JAMA network open · 2026
Incidence of Adverse Events in Peripheral Intravenous Vasopressor Use: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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ZhangJian Shang-Jun, Niu Kuang-Yu, Chen Chen-Bin, Seak Chen-June, Yen Chieh-Ching
Аннотация
IMPORTANCE: Peripheral intravenous (PIV) vasopressors are increasingly used but remain associated with adverse events (AEs). Quantifying the incidence of these AEs is essential to guide clinical decision-making regarding PIV vasopressor use.
OBJECTIVE: To assess the incidence of AEs and avoidance of central venous catheter (CVC) placement after PIV vasopressor administration in adults with hypotension, shock, or critical illness.
DATA SOURCES: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to December 13, 2025, using medical subject headings and keywords related to peripheral vasopressors.
STUDY SELECTION: Eligible studies included critically ill adults receiving vasopressors via PIV catheters and reported AEs and/or CVC avoidance.
DATA EXTRACTION AND SYNTHESIS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 investigators independently extracted data and assessed risk of bias. A random-effects model was used, and proportions were pooled using a generalized linear mixed model.
MAIN OUTCOMES AND MEASURES: The primary end point was the pooled incidence of AEs as the proportion among total catheters, and the secondary end point was the pooled proportion of CVC avoidance.
RESULTS: Forty-nine studies including 33 060 catheters were analyzed. The pooled minor AE incidence was 2.6% (95% CI, 1.4%-4.7%) for norepinephrine, 0.0% (95% CI, 0.0%-24.6%) for epinephrine, 2.9% (95% CI, 1.8%-4.8%) for phenylephrine, 1.4% (95% CI, 0.3%-5.9%) for dopamine, 0.5% (95% CI, 0.1%-1.8%) for vasopressin, and 0.9% (95% CI, 0.1%-11.5%) for metaraminol. When considering all vasopressors collectively, the pooled minor AE incidence was 2.3% (95% CI, 1.5%-3.7%). Regarding major AEs, 30 venous thromboembolism events occurred, all in the 4 studies (8.1%) using midline catheters (1126 total catheters), with a pooled incidence of 1.4% (95% CI, 0.4%-5.4%). In contrast, only 1 major AE (a tissue necrosis event) was reported in 43 studies (87.8%) using short PIV catheters (29 596 total catheters), with a pooled incidence of 0.0% (95% CI, 0.0%-0.0%). CVC avoidance ranged from 0% to 100%, with a pooled proportion of 59.7% (95% CI, 46.4%-71.7%) in 38 studies (77.6%) including 15 371 catheters.
CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of adult patients, AE incidence was low after short-term vasopressor administration through PIV catheters, particularly short catheters. These findings suggest that PIV administration might reduce the need for CVC placement with appropriate monitoring.
OBJECTIVE: To assess the incidence of AEs and avoidance of central venous catheter (CVC) placement after PIV vasopressor administration in adults with hypotension, shock, or critical illness.
DATA SOURCES: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to December 13, 2025, using medical subject headings and keywords related to peripheral vasopressors.
STUDY SELECTION: Eligible studies included critically ill adults receiving vasopressors via PIV catheters and reported AEs and/or CVC avoidance.
DATA EXTRACTION AND SYNTHESIS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 investigators independently extracted data and assessed risk of bias. A random-effects model was used, and proportions were pooled using a generalized linear mixed model.
MAIN OUTCOMES AND MEASURES: The primary end point was the pooled incidence of AEs as the proportion among total catheters, and the secondary end point was the pooled proportion of CVC avoidance.
RESULTS: Forty-nine studies including 33 060 catheters were analyzed. The pooled minor AE incidence was 2.6% (95% CI, 1.4%-4.7%) for norepinephrine, 0.0% (95% CI, 0.0%-24.6%) for epinephrine, 2.9% (95% CI, 1.8%-4.8%) for phenylephrine, 1.4% (95% CI, 0.3%-5.9%) for dopamine, 0.5% (95% CI, 0.1%-1.8%) for vasopressin, and 0.9% (95% CI, 0.1%-11.5%) for metaraminol. When considering all vasopressors collectively, the pooled minor AE incidence was 2.3% (95% CI, 1.5%-3.7%). Regarding major AEs, 30 venous thromboembolism events occurred, all in the 4 studies (8.1%) using midline catheters (1126 total catheters), with a pooled incidence of 1.4% (95% CI, 0.4%-5.4%). In contrast, only 1 major AE (a tissue necrosis event) was reported in 43 studies (87.8%) using short PIV catheters (29 596 total catheters), with a pooled incidence of 0.0% (95% CI, 0.0%-0.0%). CVC avoidance ranged from 0% to 100%, with a pooled proportion of 59.7% (95% CI, 46.4%-71.7%) in 38 studies (77.6%) including 15 371 catheters.
CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of adult patients, AE incidence was low after short-term vasopressor administration through PIV catheters, particularly short catheters. These findings suggest that PIV administration might reduce the need for CVC placement with appropriate monitoring.