Peripheral vasoactive infusions

periph-vasoactive-iconIt is often recommended that vasoactive agents are infused via central lines because of the risk of infiltration and tissue injury. The Children’s Hospital Boston transport team describe transport of 73 infants and children who were treated during interhospital transport with vasoactive medications via a peripheral intravenous line.
Median transport time was only 38 minutes (range 3[!!]-216) and median age was 1 (birth to 19) .
Dopamine monotherapy was given in 66 patients, adrenaline (epinephrine) monotherapy in 2, dobutamine plus phenylephrine in 1, dopamine and epinephrine in 3, and dopamine, dobutamine, and epinephrine in 1 patient.
In this retrospective study no patients developed infiltration or other complications related to peripheral vasoactive agents during interfacility transport. Eleven of the 73 patients, however, did develop infiltrates related to vasoactive infusion after arrival at the accepting institution; all infiltrates involved only minimal blanching and/or erythema, and all resolved without significant intervention and caused no lasting tissue injury. The risk of infiltration rose with increasing medication dose and duration of use.
Interesting that noradrenaline (norepinephrine) wasn’t used. This study is interesting but the overwhelming predominance of dopamine makes it hard to extrapolate this to European or Australasian practice.
The Use of Vasoactive Agents Via Peripheral Intravenous Access During Transport of Critically Ill Infants and Children
Pediatr Emerg Care. 2010 Aug;26(8):563-6