Critical Matters Peripheral vasopressors
Oct 23, 2025
Dr. Elizabeth Munroe, a pulmonary and critical care physician from Intermountain Health, shares her insights on peripheral vasopressor administration. She reveals how this method is shifting clinical practices, especially in sepsis management. The conversation includes historical perspectives on central lines, recent safety studies, and the CLOVERS trial’s findings. Munroe emphasizes the practicality of peripheral access for urgent needs and outlines strategies for safe administration. She advocates for open-mindedness in evolving medical practices underpinned by robust evidence.
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Why Central Lines Became Dogma
- Historical case reports drove central-line dogma despite different modern practices.
- Changes in pumps, IV placement, and hemodynamic strategy undermined that original rationale.
Multiple Forces Drove Practice Change
- Multiple forces pushed peripheral vasopressor adoption: reduced need for invasive hemodynamics, CLABSI concerns, and pragmatism.
- COVID may have accelerated practice changes but affected hospitals differently.
Avoid Delays By Allowing Peripheral Start
- When testing fluid-vs-vasopressor strategies, start vasopressors early in restrictive arms to avoid treatment delays.
- Design trials pragmatically to allow peripheral administration to prevent randomization-related delays.
