Sonja Knittel-Hliddal, MD
Fellow
Inspira Health Network
Vineland, NJ
Disclosure information not submitted.
Mejhorn Flash, MD,
Resident
HCA/UCF COM Consortium at North Florida Regional Medical Center, United States
Disclosure information not submitted.
Kristin Cannon, MD,
Resident
HCA/UCF COM Consortium at North Florida Regional Medical Center, United States
Disclosure information not submitted.
Christian Alexander Guzman, MS, CCRN, ACNPC-AG, APRN
Critical Care Nurse Practioner
North Florida Regional Medical Center, United States
Disclosure information not submitted.
Melissa K. Weaver, PA-C
Critical Care Physician Assistant
North Florida Regional Medical Center, United States
Disclosure information not submitted.
Arooj Ali, DO
Resident
HCA/UCF COM Consortium at North Florida Regional Medical Center, United States
Disclosure information not submitted.
A. Kacee Barnett, PharmD, BCCCP
Critical Care Pharmacist
North Florida Regional Medical Center, United States
Disclosure information not submitted.
Mohammed Al-Said, PharmD, BCPS, BCCCP
Critical Care Pharmacist
North Florida Regional Medical Center, United States
Disclosure information not submitted.
Rahimullah Asad, MD
Intensivist
North Florida Regional Medical Center, United States
Disclosure information not submitted.
Title: Vasopressor Administration Through A Midline: A Prospective Study
Background: Traditionally, the critically ill patient requiring vasoactive medication administration necessitated the insertion of a central venous catheter (CVC). Given that every procedure possess inherent risks, part of our tasks as health care providers consists of minimizing unnecessary procedures. CVCs have a complication rate of up 15-22%, including those associated with significant morbidity & mortality such as the central line associated blood stream infections (CLABSIs) with a 12-15% mortality rate. Literature review yields primarily case reports from last century, often in pediatric patients & with varying degrees of reported morbidity, as the basis for central administration. Newer studies have, however, demonstrated minimal to no morbidity with peripheral administration.
Methods: A prospective, IRB-approved, single-center study conducted in 2021 in a closed ICU. We aimed to enroll 100 patients ≥ 18 years old in a six-month timeframe, with vasoactive medications being administered for up to 72 hours via midline catheter. The administration was protocoled, with patients meeting strict inclusion & exclusion criteria. We defined maximum vasoactive medication dosages administered via the midline catheter as: norepinephrine 0.15 mcg/kg/min, epinephrine 0.15 mcg/kg/min, vasopressin 0.04 units/min, phenylephrine 1.5 mcg/kg/min, dobutamine 10 mcg/kg/min & dopamine 10 mcg/kg/min. The study team was alerted by treating physicians if screening criteria were met, after which chart review was conducted & informed consent was obtained. Midline insertion was by the hospital’s trained vascular access team. If the patient required a third vasoactive medication, dosages above the defined maximum for this study or ≥ 72 hours, administration was switched to another peripheral IV until central access was obtained.
Results: Although the study is currently ongoing & full results are outstanding, preliminary data on enrolled patients has demonstrated no significant adverse events with protocoled administration of vasopressors via midline catheter.
Conclusions: Vasoactive medication administration alone likely no longer represents an indication for peripherally inserted central venous catheters or central venous catheters, as they can be administered through a midline catheter without associated increase in morbidity.