The use of vasoactive agents via peripheral intravenous access during transport of critically III infants and children.

Published

Journal Article

OBJECTIVES: Many experts recommend that vasoactive agents be infused via a central venous line (CVL) because of the potential risk of infiltration, but CVL placement in pediatric patients is often challenging. We hypothesized that it is safe to administer vasoactive infusions via peripheral intravenous (PIV) line in critically ill infants and children during interhospital transport. METHODS: We retrospectively reviewed the medical records of 1133 neonatal and pediatric patients transported to the intensive care units at Children's Hospital Boston from May 2004 through June 2006 to identify patients treated with vasoactive medications via PIV line. Mann-Whitney U analysis was used to identify variables associated with complications of peripheral vasoactive infusion. RESULTS: Seventy-three (6%) of the 1133 patients were treated during transport with vasoactive agents via PIV line. No complications occurred during transport, but 11 (15%) of 73 patients developed intravenous (IV) infiltrates related to vasoactive infusion at a mean of 7 hours after arrival to the receiving facility (range, 2-24 hours). Compared with patients with IV infiltrations, those without IV infiltrates had significantly lower median duration of vasoactive infusion and median maximum medication dose (256 vs 810 minutes and 10 vs 15 microg/kg per minute, respectively; P < 0.05). There were no significant differences between any other variables tested, and all infiltrates resolved without significant intervention or lasting injury. CONCLUSIONS: Results from our series suggest that administration of vasoactive medications via PIV line during transport of critically ill infants and children is safe. The risk for complications increased with higher infusion rates and longer duration of therapy. Prompt transitioning of vasoactive infusions to a CVL may lead to fewer complications but does not seem to be necessary before transport.

Full Text

Duke Authors

Cited Authors

  • Turner, DA; Kleinman, ME

Published Date

  • August 2010

Published In

Volume / Issue

  • 26 / 8

Start / End Page

  • 563 - 566

PubMed ID

  • 20657339

Pubmed Central ID

  • 20657339

Electronic International Standard Serial Number (EISSN)

  • 1535-1815

Digital Object Identifier (DOI)

  • 10.1097/PEC.0b013e3181ea71e1

Language

  • eng

Conference Location

  • United States