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Education, Teaching, and Quality Improvement |

Peripheral Intravenous Administration of Vasoactive Medication in the Medical Intensive Care Unit

Jose Cardenas-Garcia, MD; Mangala Narasimhan, DO; Paul Mayo, MD
Author and Funding Information

Department of Pulmonary, Critical Care and Sleep Medicine. Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY


Chest. 2013;144(4_MeetingAbstracts):576A. doi:10.1378/chest.1703840
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Abstract

SESSION TITLE: Patient Safety Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: In this report, we evaluate the safety of VM administered through peripheral intravenous access (PIVA) in critically ill patients.

METHODS: For a four-month period starting in October 2012, we monitored use of VM via PIVA in an 18-bed MICU. If the patient required VM for blood pressure support, the MICU team made a clinical decision as to the appropriate route for administration of VM. Use of VM through PIVA was guided by protocol. Dobutamine, dopamine, epinephrine, norepinephrine, and phenylephrine were all approved for use through PIVA. Data was collected prospectively on a daily basis by one investigator and entered into a standard de-identified data sheet for quality and safety assessment.

RESULTS: Fifty patients (age 70.8 +/-15.9, male/female 25:25, SAPS II score 72.8 +/-19.3) received VM by PIVA 64 times. Vasoactive medication used: dobutamine (n=4), dopamine (n=47), epinephrine (n=0), norepinephrine (n=7), and phenylephrine (n=6). Infiltration of the PIVA occurred in two patients without any tissue injury following local phentolamine/nitropaste. Seven patients receiving VM through PIVA eventually required central intravenous access (CIVA).

CONCLUSIONS: We demonstrated that administration of VM through PIVA is safe in MICU. Infiltration of venous line is uncommon; phentolamine/nitropaste appeared to be effective in preventing local ischemic injuy, in the two cases that we observed. Our results do not allow comment on the indications or efficacy but instead focus on safety. CIVA has risks during insertion (pneumonthorax/vascular injury), and while indwelling (line infection/thrombosis/venous air embolism). These risks must be balanced against the risk of peripheral vasopressor use. A traditional indication for CIVA insertion has been VM use; our results suggest that CIVA may not be necessary in all cases. During the study period we were able to avoid the use of CIVA in fifty-seven patients by using PIVA.

CLINICAL IMPLICATIONS: Use of PIVA for VM administration may reduce the use of CIVA, and thus represents potential for risk reduction in the MICU.

DISCLOSURE: The following authors have nothing to disclose: Jose Cardenas-Garcia, Mangala Narasimhan, Paul Mayo

No Product/Research Disclosure Information


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