Local complications of peripheral intravenous vasopressor use with phentolamine as an antidote: a retrospective review

BACKGROUND: Prior studies have indicated that peripheral administration of vasopressors, particularly norepinephrine, can be considered safe, with local complications occurring in 0% to 1.8% of patients. Our study further explored the local skin complications from peripheral vasopressor administration treated with phentolamine in a large health care system. METHODS: A retrospective chart review was performed on patients who received phentolamine for effects of local infiltration of pressors. Data were collected for demographics, vasopressor dose and duration of use, phentolamine dose and time after extravasation until administration, peripheral intravenous characteristics, as well as outcomes such as length of stay and mortality. Data on patients who did and did not require central venous catheter placement postextravasation were compared. The most common sites of intravenous access were the antecubital fossa (33%) and forearm (27%). Mean number of hours prior to extravasation of peripheral vasopressors requiring phentolamine administration was 21 hours. Mean number of minutes prior to phentolamine administration after extravasation was 131 minutes. Seventy-six percent of patients did not any have significant ischemic tissue injury with extravasation, and 24% of patients had only minor bruising and erythema. Two significant reactions occurred, including deep vein thrombosis and local skin necrosis. Fifty-two percent of patients required a subsequent central venous line placement. The mean length of stay was 5.4 days in the intensive care unit and 11.8 days in the hospital, and in-patient mortality was 17%. CONCLUSION: In our large cohort of patients with extravasation from peripheral vasopressors managed with local phentolamine administration, severe tissue skin or soft tissue injury was rare.