Peripherally administered vasopressin initiated in the emergency department
Abstract:
Context: Vasopressors are frequently administered in the emergency department (ED) to improve hemodynamic stability in critically ill patients. Due to their potent vasoconstrictive properties, these medications are typically delivered through a central venous catheter (CVC) to minimize the risk of extravasation or infiltration. The use of peripheral venous access for administering vasopressors has grown as more safety data has been published; however, the majority of data does not include vasopressin.
Objective: The purpose of this study was to evaluate the incidence of reported infiltrations or extravasations following the administration of peripheral vasopressin.
Design: A single-center, retrospective study between 2014 and 2024.
Setting: Seventy-nine-bed ED in a 620-bed academic tertiary medical center.
Patients: A total of 80 patients received vasopressin via peripheral administration in the ED.
Results: The median duration of peripheral vasopressin administration was 444 min [IQR 196, 1314]. The documented minimum and maximum rates of vasopressin were 0.01 units/min and 0.08 units/min, respectively, with a median rate of 0.03 units/min [IQR 0.03, 0.04]. There were no reports or incidents of infiltration or extravasation related to the administration of peripheral vasopressin. Although patients initially received peripheral vasopressin, 26 patients (32.5 %) were later transitioned to CVC administration.
Conclusions: With no observed instances of infiltration, extravasation, or other related complications, peripheral administration of vasopressin initiated in the ED for select, hemodynamically compromised patients may represent a feasible approach to initiate early vasopressor therapy while allowing clinicians to more carefully weigh the risks and benefits of CVC placement. Future research should focus on prospective, multicenter studies to validate these findings in larger and more diverse patient populations.
Reference:
McCurry K, DeWitt K, Upchurch CP, Wren RN. Peripherally administered vasopressin initiated in the emergency department. J Crit Care. 2025 Nov 26;92:155363. doi: 10.1016/j.jcrc.2025.155363. Epub ahead of print. PMID: 41308502.