Vasopressor Administration and Safety in Critical Care Settings

Vasopressors are frontline agents for restoring and maintaining adequate perfusion pressure in patients with circulatory shock. These drugs, which include norepinephrine, dopamine, epinephrine and metaraminol, act on adrenergic receptors to induce vasoconstriction and support cardiac output. Traditionally administered via central venous catheters to minimise local tissue injury, there has been growing interest in peripheral intravenous routes, especially when rapid haemodynamic support is required or central access is delayed. Critical care teams must balance the urgency of vasopressor initiation against risks such as extravasation, local ischaemia and infection. Advances in infusion technology, standardised line management protocols and close monitoring have broadened the safe use of peripheral administration in adult and paediatric populations. Global surveys reveal marked variation in practice patterns, with institutional policies and resource availability shaping the choice of infusion route, concentration and duration. Emerging evidence underscores low rates of serious adverse events when peripheral administration is guided by robust protocols, while highlighting ongoing challenges in resource-limited settings. Safe vasopressor delivery remains a multidisciplinary endeavour, requiring clear guidelines, nurse-led titration strategies and prompt recognition of complications to optimise outcomes in patients with septic, cardiogenic and distributive shock.

Research from Nature Portfolio

A retrospective single-centre study of children receiving short-term peripheral vasoactive infusions in an emergency department found no local or regional complications over a seven-year period. Among 65 paediatric patients treated primarily for septic shock, dopamine was the most common agent and median time to central access was two hours. Close monitoring and standardised protocols enabled peripheral infusions to serve as an effective bridge until central lines were secured, demonstrating feasibility in time-critical paediatric resuscitations without tissue injury.

Vasopressor Administration and Safety in Critical Care Settings publication trend

The graph below shows the total number of articles in vasopressor administration and safety in critical care settings across all publications each year (not limited to Nature Index journals).

Technical terms

Vasopressor: A medication that induces blood vessel constriction to raise blood pressure and improve organ perfusion.

Peripheral intravenous catheter (PIVC): A short catheter inserted into a peripheral vein, commonly used for fluid and drug administration.

Central venous catheter (CVC): A longer catheter placed in a large central vein, typically in the neck, chest or groin, allowing high-flow infusions and haemodynamic monitoring.

Extravasation: Leakage of infused fluid or drug from the vessel into surrounding tissue, potentially causing local injury.

Mean arterial pressure (MAP): An average blood pressure during a single cardiac cycle, often targeted above 65 mmHg in septic shock to ensure organ perfusion.

References

1. Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis. Critical Care (2021).
2. International pharmacy survey of peripheral vasopressor infusions in critical care (INFUSE). Journal of Critical Care (2023).
3. Safety and outcomes of short-term use of peripheral vasoactive infusions in critically ill paediatric population in the emergency department. Scientific Reports (2022).
4. Norepinephrine Infusion in the Emergency Department in Septic Shock Patients: A Retrospective 2-Years Safety Report and Outcome Analysis. International Journal of Environmental Research and Public Health (2021).