Vasopressors are frequently used in critically ill patients with hemodynamic instability both in the emergency department (ED) as well as intensive care units (ICUs). Typically, vasopressors are given through central venous catheters (CVCs) as opposed to peripheral intravenous (PIV) access due to the concerns about adverse events (i.e. tissue ischemia/necrosis) associated with extravasation through PIVs. In a truly hypotensive, critically ill patient the use of a PIV to administer vasopressors will allow the medication to stabilize the patient sooner and reduce the time to hemodynamic stability. Currently administration of vasopressors via peripheral IVs is considered to be unsafe and often discouraged by some due to the concern of local tissue injury from extravasation, but this systematic review found only observational reports of complications of vasopressor infusion from PIVs. Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports and further study is warranted to clarify the safety of vasopressor administration via PIVs.

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