Safety of Administration of Vasopressors Through Peripheral Compared to Central Venous Catheters in a Rural Kenyan Hospital: Protocol for a Prospective Observational Cohort Study

TL;DR

This study aims to compare the safety of giving vasopressor drugs through peripheral versus central venous catheters in a rural Kenyan hospital.

Contribution

It is the first study to include both adult and pediatric patients in a mixed ICU population in a resource-variable setting.

Findings

The study will collect data on complication rates from vasopressor infusion via peripheral catheters.

It will assess whether peripheral administration is as safe as central venous administration.

The study includes a broad patient population with diverse causes of shock.

Abstract

The infusion of vasopressors is a standard treatment for shock, and international guidelines recommend administering these medications through central venous catheters (CVCs) due to concerns about potential extravasation and local tissue injury with peripheral intravenous (PIV) administration. However, CVCs are often unavailable in resource-variable settings due to lack of human and material resources. Previous studies have assessed the safety of vasopressor infusion through PIV catheters but have considered only limited patient populations or a short infusion time or have used retrospective designs that may have failed to capture mild complications.

The primary objective of this study is to observe and describe the incidence of complications among patients receiving vasopressor infusion via PIV administration. The secondary objective is to assess whether the safety of PIV vasopressor administration is noninferior to the safety of administration via CVC.

This prospective observational study is being conducted at African Inland Church (AIC) Kijabe Hospital, a 360-bed tertiary care teaching hospital in rural Kenya. All patients (adult, obstetric, and pediatric) receiving intravenous vasopressor infusions who are admitted to the intensive care unit or high-dependency unit will be included. Patients will be followed up on twice daily from the start of vasopressor infusion to 72 hours after vasopressor discontinuation or death, whichever occurs first. Demographic, physiological, laboratory, therapeutic, and outcome data will be collected.

Consecutive enrollment began in October 2023 and is ongoing. As of July 2025, we have enrolled 190 patients. We anticipate that the time to enroll the number of patients required to reach our power goal will be 24 months.

This study in a resource-variable setting will allow for more accurate and comprehensive data collection on vasopressor administration and potential complications as they arise, whereas most previous studies have been retrospective in nature. In addition, this is the first study of its kind to include both adult and pediatric patients within a mixed intensive care unit population with broad etiologies of shock, which could improve generalizability.