Peripheral IV vasopressors show low complication rates in large meta-analysis

A large systematic review and meta-analysis found that adverse events (AEs) were uncommon after short‑term vasopressor administration through peripheral IV (PIV) catheters. Across 49 studies including 33,060 catheters, minor AE rates varied by agent—2.6% for norepinephrine, 0.0% for epinephrine, 2.9% for phenylephrine, 1.4% for dopamine, 0.5% for vasopressin, and 0.9% for metaraminol—resulting in an overall pooled minor AE rate of 2.3%. Major AEs were rare and strongly catheter‑dependent: all 30 venous thromboembolism events occurred in studies using midline catheters (1.4% pooled incidence), whereas just one major event (tissue necrosis) was reported across 43 studies of short PIV catheters, yielding a pooled incidence of 0.0%. Central venous catheter avoidance averaged nearly 60%.

Clinical takeaway: Short PIV catheters, paired with vigilant monitoring, may offer a low‑risk, practical option when rapid vasopressor initiation is needed before central access can be established.

Source:

ZhangJian SJ, et al. (2026, March 16). JAMA Netw Open. Incidence of Adverse Events in Peripheral Intravenous Vasopressor Use: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/41838001/