This document aims to provide guidance to adult critical care professionals on the administration of vasopressor agents via a peripheral venous cannula (PVC) to adult critical care patients and to set out safe principles and standard concentrations in order to inform local policy.

We anticipate that in most circumstances this would be done as a bridging measure as an adjunct to good patient management, until such a time that a central venous access device (CVAD) is available; or used for a short term under specific circumstances.

Whereas traditionally it has been commonplace to only administer vasopressor agents via a CVAD (with the risks of peripheral extravasation often cited as the reason for this), the practice of administering vasopressor agents peripherally is emerging (as it is in anaesthetic practice in the perioperative period) with a recent systematic review of over 1300 patients suggesting the risk of doing so being lower than is anecdotally cited [1]. This review reported that extravasation events were uncommon (event rate 3.4%), with no reported incidents of tissue necrosis or limb ischaemia.

The most common alternative to a PVC is the insertion of a central venous cannula (CVC).  Whilst the use of ultrasound-guided insertion will aid in the reduction of the incidence of such risks, many remain clinically significant (such as pneumothorax, arterial injury, arrhythmias and catheterrelated infection) and so it seems sensible to consider circumstances wherein administration via
PVC may be preferable.

Such situations might include, but are not limited to, stabilisation of critically unwell patients awaiting transfer to a critical care area; short term post-operative use; patient preference; or where central venous access would prove problematic. The decision will ultimately come down to local policy and the responsible senior decision-maker at the time.