Utilisation of peripheral vasopressor medications and extravasation events among critically ill patients in Rwanda: A prospective cohort study

Catalina G. Marques, Lucien Mwemerashyaka, Kyle Martin, Oliver Tang, Chantal Uwamahoro, Vincent Ndebwanimana, Doris Uwamahoro, Katelyn Moretti, Vinay Sharma, Sonya Naganathan, Ling Jing, Stephanie C. Garbern, Menelas Nkeshimana, Adam C. Levine, Adam R. Aluisio

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: In high-income settings, vasopressor administration to treat haemodynamic instability through a central venous catheter (CVC) is the preferred standard. However, due to lack of availability and potential for complications, CVCs are not widely used in low- and middle-income countries. This prospective cohort study evaluated the use of peripheral vasopressors and associated incidence of extravasation events in patients with haemodynamic instability at the Centre Hospitalier Universitaire Kigali, Rwanda. Methods: Patients ≥18 years of age receiving peripheral vasopressors in the emergency centre (EC) or intensive care unit (ICU) for >1 hour were eligible for inclusion. The primary outcome was extravasation events. Patients were followed hourly until extravasation, medication discontinuation, death, or CVC placement. Extravasation incidence with 95% confidence intervals (CI) were calculated using Poisson exact tests. Results: 64 patients were analysed. The median age was 49 (Interquartile Range [IQR]:33-65) and 55% were female. Distributive shock was the most frequent aetiology (47%). Intravenous (IV) location was most commonly antecubital fossa/upper arm (31%) and forearm/hand (43%). IV gauges ≤18 were used in 58% of locations. Most patients were treated with adrenaline (66%) and noradrenaline (41%), and 11% received multiple vasopressors. The median treatment duration was 19 hours (IQR:8.5-37). Treatment discontinuation was predominantly due to mortality (41%) or resolution of instability (36%). There were two extravasation events (2.9%), both limited to soft tissue swelling. Extravasation incidence was 0.8 events per 1000 patient-hours (95% CI:0.2-2.2). Conclusion: Extravasation incidence with peripheral vasopressors was low, even with long use durations, suggesting peripheral infusions may be an acceptable approach when barriers exist to CVC placement.

Original languageEnglish (US)
Pages (from-to)154-159
Number of pages6
JournalAfrican Journal of Emergency Medicine
Volume12
Issue number2
DOIs
StatePublished - Jun 2022
Externally publishedYes

Keywords

  • Extravasation
  • Global health
  • Peripheral vasopressors
  • Resuscitation
  • Rwanda
  • Vasoactive agents

ASJC Scopus subject areas

  • Emergency Medicine
  • Gerontology
  • Emergency
  • Geochemistry and Petrology
  • Critical Care

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