Document Type

Conference Proceeding

Publication Date


Publication Title

Crit Care Med


INTRODUCTION: Central venous catheters (CVC) are associated with various complications. In several studies, the use of vasopressors through peripheral venous catheters (PVC) obviated the need for CVC insertion in 34-87% of patients. Although evidence indicates that the peripheral administration of vasopressors is safe, most health systems currently use protocols that favor the use of CVC over PVC. We proposed a quality improvement study evaluating the use of a protocol for the peripheral administration of a dilute norepinephrine solution (16 mcg/ml) in the surgical intensive care unit (SICU).

METHODS: This was a retrospective quality improvement study conducted at Henry Ford Hospital in Detroit, MI. We included 100 patients that were admitted to the SICU between June and December 2021 and received dilute norepinephrine for any cause through a PVC under our prespecified protocol. Guidelines for CVC insertion were present in the protocol to assist clinicians. An extravasation protocol was instituted which included application of 2% nitroglycerin ointment. The primary endpoint evaluated was the number of patients in which a CVC was placed, regardless of the cause, within 24 hours of discontinuation of norepinephrine through the PVC. Secondary endpoints included the indication for central line placement, dose of norepinephrine infused, duration of norepinephrine infusions, gauge and location of the PVC, frequency of extravasation events, and tissue injury.

RESULTS: Out of the 100 included in the study 51 patients (51%) did not receive a CVC, and 60 patients (60%) did not receive a CVC within the first 24 hours of discontinuation of peripheral norepinephrine. Norepinephrine extravasation was noted in 6 patients (6%). These incidents were successfully managed with nitroglycerin (2%) ointment.

CONCLUSIONS: We demonstrated that administration of diluted norepinephrine through a PVC following a protocol in the SICU was associated with a reduction in CVC placement. The incidence of extravasation of norepinephrine was rare. Careful assessment of the PVC allowed for early treatment with topical nitroglycerine and no harm was identified to any patient.





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