasopressor Usage in an Academic Health System.

Abstract

Rationale: Despite historical concerns for tissue injury from extravasation, studies suggest that peripheral administration of vasopressors is safe. However, peripheral vasopressor utilization remains variable.

Objectives: To characterize the use of peripheral vasopressors over time, identify variability in use, and assess outcomes associated with their use.

Methods: We conducted a retrospective cohort study of adult patients admitted to 10 hospitals in Minnesota (10/2020 - 10/2023) who received any vasopressors. Patients receiving vasopressors initially through a peripheral intravenous catheter were compared to those receiving vasopressors initially through central access. Safety, efficacy and utilization patterns across hospitals and providers were studied.

Measurements and main results: 9,493 total patients received vasopressors, including 3,734 with peripheral initiation and 5,759 with central initiation. 31 (0.8%) of the 3,734 patients with peripheral vasopressors received phentolamine for extravasation events, with one receiving a surgical consultation for tissue necrosis. Community hospitals had the highest utilization of peripheral vasopressors (50.7%), and academic medical centers had the lowest usage (27.6%). Initiation of vasopressors peripherally was not associated with increased hospital (aOR 0.87; 95% CI 0.78-0.97), 90-day (aOR 0.92; 95% CI 0.83-1.02), or 1 year mortality (aOR 1.0; 95% CI 0.91-1.11). Significant variation in use of peripheral vasopressors was observed across providers.

Conclusions: Peripheral vasopressors were commonly and safely used in our 10-hospital health system, particularly in the community hospitals. Peripheral initiation of vasopressors was not associated with increased mortality at 90 days, but was associated with decreased hospital length of stay. Variation in peripheral vasopressor utilization was found across hospitals and providers.