Explore the incidence of complications from the administration of peripheral vasopressors at a larger scale and identify the conditions of administration that make it safer (i.e. sites of infusion, dilution of the vasopressors, etc).
Primary Outcome: the rate of complications among patients who received peripheral vasopressors
Secondary Outcomes: ICU length of stay, hospital length of stay, ED length of stay, and in-hospital mortality.
We enrolled any patient, including pediatric patients, presenting to AUBMC- ED in whom vasopressors were initiated through a peripheral intravenous line while still in the emergency department. Once a candidate for the study has been identified, one of two research fellows (RFs) will approach these patients or their relatives to explain and consent for the study.
The research fellows were physicians that had been educated to identify the complications of interest. These were divided into minor complications; drug extravasation, thrombophlebitis, and localized cellulitis. And major complications; tissue necrosis, and limb ischemia. The role of the research fellows was entirely observational and they did not influence decisions made by the medical teams caring for the patients.
1) Candidates for the study who are willing to participate will be enrolled and sign the consent form.
2) The research fellow (RF) will record the patients’ Medical Record Number (MRN), as well as the patients’ full name and date of birth. This information will serve to track and properly identify patients should they be moved from the emergency department to the intensive care unit or an inpatient floor.
3) The RF will also note the time and day at which the vasopressor was started, the type of vasopressor (i.e. norepinephrine, phenylephrine, dopamine, epinephrine, etc.), the dilution of the vasopressor (in micrograms per milliliter), and the site of the peripheral intravenous access though which the vasopressor is being administered (i.e. hand, antecubital fossa, external jugular, etc.).
4) The RF will follow the patients on a daily basis and inquire the nurse and/or caring team about the status of the peripheral vasopressor (i.e.has it been changed to another pressor and/or inotrope, is it still infusing, is there suspicion or confirmation of infiltration, has it been discontinued and if so why. If the patient expired the RF will note whether it is believed that the death is related to the peripheral infusion of the vasopressor. In the event of a complication related to the peripheral administration of the vasopressor, the nature of the complication will be noted (i.e. phlebitis, skin necrosis, limb ischemia).
5) The RF will continue following the patient while in the hospital for 48 hours after discontinuation of the peripheral vasopressor.
Any patient, including pediatric patients, presenting to AUBMC- ED in whom vasopressors are initiated through a peripheral intravenous line
Patients arriving to AUBMC-ED who are already
receiving a vasopressor infusion through a peripheral line