Peripheral Vasopressors in Critical Care: What Does PIVC Practice Look Like?

Posted on 19 January 2027

Study Overview
Vasopressors are often started through a peripheral intravenous catheter when critically ill patients need rapid circulatory support, particularly while central access is being considered or established.
This descriptive exploratory sub-study examined 64 PIVCs in 40 critically ill adults receiving peripheral vasopressors in intensive care and emergency settings. Researchers described device selection, insertion sites, insertion success and ongoing catheter management.

Key Findings

An 18-gauge PIVC was the most commonly used catheter size.
The antecubital fossa was the most common insertion site, used for approximately 70% of initial PIVCs, despite guidelines generally favouring forearm placement.
First-attempt insertion success was high — 85% for first PIVCs and 91.7% for second PIVCs.
More than half of the devices remained in place for longer than 24 hours.
PIVC complications occurred in 20% of patients, including phlebitis, external leakage and one episode of infiltration/extravasation. The extravasation event did not result in tissue injury, and no necrosis or ischaemia was observed.

Implications
The study provides a useful snapshot of how PIVCs are currently being used for vasopressor administration in Australian critical care.
The frequent use of the antecubital fossa highlights an opportunity to consider more evidence-aligned site selection, including forearm placement where appropriate, and timely re-siting of antecubital devices.
Further research is needed to establish the safest device, site and management approach for peripheral vasopressor therapy.

Read more:https://doi.org/10.5737/va.v21.i2.43

Authors: Alison Craswell; Stacey Watts; April Hatt; Frances Lin; Yogesh Apte; Thomas Holland; Nicole Marsh; Mahesh Ramanan

Peripheral Vasopressors in Critical Care: What Does PIVC Practice Look Like?

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