Extravasation, thrombosis, and infection with vasopressor infusion through peripheral intravenous catheters: a systematic review and meta-analysis.

Abstract

Background: The safety of administering vasopressors through peripheral venous catheters (PVCs) remains controversial, primarily due to concerns regarding extravasation, thrombosis, and catheter-related infections. This study aimed to systematically summarize the prevalence of these complications through a meta-analysis.

Methods: The PubMed, Excerpta Medical Database (Embase), Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Wanfang (WF), Chinese Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBMdisc) databases were systematically searched (from database establishment 16 August 2025) to retrieve pertinent articles, and study quality was rated via the Joanna Briggs Institute (JBI) scale and Newcastle-Ottawa Scale (NOS). The data analysis was conducted using the meta package in R, and random/fixed-effects models were applied to combine the complication rates based on heterogeneity. Sensitivity and subgroup analyses were also carried out.

Results: A total of 19 studies comprising 6,852 patients across 10 counties, including Sweden, the USA, and China, were encompassed in the meta-analysis, with the majority being intensive care unit (ICU) patients. The overall rates of extravasation, thrombosis, and infection were 1.43% [95% confidence interval (CI): 0.72-2.32%; I²=71%], 1.47% (95% CI: 0.32-3.18%; I²=86%), and 0.72% (95% CI: 0.14-1.60%; I²=63%), respectively. The subgroup analysis peripherally inserted central catheters (PICCs) carried a higher risk of thrombosis, while midline catheters (MCs) had the lowest risk of extravasation. In relation to the catheter-related infection risks, PVCs showed the lowest incidence, whereas PICCs had the highest. Limited direct comparative evidence indicated no statistically significant differences between PVCs and central venous catheters (CVCs).

Conclusions: Under standardized procedures, PVCs may be a viable option for vasopressor infusion, particularly MCs, which showed the lowest risk of extravasation. Caution is warranted with PICCs due to the potential risk of thrombosis, while traditional PVCs should be limited to short-term or emergency use. Future well-designed studies with standardized definitions are needed to strengthen the reliability and clinical applicability of the evidence.