Can vasopressors be administered via Peripherally Inserted Central Catheter (PICC) line?

From the Guidelines

Pressors should not be given via PICC line in hemodynamically unstable patients or when central access is necessary, as per the recommendations of a multispecialty panel using the RAND/UCLA appropriateness method 1. When considering the administration of pressors via a PICC line, it is essential to weigh the risks and benefits, particularly in critically ill patients. Key points to consider include:

• The position of the PICC line, with its tip in the superior vena cava, to ensure adequate dilution of the medication
• Frequent monitoring of the insertion site for signs of extravasation, which can cause tissue damage
• The use of compatible solutions for co-administration and dedicating the line to vasopressor administration when possible However, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 1, panelists preferred CVCs to PICCs in patients who were hemodynamically unstable or were actively receiving vasopressors, highlighting the importance of careful consideration of the patient's clinical condition and the expected duration of vasopressor therapy. Some key considerations for the use of PICC lines in special populations, such as those with coagulopathies or requiring lifelong intravenous access, include:
• The risk for insertion complications and the preference for PICCs over CVCs in patients with coagulopathies
• The appropriateness of PICC insertion in populations that need lifelong intravenous access, which is rated as uncertain when the expected duration of use is between 6 and 14 days 1. In general, while PICC lines can serve as an alternative for pressor administration in emergent situations or when central access is challenging, traditional central lines remain the preferred route due to their larger diameter and shorter length, allowing for higher flow rates and less resistance.

From the Research

Administration of Pressors via PICC Line

• The administration of pressors, such as norepinephrine, via a Peripheral Intravenous Catheter (PICC) line is a topic of interest in medical research 2, 3, 4, 5, 6.
• Studies have shown that the use of PICC lines for pressor administration can be a safe and effective alternative to central venous catheters (CVCs) in certain situations 2, 4, 6.
• The safety and efficacy of peripheral versus central administration of vasopressor infusions have been compared in several studies, with results suggesting that peripheral administration may be a viable option for short-term use 3, 5.

Key Findings

• A study published in the Journal of pharmacy practice found that the use of a protocol for peripheral administration of norepinephrine resulted in a significant reduction in the need for CVC placement 2.
• A systematic review published in Emergency medicine Australasia found that the administration of vasopressor medications via peripheral intravenous catheters (PiVCs) was associated with a low risk of complications, including extravasation and tissue necrosis 3.
• A retrospective study published in the Journal of infusion nursing found that the use of peripherally administered norepinephrine was associated with a reduction in the need for central venous access and a decrease in direct supply costs 4.

Considerations for PICC Line Use

• The use of PICC lines for pressor administration should be considered on a case-by-case basis, taking into account the individual patient's clinical status and the anticipated duration of therapy 2, 4, 6.
• Close monitoring of the patient and the PICC line is essential to minimize the risk of complications, such as extravasation and infection 3, 5.
• Further research is needed to confirm the safety and efficacy of routine use of PICC lines for pressor administration in clinical practice 6.