Risks Associated With Peripheral Vasopressor Administration

As a vascular access specialist with deep clinical experience, I feel compelled to express concern regarding the increasing use of peripheral venous access devices, particularly short peripheral catheters and midline catheters, for the administration of vasopressor therapy, as referenced in the article by Mazzeffi et al in the June issue.1 The authors should be commended for their efforts to reduce central line catheter–associated bloodstream infection (CLABSI) through interprofessional collaboration, but I am concerned by the implied endorsement of midline catheters for vasopressor administration, a practice not adequately supported by safety data or national guidelines.2-4Administering vasopressors through peripheral venous access devices, including midline catheters, poses significant risks. Extravasation of vasopressors can cause irreversible tissue injury and necrosis if not promptly identified and managed. The Infusion Nurses Society "Infusion Therapy Standards of Practice, 9th Edition," clearly states that while peripheral administration of vasopressors may be appropriate for short-term use in emergency or resource-limited situations, central venous access is preferred for continuous vasopressor infusion due to the risk of extravasation and associated harm.2-7Mazzeffi et al emphasize CLABSI reduction, but the omission of discussion about the risks associated with peripheral vasopressor administration in the article is concerning. The authors do not address the potential for harm when peripheral devices are used outside their recommended scope. Notably, bacteremia or fungemia can result from any vascular access device if insertion and maintenance practices are suboptimal. Infection prevention efforts must therefore be balanced with the appropriateness of device selection based on clinical indications, rather than being driven solely by the avoidance of reportable metrics, such as CLABSI.8,9It is also essential that patient and family input be part of shared decision-making when determining vascular access strategy, especially when the alternative device may increase the risk of tissue damage, thrombosis, or delays in therapy. This practice aligns with The Joint Commission's emphasis on patient involvement in clinical care planning.10,11If hospital-onset bacteremia or fungemia were subject to mandated reporting and financial penalties, or if extravasation injuries from peripheral intravenous catheters were considered reportable adverse events, organizations might adopt a more balanced and patient-centered approach to vascular access.9,12-14In summary, while efforts to reduce CLABSI are essential, the solution is not to substitute central catheters with suboptimal alternatives. Patients deserve the correct device for their condition, guided by clinical evidence, not cost-avoidance strategies. I urge Critical Care Nurse and critical care leaders to promote vascular access decisions that prioritize patient safety ahead of metric avoidance.