SGEM#522: Va-so-Pressors – Can You Run Them Peripherally?
Summary
Host Ken Milne and guest Dr. Aaron Skolnick discuss whether vasopressors can be safely administered through peripheral IVs instead of central lines. They analyze a 2026 JAMA Network Open meta-analysis of over 33,000 catheters, which found low rates of major adverse events and that central lines were avoided in 60% of cases. The episode highlights the trade-off between delaying treatment for central access and the minimal risk of peripheral infiltration, concluding that starting pressors peripherally is a reasonable, patient-centered strategy.
Topics discussed
Introduction, guest welcome, and small talk
Clinical case presentation and the nurse's question
Risks of central lines vs. benefits of peripheral access
Defining the research question and study reference
Study design, population, and primary outcomes
Quality checklist: validity and heterogeneity concerns
Study characteristics and key result summary
Analysis of minor and major adverse events
Secondary outcome: Central venous catheter avoidance
Critical appraisal: Bias, heterogeneity, and limitations
SGEM conclusions and bottom line recommendation
Case resolution and clinical application strategy
Patient communication and bedside translation
Keener contest question and episode wrap-up
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