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Peripheral Pressor Use & Treatment of Extravasation

12/14/2016

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Utilizing peripheral IVs for short-term treatment with IV vasopressors is frequently utilized while obtaining additional access. Are we risking skin necrosis for short term gains? 

Literature Review of Tissue Necrosis

  • Most reported adverse events are associated with a distal peripheral site or prolonged duration of administration.
  • Many reported cases do not disclose the IV gauge, technique of placement, type of vasopressor, or if ultrasound was utilized to gain access. 
  • 85% of reported tissue necrosis occurs in a vein distal to the antecubital or popliteal veins. 
  • More than 50% of cases occur when utilizing the saphenous vein for access
  • A recent pilot study with 506 patients in the ICU setting shows peripheral use of phenylephrine in peripheral access identified zero episodes of tissue injury or necrosis or extravasation.  
can_vasopressors_safely_be_administered.pdf
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a_systematic_review_of_extravasation_and_local_tissue_injury_from.pdf
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safety_of_peripheral_administration_of_phenylephrine.pdf
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Utilization of Peripheral IVs

  • Utilize ultrasound for IV placement
  • Test IV access with saline prior to starting vasopressors
  • Consider phenylephrine for short-term boluses
  • Identify your next step; being identifying your next access point, such as  a central line or proximal IV. 

Treatment of Extravasation

  • Immediately stop infusions
  • Aspirate as much infusion as possible from IV
  • Inject Phentolamine into IV prior to removal followed by subcutaneous injections into the surrounding skin (0.1mg/kg with a maximum dose of 10mg)
  • Consider consulting plastics for further treatment.
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phentolamine.pdf
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  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map