Evaluation of the safety and efficacy of peripheral vasopressors to decrease central line placement and associated bloodstream infections.
Background: In 2020, as a result of evidence of demonstrated safety of an initial pilot program, our institution set out to implement a peripheral vasopressor infusion protocol. Objective: To evaluate the use of peripheral lines for vasopressor administration to reduce placement of unnecessary centr...
| Publicado en: | Journal of Infection Prevention Vol. 25; no. 5; pp. 153 - 161 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Sep2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=179712601&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 179712601 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17571774 8URG jtl: Journal of Infection Prevention issn: 17571774 maglogo: Y pubinfo: dt: Sep2024 vid: 25 iid: 5 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 179712601 176428872 179712601 179712601 10.1177/17571774241245437 179712601 ppf: 153 ppct: 8 formats: tig: atl: Evaluation of the safety and efficacy of peripheral vasopressors to decrease central line placement and associated bloodstream infections. aug: au: Dansereau, Angela C Marti, Kristen E Mah, John W Pugliese, Nicholas M affil: Department of Pharmacy Services, 41528 UMass Memorial Medical Center, Worcester, MA, USA sug: subj: Catheter-Related Bloodstream Infections Prevention and Control Catheterization, Peripheral Central Venous Adverse Effects Vasoconstrictor Agents Administration and Dosage Infection Control Methods Patient Safety Evaluation Drug Efficacy Evaluation Human Male Female Middle Age Aged Aged, 80 and Over Connecticut Retrospective Design Record Review Catheter-Related Bloodstream Infections Complications Infusions, Intravenous Administration, Intravenous Intensive Care Units Drug Administration Routes Extravasation of Diagnostic and Therapeutic Materials Implementation Science Pearson's Correlation Coefficient Chi Square Test T-Tests Mann-Whitney U Test Statistical Significance Data Analysis Software Descriptive Statistics Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: Background: In 2020, as a result of evidence of demonstrated safety of an initial pilot program, our institution set out to implement a peripheral vasopressor infusion protocol. Objective: To evaluate the use of peripheral lines for vasopressor administration to reduce placement of unnecessary central lines and central line days. Methods: This is an Institutional Review Board approved, single center retrospective chart review conducted as pre/post-analysis. Our hospital is a quaternary care, level 1 trauma center in Hartford, Connecticut that serves 100,000-120,000 patients annually. Patients >18 years admitted to an intensive care unit (ICU) were included if meeting protocol specific inclusion criteria pertaining to moderate expected duration and dose of vasopressor. Patients were excluded if vasculature not supportive of placement of two peripheral intravenous (PIV) sites, PIV sites without brisk blood return, had a limb restriction, or metacarpal line. All analyses were conducted with SPSS v. 26 (IBM; Armonk, NY 2019), using an a priori alpha level of 0.05 such that all results yielding p <.05 were deemed statistically significant. Primary efficacy outcomes of this study are number of central lines placed and number of central line days. The primary safety outcome is the number of extravasation events attributed to peripheral administration of vasopressors. Results: Overall, 146 patients avoided central line placement constituting a 58.4% (p <.001) decrease in central line placement with peripheral vasopressor use. Out of 382 administrations there were a total of 14 extravasation events that occurred with peripheral vasopressor use in the post-intervention group. Implementation was associated with a statistically significant reduction in CLABSI occurrence. Conclusions: The results of this analysis demonstrate that vasopressors can peripherally administered safely, when proximal to the antecubital fossa, at lower doses, and for short durations of infusion with minimal adverse events. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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