Association of Peripheral Norepinephrine Protocol Implementation on Central Venous Catheter Placement in a Medical ICU

Abstract

Background

Central venous catheters (CVCs) are associated with significant morbidity, mortality, and costs in the ICU. One strategy to reduce CVC complications is to avoid placing them altogether. Although norepinephrine (NE) is typically administered via a CVC, data increasingly suggest it may be safely administered via peripheral IV lines.

Research Question

Can protocolized administration of peripheral NE decrease CVC utilization?

Study Design and Methods

We implemented a protocol using peripheral IVs to administer NE infusion in our medical ICU (MICU) in March 2019. To determine the impact of our protocol on CVC placement, we compared the proportion of MICU patients who received a CVC before (July 1, 2017, to February 28th, 2019) and after (March 1, 2019 to December 31, 2023) protocol implementation. We then compared the change in CVC utilization in the MICU with that in all other ICUs in the same hospital from 2017 to 2023. We also evaluated the percentage of patients receiving the peripheral infusion who ultimately did not require a CVC during their index MICU stay.

Results

The average proportion of MICU patients who received a CVC decreased significantly after protocol initiation: pre, 59.5% vs post, 53.5%, P < .01. Central line utilization in the control ICUs remained consistent over the same period, with 60.5% in the pre-intervention period and 61.5% in the postintervention period (P = .34). In the MICU postintervention period, there were 819 peripheral NE infusions, with 391 (47.4%) never receiving a CVC during their index MICU stay. Nine patients (1.1%) received extravasation treatment.

Interpretation

Implementation of a protocol using peripherally infused NE was found to be safe, feasible, and associated with a decrease CVC utilization over time. Our study provides further evidence that many patients prescribed NE do not require a central line, and protocolized administration can decrease the use of CVCs on a broader scale.