(926) Peripheral Norepinephrine Decreased Central Line Placement in a Medical Intensive Care Unit

Introduction: Central venous catheters (CVCs) are associated with significant morbidity, mortality, and costs in the intensive care unit (ICU). Major CVC adverse events include mechanical complications during placement, thromboembolic events, and catheter-associated bloodstream infections (CLABSIs). Reducing CVC complications, including avoiding CVC placement altogether, is a crucial patient safety priority. While the vasopressor norepinephrine (NE) is typically administered via a central line to avoid local complications from extravasation, lower concentrations of norepinephrine may be safely administered via peripheral intravenous (IV) lines.

Methods: We implemented a protocol using peripheral IVs to administer a lower-dose and lower-concentration norepinephrine infusion in our medical intensive care unit (MICU) in March 2019. We reviewed peripheral norepinephrine (pNE) charges from 2017 to 2022 to determine the impact of our protocol on CVC placement. We compared the proportion of patients who received a CVC before (January 1st, 2017 to February 29th, 2019) and after (March 1st, 2019 to December 31st, 2022) protocol implementation. Extravasation events were evaluated based on phentolamine charges.

Results: Over the six-year period, there were 730 patients with a charge for the pNE concentration, with the most occurring in 2022 (N=273). Over this time, there were 14,154 MICU admissions, with 7956 (56%) requiring a CVC. The percentage of patients with a CVC decreased from 61% in 2017 to 52% in 2022, p < 0.01. The average proportion of MICU patients who received a CVC decreased significantly after protocol initiation (pre= 60% vs. post= 54%, p< 0.01). This intervention was associated with approximately 16 less central lines placed per month. There were nine charges (1.2%) for phentolamine in patients who received pNE over this time period.

Conclusions: Implementation of a protocol using peripherally infused NE was associated with a decrease in the number of patients at the unit level who received CVCs over a sustained period.