Safety and efficiency of Peripheral versus Central Line Vasopressor Administration in Septic Shock: A Systematic Review and Meta-Analysis

Abstract

Objective: Vasopressors are administered via central venous catheters (CVCs) to avoid tissue injury from extravasation. Obtaining central access often delays hemodynamic stabilization and poses a risk of procedural complications. This systematic review and meta-analysis evaluate the safety and efficacy of peripheral versus central line vasopressor delivery in adult septic shock to address current evidence gaps. Methods: Electronic databases were searched for cohort studies and clinical trials comparing peripheral and central vasopressor administration in patients with septic shock. Following the PRISMA guidelines, data were extracted by independent reviewers. The risk of bias was assessed using the ROBINS-I tool. A meta-analysis was performed using a random-effects model with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment, while statistical heterogeneity was evaluated using the I² statistic and τ² to evaluate mortality, initiation time, and extravasation. Results: Five studies (17,264 patients) were included. In the pooled analysis of 10,629 patients, there was no significant difference in mortality between the two groups (OR, 0.90; 95% CI, 0.26–3.05; p = 0.74), although statistical heterogeneity was substantial (I² = 93%). Peripheral administration significantly reduced the time to vasopressor initiation by a median of 1.4–2.1 hours. Extravasation was low (0%–5.5%) and minor. The certainty of evidence (GRADE) for mortality was very low because of inconsistency and the observational nature of the data. Conclusions: Peripheral vasopressors are safe and efficient for initial resuscitation in septic shock, facilitating rapid support while avoiding mechanical or infectious CVC risks. The findings support the protocolized peripheral vasopressors during the early phase of shock management.