Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis

Vasopressors are mainstay treatment for patients in shock and are usually infused through central venous catheters (CVCs). However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be...

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Veröffentlicht in:The American journal of emergency medicine 2020-11, Vol.38 (11), p.2434-2443
Hauptverfasser: Tran, Quincy K., Mester, Gaurika, Bzhilyanskaya, Vera, Afridi, Leenah Z., Andhavarapu, Sanketh, Alam, Zain, Widjaja, Austin, Andersen, Brooke, Matta, Ann, Pourmand, Ali
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container_end_page 2443
container_issue 11
container_start_page 2434
container_title The American journal of emergency medicine
container_volume 38
creator Tran, Quincy K.
Mester, Gaurika
Bzhilyanskaya, Vera
Afridi, Leenah Z.
Andhavarapu, Sanketh
Alam, Zain
Widjaja, Austin
Andersen, Brooke
Matta, Ann
Pourmand, Ali
description Vasopressors are mainstay treatment for patients in shock and are usually infused through central venous catheters (CVCs). However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs. We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031–0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018–0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038–0.30, p = 0.024). There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. Further studies are needed to confirm our observations.
doi_str_mv 10.1016/j.ajem.2020.09.047
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However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs. We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031–0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018–0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038–0.30, p = 0.024). There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. 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However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs. We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031–0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018–0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038–0.30, p = 0.024). There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. 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However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs. We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031–0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018–0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038–0.30, p = 0.024). There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. Further studies are needed to confirm our observations.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33039229</pmid><doi>10.1016/j.ajem.2020.09.047</doi><tpages>10</tpages></addata></record>
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subjects Adverse events
Agreements
Bias
Case reports
Catheterization, Central Venous
Catheterization, Peripheral
Catheters
Central Venous Catheters
Clinical trials
Complications
Emergency medical care
Emergency Service, Hospital
Erythema - epidemiology
Erythema - etiology
Extravasation of Diagnostic and Therapeutic Materials - epidemiology
Extravasation of Diagnostic and Therapeutic Materials - etiology
Health risks
Humans
Infusions, Intravenous - adverse effects
Infusions, Intravenous - methods
Intensive Care Units
Medical instruments
Meta-analysis
Mortality
Peripheral intravenous catheters
Point of care testing
Practice Guidelines as Topic
Safety
Sepsis
Shock - drug therapy
Systematic review
Time-to-Treatment
Ultrasonic imaging
Vasoactive medication
Vasoconstrictor Agents - administration & dosage
Vasopressors
Venous Thrombosis - epidemiology
Venous Thrombosis - etiology
title Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis
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