Peripheral Pressor Use & Treatment of Extravasation

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
File Size:	517 kb
File Type:	pdf

Download File

---

a_systematic_review_of_extravasation_and_local_tissue_injury_from.pdf
File Size:	530 kb
File Type:	pdf

Download File

---

safety_of_peripheral_administration_of_phenylephrine.pdf
File Size:	207 kb
File Type:	pdf

Download File

---

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.

phentolamine.pdf
File Size:	120 kb
File Type:	pdf

Download File

---