Incidence of Extravasation during Norepinephrine Administration via Peripheral Venous Catheter in Emergency Patients

Objective: To describe the incidence of extravasation resulting from the administration of norepinephrine through a peripheral venous catheter in emergency patients.Material and Methods: This prospective observational study was conducted on 150 adult patients in the emergency department at Siriraj Hospital, Thailand. Physicians closely monitored patients who received norepinephrine via a peripheral venous catheter examining the intravenous access sites during the period of treatment and for up to 48 hours after discontinuation of treatment. We collected demographic data, norepinephrine administration details, potential risk factors for extravasation, the incidence of extravasation, and mortality rate.Results: The median age of the patients was 67 years, and 60.7% were male. Most patients (93.3%) received peripheral intravenous norepinephrine for septic shock, administered below the wrist joint (47.3%) through a 22-gauge catheter (82.7%). The median duration of total peripheral intravenous norepinephrine administration was 19.92 hours (interquartile range (IQR) 9.48-38.09). The median maximum dose was 0.07 mcg/kg/min (IQR 0.04-0.10). Extravasation occurred in three patients (2.0%) (95% CI: 0.6 - 6.1), none of which resulted in significant morbidity. The timing from shock diagnosis to peripheral intravenous norepinephrine administration did not statistically differ between survivors and non-survivors at both 7 and 30 days. However, the median time from shock diagnosis to achieve mean arterial pressure (MAP)≥65 mmHg, and time from norepinephrine administration to achieve MAP ≥65 mmHg, was shorter in the survivors compared to the non-survivors.Conclusion: Given that the incidence of extravasation events was low and did not result in significant morbidity, we suggest that peripheral intravenous norepinephrine administration is safe under close observation and for a limited duration.