Vasopresores e inotrópicos: vía de administración central y periférica
Artículo de Revisión
Abstract
Intravenous vasopressors stand out as medications used for the treatment of shock states. In fact, they have been administered via central venous catheters (CVCs), primarily due to concerns of peripheral extravasation of vasoconstrictor medications and subsequent tissue necrosis. Objective: Describe advantages and limitations of the central and peripheral administration route of vasopressors and inotropes. Materials and methods: A bibliographic review was carried out with a descriptive approach. Information was collected from the digital search platforms: Scopus, Pubmed and Scielo. Meta-analyses, cohort studies and clinical trials from the last 5 years were included. Results: A total of 10 relevant articles were identified. In which it is highlighted that the placement of a CVC in a critically ill patient can take a considerable time and is not without risks. It has been detailed that the administration of vasopressors for short-term use through a peripheral venous catheter can be considered a viable and safe alternative. Conclusion: Lower concentrations of norepinephrine can be administered safely through peripheral intravenous lines. In fact, earlier administration of vasopressors is associated with better clinical outcomes.
References
Ballard D, Reed M, Rauchwerger A. Emergency physician perspectives on central venous catheterization in the emergency department: a survey-based study. Acad. Emerg. Med. 2014; 21: 623-30. .
Beck V, Chateau D, Bryson GL. Timing of vasopressor initiation and mortality in septic shock: a cohort study. Crit Care. 2014 May 12;18(3):R97. doi: 10.1186/cc13868. .
Heidemann L, Nathani N, Sagana R, Chopra V, Heung M. A contemporary assessment of mechanical complication rates and trainee perceptions of central venous catheter insertion. J. Hosp. Med. 2017; 12: 646-51. .
Shabana A, Dholoo F, Banerjee P. Inotropic Agents and Vasopressors in the Treatment of Cardiogenic Shock. Curr Heart Fail Rep. 2020 Dec;17(6):438-448. doi: 10.1007/s11897-020-00493-9. Epub 2020 Oct 26. PMID: 33103204. .
Stratton L, Berlin DA, Arbo JE. Vasopressors and inotropes in Sepsis. Emerg. Med. Clin. North Am. 2017; 35: 75-91. .
Tian D, Smyth C, Keijzers G, Macdonald S, Peake, Udy A, Delaney A. Delaney A. Safety of peripheral administration of vasopressor medications: A systematic review. Emergency medicine Australasia : EMA.2020;32(2), 220–227. .
Stolz A, Efendy R, Apte Y, Craswell A, Lin F, Ramanan M. Safety and efficacy of peripheral versus centrally administered vasopressor infusion: A single-centre retrospective observational study. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.2022; 35(5). .
Yerke J, Mireles-Cabodevila E, Chen A, Bass S, Reddy A, Bauer S, et al. Peripheral Administration of Norepineph-rine: A Prospective Observational Study. Chest.2024; 165(2), 348–355. .
Groetzinger L. M Williams J, Svec S, Donahoe M, Lamberty P, Barbash I. Peripherally Infused Norepinephrine to Avoid Central Venous Catheter Placement in a Medical Intensive Care Unit: A Pilot Study. The Annals of pharmacotherapy.2022; 56(7), 773–781. .
Cape K, Jones L, Weber M, Elefritz J. Implementation of a Protocol for Peripheral Intravenous Norepinephrine: Does It Save Central Line Insertion, Is It Safe? Journal of pharmacy practice.2022; 35(3), 347–351. .
Powell S, Faust A, George S, Townsend R, Eu-bank D, Kim R. Effect of Peripherally Infused Norepinephrine on Reducing Central Venous Catheter Utilization. Journal of infusion nursing : the official publica-tion of the Infusion Nurses Society.2023; 46(4), 210–216. .
Bae S, Kim Y, Chang H, Kim, S, Kim H, Jeon H, et al. The effect of the multimodal intervention including an au-tomatic notification of catheter days on reducing central line-related bloodstream infec-tion: a retrospective, observa-tional, quasi-experimental study. BMC infectious diseas-es.2022; 22(1), 604. .
Brewer J, Puskarich M, Jones A. Can Vasopressors Safely Be Administered Through Pe-ripheral Intravenous Cathe-ters Compared With Central Venous Catheters? Annals of emergency medi-cine.2015; 66(6), 629–631. .
Tran Q, Mester G, Bzhilyanskaya V, Afridi L, Andhavarapu S, Alam Z, et al. Complication of vasopressor infusion through peripheral venous catheter: A sys-tematic review and meta-analysis. The American journal of emergency medi-cine.2020; 38(11), 2434–2443. .
Ekeløf SA, Ekeløf S, Bech JN, Ekeløf P. Administration of norepinephrine in peripheral venous catheter on surgical patients. Ugeskr Laeger. 2017 Aug 21;179(34):V02170157. Danish. PMID: 28869020. .
Nguyen TT, Surrey A, Barmaan B, Miller S, Oswalt A, Evans D, Dhindsa H. Utilization and extravasation of peripheral norepinephrine in the emergency department. Am J Emerg Med. 2021 Jan;39:55-59. doi: 10.1016/j.ajem.2020.01.014. .
Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the Peripheral Administration of Vasopressor Agents. J Intensive Care Med. 2019 Jan;34(1):26-33. doi: 10.1177/0885066616686035. .
Nickel B.Peripheral Intravenous Administration of High-Risk Infusions in Critical Care: A Risk-Benefit Analysis. Crit Care Nurse. 2019 Dec 1;39(6):16-28. doi: 10.4037/ccn2019443. PMID: 31961938. .
Asher E, Karameh H, Nassar H, Yosefy C, Marmor D, Perel N, et al. Safety and Outcomes of Peripherally Administered Vasopressor Infusion in Patients Admitted with Shock to an Intensive Cardiac Care Unit-A Single-Center Prospective Study. J Clin Med. 2023 Sep 3;12(17):5734. doi: 10.3390/jcm12175734. .
Stefanos SS, Kiser TH, MacLaren R, Mueller SW, Reynolds PM. Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline. Pharmacotherapy. 2023 Apr;43(4):321-337. doi: 10.1002/phar.2794. .
Loubani O, Green R. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. Journal of critical care, 30(3).2015; 653.e9–653.e6.53E17. https://doi.org/10.1016/j.jc. .
Ball CM, Featherstone PJ. The early history of adrenaline. Anaesth. Intensive Care 2017; 45: 279-81. .
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is a human-readable summary of (and not a substitute for) the license.
You are free to:
Share — copy and redistribute the material in any medium or format
Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
NonCommercial — You may not use the material for commercial purposes.
ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
