TY - JOUR
T1 - Utilisation of peripheral vasopressor medications and extravasation events among critically ill patients in Rwanda
T2 - A prospective cohort study
AU - Marques, Catalina G.
AU - Mwemerashyaka, Lucien
AU - Martin, Kyle
AU - Tang, Oliver
AU - Uwamahoro, Chantal
AU - Ndebwanimana, Vincent
AU - Uwamahoro, Doris
AU - Moretti, Katelyn
AU - Sharma, Vinay
AU - Naganathan, Sonya
AU - Jing, Ling
AU - Garbern, Stephanie C.
AU - Nkeshimana, Menelas
AU - Levine, Adam C.
AU - Aluisio, Adam R.
N1 - Funding Information:
Funding for data collection was provided by a grant from the Framework Global Health Scholars Program at the Brown University School of Public Health.
Publisher Copyright:
© 2022
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - Extravasation
KW - Global health
KW - Peripheral vasopressors
KW - Resuscitation
KW - Rwanda
KW - Vasoactive agents
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U2 - 10.1016/j.afjem.2022.03.006
DO - 10.1016/j.afjem.2022.03.006
M3 - Article
C2 - 35505668
AN - SCOPUS:85129483212
SN - 2211-419X
VL - 12
SP - 154
EP - 159
JO - African Journal of Emergency Medicine
JF - African Journal of Emergency Medicine
IS - 2
ER -