Utility of a Peripheral Intravenous Catheter for Administration of Vasopressors: A Narrative Review

Vasopressors are the cornerstone of the management of shock, a life-threatening condition characterized by inadequate tissue perfusion, with risks of organ failure and death. Prompt initiation of vasopressors restores hemodynamic stability and prevents shock sequelae. Vasopressors have long been administered via central venous catheters (CVCs) due to concerns about extravasation and tissue injury with peripheral venous administration. However, CVC placement is an invasive, time-consuming procedure requiring specialized personnel and resources, potentially delaying the initiation of life-saving medications. With the 'time to management' being a detrimental factor in shock, there has been a renewed interest in peripheral vasopressor therapy, particularly in emergent or resource-limited settings where complications and delays exceed expectations. Over the last decade, multiple observational studies have demonstrated the safety and efficacy of peripheral vasopressor administration, especially when using large-bore catheters placed in proximal upper extremity veins and under vigilant monitoring. Early initiation of vasopressors via peripheral venous access has been associated with faster attainment of target mean arterial pressure and shorter time to hemodynamic stabilization, without increased mortality or severe complications. Prompt recognition and management of extravasation, including the use of phentolamine, further mitigates risks. Guidelines suggest starting vasopressors peripherally to avoid delays, with a transition to central access if prolonged infusion is anticipated. Institutional protocols, including site selection, catheter type, infusion duration, and escalation criteria, are essential to optimize safety. Further research is needed to refine protocols and address remaining knowledge gaps regarding prolonged use and optimal catheter selection.