Short term Vasopressor use via Peripheral IV catheter tied to Low Adverse Event Risk: JAMA
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A recent study published in the Journal of the American Medical Association found that short-term vasopressor use via peripheral IV (PIV) catheters is associated with low adverse event rates, especially with short catheters. These results suggest that PIV administration can be a safe alternative, potentially reducing the need for central venous catheter (CVC) placement when proper monitoring is ensured.
The study analyzed data from 49 clinical studies encompassing more than 33,000 catheter uses, found that adverse events (AEs) associated with PIV vasopressor administration are relatively rare, particularly when short peripheral catheters are used. This research combed through major medical databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials, and covered studies published up to December 2025.
Across all vasopressors studied, the pooled rate of minor AEs was just 2.3%. Among commonly used agents, norepinephrine had a minor AE rate of 2.6%, phenylephrine 2.9%, dopamine 1.4%, vasopressin 0.5%, and metaraminol 0.9%. Epinephrine showed no recorded minor AEs, though with a wide confidence interval due to limited data.
Only one major adverse event (tissue necrosis) was reported among nearly 30,000 short catheter uses. All 30 recorded cases of venous thromboembolism occurred in studies using midline catheters, which suggested that a higher risk profile for these devices. The pooled incidence of major AEs with midline catheters was 1.4%, while it was effectively 0% for short PIV catheters.
Beyond safety, the study also examined whether PIV vasopressor use could reduce reliance on central lines, which are more invasive and carry risks such as infection and mechanical complications.
The findings indicate that nearly 60% of patients receiving vasopressors via PIV were able to avoid CVC placement altogether. This rate varied widely across studies, ranging from 0% to 100%, but the overall trend suggests a strong chance to reduce invasive procedures in critically ill patients.
Most studies included in the analysis involved short-term use of vasopressors and careful site observation, which likely contributed to the low complication rates. Overall, with appropriate safeguards, this approach may streamline care and reduce the burden of invasive procedures in critical care environments.
Source:
ZhangJian, S.-J., Niu, K.-Y., Chen, C.-B., Seak, C.-J., & Yen, C.-C. (2026). Incidence of adverse events in peripheral intravenous vasopressor use: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Network Open, 9(3), e260710. https://doi.org/10.1001/jamanetworkopen.2026.0710
