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Am J Perinatol 2025; 42(07): 862-867
DOI: 10.1055/a-2435-1000
Original Article

Peripheral Use of Vasopressors in Shock: Clinical Considerations and Recommendations for Use in Obstetrics

Luis D. Pacheco
1   Divisions of Maternal Fetal Medicine and Surgical Critical Care, University of Texas Medical Branch at Galveston, Galveston, Texas
,
Karin A. Fox
2   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Corey C. Clifford
2   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Faranak Behnia
2   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Melissa E. Bauer
3   Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
,
Antonio F. Saad
4   Department of Obstetrics and Gynecology, Inova Fairfax, Fairfax, Virginia
,
George R. Saade
5   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
› Author Affiliations Funding None.
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Abstract

Objective

This study aimed to evaluate the safety of peripheral administration of vasopressor agents among patients with circulatory shock.

Study Design

We reviewed the published literature evaluating the use of peripheral norepinephrine in patients with shock and proposed a protocol for use in labor and delivery units.

Results

Peripheral administration of norepinephrine is a safe and potentially lifesaving intervention for patients in labor and delivery with extremely low complication rates.

Conclusion

Adoption of a protocol for peripheral administration of vasopressors in labor and delivery is safe and may prevent life threatening delays in hemodynamic resuscitation.

Key Points

  • Administering vasopressors through a peripheral line is safe and helps avoid delays in care.

  • An established protocol is essential for the safe peripheral administration of vasopressors.

  • Understanding continuous blood pressure monitoring is crucial for managing critically ill patients.

Keywords

pregnancy - shock - vasopressors - peripheral venous lines


Publication History

Received: 15 July 2024

Accepted: 05 October 2024

Article published online:
29 October 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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  • References

  • 1 Jentzer JC, Vallabhajosyula S, Khanna AK, Chawla LS, Busse LW, Kashani KB. Management of refractory vasodilatory shock. Chest 2018; 154 (02) 416-426
    CrossrefPubMedSearch in Google Scholar
  • 2 Demiselle J, Fage N, Radermacher P, Asfar P. Vasopressin and its analogues in shock states: a review. Ann Intensive Care 2020; 10 (01) 9
    CrossrefPubMedSearch in Google Scholar
  • 3 Bloom JE, Chan W, Kaye DM, Stub D. State of shock: contemporary vasopressor and inotrope use in cardiogenic shock. J Am Heart Assoc 2023; 12 (15) e029787
    CrossrefPubMedSearch in Google Scholar
  • 4 Fage N, Asfar P, Radermacher P, Demiselle J. Norepinephrine and vasopressin in hemorrhagic shock: a focus on renal hemodynamics. Int J Mol Sci 2023; 24 (04) 4103
    CrossrefPubMedSearch in Google Scholar
  • 5 McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003; 348 (12) 1123-1133
    CrossrefPubMedSearch in Google Scholar
  • 6 Colon Hidalgo D, Patel J, Masic D, Park D, Rech MA. Delayed vasopressor initiation is associated with increased mortality in patients with septic shock. J Crit Care 2020; 55: 145-148
    CrossrefPubMedSearch in Google Scholar
  • 7 Evans L, Rhodes A, Alhazzani W. et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021; 49 (11) e1063-e1143
    CrossrefPubMedSearch in Google Scholar
  • 8 Yerke JR, Mireles-Cabodevila E, Chen AY. et al. Peripheral administration of norepinephrine: a prospective observational study. Chest 2024; 165 (02) 348-355
    CrossrefPubMedSearch in Google Scholar
  • 9 Munroe ES, Heath ME, Eteer M. et al. Use and outcomes of peripheral vasopressors in early sepsis induced hypotension across Michigan hospitals. Chest 2023; 26: 12-16
    PubMedSearch in Google Scholar
  • 10 Owen VS, Rosgen BK, Cherak SJ. et al. Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis. Crit Care 2021; 25 (01) 146
    CrossrefPubMedSearch in Google Scholar
  • 11 Shields AD, Plante LA, Pacheco LD, Louis JM. Society for Maternal-Fetal Medicine (SMFM), SMFM Publications Committee. Electronic address: pubs@smfm.org. Society for Maternal-Fetal Medicine Consult Series #67: Maternal sepsis. Am J Obstet Gynecol 2023; 229 (03) B2-B19
    CrossrefPubMedSearch in Google Scholar
  • 12 Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the peripheral administration of vasopressor agents. J Intensive Care Med 2019; 34 (01) 26-33
    CrossrefPubMedSearch in Google Scholar
  • 13 Riley LE, Chen GJ, Latham HE. Comparison of noninvasive blood pressure monitoring with invasive arterial pressure monitoring in medical ICU patients with septic shock. Blood Press Monit 2017; 22 (04) 202-207
    CrossrefPubMedSearch in Google Scholar
  • 14 Ziyaeifard M, Alizadehasl A, Aghdaii N. et al. Heparinized and saline solutions in the maintenance of arterial and central venous catheters after cardiac surgery. Anesth Pain Med 2015; 5 (04) e28056
    CrossrefPubMedSearch in Google Scholar
  • 15 Saugel B, Kouz K, Meidert AS, Schulte-Uentrop L, Romagnoli S. How to measure blood pressure using an arterial catheter: a systematic 5-step approach. Crit Care 2020; 24 (01) 172
    CrossrefPubMedSearch in Google Scholar
  • 16 Lam S, Liu H, Jian Z, Settels J, Bohringer C. Intraoperative invasive blood pressure monitoring and the potential pitfalls of invasively measured systolic blood pressure. Cureus 2021; 13 (08) e17610
    PubMedSearch in Google Scholar