A Comprehensive Review of the Use of Peripheral Vasopressors and Their Implications

Abstract: The use of peripheral vasopressors has gained attention as a viable alternative to central venous catheter (CVC) administration in critically ill patients. This review explores the evolving evidence on the safety, efficacy, and clinical considerations of peripheral vasopressor use, particularly in acute hypotensive states. Although central access remains the standard for vasopressor administration, delays in CVC placement may necessitate peripheral access as a temporizing measure. While other forms of venous access, such as Peripherally Inserted Central Catheters (PICCs) provide reliable administration routes, they are classified as central access; this review focuses exclusively on the safety and implications of vasopressor administration via peripheral venous catheters (PVCs). Studies have shown that peripheral vasopressors, when administered with proper protocols, can effectively stabilize patients while avoiding the risks associated with CVCs, such as infections, thrombosis, and pneumothorax. However, complications, particularly extravasation, remain a concern. This review discusses various vasopressor agents, including norepinephrine, epinephrine, and dopamine, highlighting their safety profiles and the importance of catheter size, location, and duration of infusion. Furthermore, the review addresses gaps in current guidelines and the lack of standardized protocols. Given the promising results, further research is needed to establish best practices for peripheral vasopressor use, including optimal dosing, duration, and patient selection. A protocol-driven approach, combined with enhanced monitoring, could potentially reduce complications and improve patient outcomes in critical care settings.