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Meta-Analysis
. 2021 Apr 16;25(1):146.
doi: 10.1186/s13054-021-03553-1.

Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis

Victoria S Owen  1 , Brianna K Rosgen  1 , Stephana J Cherak  1 , Andre Ferland  2 , Henry T Stelfox  1   2   3 , Kirsten M Fiest  1   2   3 , Daniel J Niven  4   5   6
Affiliations
Meta-Analysis

Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis

Victoria S Owen et al. Crit Care. .

Abstract

Background: It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment.

Methods: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity.

Results: Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1-4.8%, I2 = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0-10.1%, I2 = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias.

Conclusion: The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.

Keywords: Adverse event; Ionotrope; Peripheral intravenous; Safety; Vasoconstrictor; Vasopressor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Forest plot examining the incidence proportion of adverse events associated with peripheral intravenous vasopressor administration
Fig. 3
Fig. 3
Forest plot of adult incidence proportion of adverse events stratified by risk of bias score. *For Lower Risk of Bias the subtotal I2 = 0.00%, p = 0.40
See this image and copyright information in PMC

Comment in

References

    1. Gordon A. Vasopressors. In: Vincent JL, Hall JB, editors. Encyclopedia of intensive care medicine. Berlin: Springer; 2012.
    1. Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10(9):581–585. doi: 10.1002/jhm.2394. - DOI - PubMed
    1. Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the peripheral administration of vasopressor agents. J Intensive Care Med. 2019;34(1):26–33. doi: 10.1177/0885066616686035. - DOI - PubMed
    1. Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30(3):653. doi: 10.1016/j.jcrc.2015.01.014. - DOI - PubMed
    1. Parienti JJ, Mongardon N, Megarbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373(13):1220–1229. doi: 10.1056/NEJMoa1500964. - DOI - PubMed

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