1. 實證探討Norepinephrine使用周邊靜脈管路輸注之安全性
Mei-Hsien Lin*, Hui-Chuan Lin
Department of Pharmacy, Ditmanson Medical Foundation Chia-Yi Christian Hospital
Background & Aims
Results
Norepinephrine is a direct-acting sympathomimetic agent which is indicated for blood pressure control associated with acute hypotensive states. It is commonly administered in the emergency department and intensive care unit to treat hemodynamic instability in critically ill patients. Although administration of norepinephrine through central venous catheters located in the large vein is the preffered route, peripheral IV accesses is readily obtained in most patients and allow the medication to reach the patient sooner and reduce the time required to achieve hemodynamic stability. However, the adverse events of extravasation and local tissue injury seem increase under the process. Here we aimed to assess the safety of norepinephrine infusion through the peripheral IV line.
The systematic review article identified a total of references, of which 85 met final inclusion criteria. Of the 85 included references, 80 presented individual data and were made up of case studies and case series, while 5 presented aggregate data and included 1 randomized controlled trial and 4 case series.
There were 325 separate events of local tissue injury or vasopressor extravasation associated with administration of vasopressors, 318 events resulted from peripheral IV administration. Of these 318 events, there were 204 local tissue injury events and 114 events of extravasation of vasopressor solution. Norepinephrine were most commonly administered in instances of local tissue complications (80.4%).
Local tissue injury attributable to peripheral administration tends to occur in distal IV sites following long durations of infusion. The duration of hypoperfusion required to cause injury is in the range of hours and most commonly after 12 to 24 hours. In emergency situations, short-term administration (<2hours) of vasopressor infusions via proximal, well-placed peripheral IVs is less likely to cause local tissue injury. But this should only be performed as a temporizing measure until central venous access is obtained.
Methods
We searched PubMed, Medline, the Cochrane Library and airity library and limited the type of articles as randomized controlled trial, meta-analysis or systematic review. There are three relevant literatures. After screening the title and abstract contents, we finally adopted one document to conduct a detailed study.
Key word：norepinephrine , peripheral intravenous line, central venous catheter, extravasation, tissue injury or necrosis.
Total local tissue injury and/or extravasation
325 events
(270 patient)
Duration of infusion:
55.9 ± 68.1 hrs Median : 24 hrs
Range: hrs
Peripheral IV
318 events (97.8%)
Local tissue injury 204 events
Central IV
7 events (2.2%)
Extravasation
114 events
PICO
Patient
the elderly man who was hemo- dynamic instable and received norepinephrine infusion
Intervention
peripheral intravenous line
Comparison
central venous catheter
Outcome
incidence of extravasation, tissue injury or necrosis
Application
The available evidence seems no definitive conclusions can be drawn regarding the safety of peripheral administration of norepinephrine. Further study is warranted to clarify. However, the frequency of occurrence of local tissue injury increases when prolonged administration of norepinephrine via peripheral IVs was done. To avoid this complication, temporary administration or through a central vein should be implement whenever possible.
PubMed
Medline
airity
Cochrane
3 articles
1 articles
0 articles
1 articles
Duplication: 0
Reference
5 articles
A systematic review of extravasation and local tissue injury from administration ofvasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care 2015 Jun;30(3):653.e9-17. 
Extravasation of Noncytotoxic Drugs: A Review of the Literature. Ann Pharmacother 2014 Apr 8;48(7):  
Excluded
Title: 3
Abstract: 1
1 articles