From the Research
Vasopressors can be safely administered through a peripheral IV for up to 24 hours, with careful monitoring and proper technique, as supported by the most recent and highest quality study 1.
Key Considerations
- The use of peripheral IV access for vasopressor administration is acceptable, especially in emergency situations where central access is not immediately available.
- Common peripheral vasopressors include norepinephrine, phenylephrine, and vasopressin, which should be diluted appropriately and administered through a large vein, preferably in the antecubital area.
- Monitoring the IV site frequently for extravasation and having phentolamine readily available to treat any infiltration is crucial for safe administration.
- The risks of tissue damage from extravasation increase with time, concentration, and certain agents, making proper venous access crucial for safe administration.
Administration Guidelines
- Choose a large vein (preferably antecubital) for peripheral access.
- Dilute the medication appropriately to minimize the risk of extravasation.
- Monitor the IV site frequently for signs of extravasation or other complications.
- Have phentolamine (5-10 mg diluted in 10 mL saline) readily available to treat any infiltration.
Evidence Summary
The most recent and highest quality study 1 supports the safe administration of vasopressors through peripheral IV access for up to 24 hours, with careful monitoring and proper technique. This study found that 37% of patients who started on peripheral norepinephrine avoided the need for central catheter placement, with no reported episodes of extravasation or local complications. Other studies 2, 3, 4, 5 also support the safety and efficacy of peripheral vasopressor administration, but with varying durations and complications. However, the study by 1 provides the most recent and highest quality evidence, making it the basis for this recommendation.