What are the treatment options for dobutamine extravasation?
Treatment of dobutamine extravasations remains speculative because reports of successful treatment are few. Terbutaline, as mentioned previously, has been successful for the reversal of a mixed dopamine and dobutamine extravasation. 31 Phentolamine and nitroglycerin remain reasonable treatment options for dobutamine extravasations.
Can dopamine infusion cause extravasation injury?
Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene. To overcome the hypotension, dopamine infusion was administered, using a microdrip set through a cannula inserted in the antecubital fossa. The rate of infusion was 5 mcg/kg/min initially and it was later increased to 10 mcg/kg/min.
How do you administer dopamine infusion?
A central intravenous access should be placed for dopamine infusion whenever possible. If this approach is not feasible, dopamine should be infused only peripherally through a long intravenous catheter i … Low-dose dopamine therapy should be administered with similar precautions as high-dose dopamine.
What is the first step in the treatment of extravasation?
Nursing interventions At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig. 1). Open in a separate window
What is the antidote for dopamine extravasation?
Phentolamine. Phentolamine is an antidote that will counteract the effect of vasoactive agents such as dopamine, epinephrine, norepinephrine and phenylephrine.
What is the treatment for extravasation?
Treatment of a vesicant extravasation includes immediate cessation of infusion, aspiration of as much extravasated drug as possible through the still-intact catheter, and attempts for the aspiration of the extravasated agent in the surrounding tissue. This aspiration may help to limit the extent of tissue damage.
How is dobutamine extravasation treated?
Extravasation of vasopressors is of great concern due to vasoconstriction and tissue necrosis at the site of extravasation. Since the vasoconstriction is due to alpha1-adrenergic agonism, phentolamine works as a direct antidote to extravasation by blocking alpha1 receptors.
Is dopamine an extravasation risk?
Dopamine infusion can cause tissue ischemia or necrosis secondary to vasospasm and extravasation. Most of the case reports in the literature have occurred when relatively high doses of dopamine were infused.
Is dopamine a vesicant?
In conclusion, mannitol and glucose at osmolarities of 549-1098 and 833-1110 mOsm/L, respectively, can be classified as "irritants," while ≥1388 mOsm/L glucose can be classified as a "vesicant." As for vasopressors, adrenaline and noradrenaline can be classified as "vesicants" whereas dopamine can be classified as an " ...
What is the very first thing you should do if you suspect a drug extravasation?
When an extravasation occurs or is suspected, the first action to take is to stop the infusion (AII). Leave the cannula in position and attempt to aspirate as much of the vesicant as possible from the device; if an antidote is available, an appropriate amount should be instillated through the existing i.v. (AIII).
When do I use hot or cold compress for extravasation?
Apply dry cold compresses for 20–30 min at a time, 4 times a day for the first 24–48 hr following extravasation. Use the antidote specific to the agent. Apply dry warm compresses for 20–30 min at a time, 4 times a day for the first 24–48 hr following extravasation.
When is phentolamine used for extravasation?
You'll want to give the phentolamine as soon as possible, although it may be effective as long as 12 hours after the extravasation.
How is phentolamine used for extravasation?
Depending on the severity of ischemia, debridement of necrotic tissue may be necessary. Phentolamine mesylate, dosed at 5–10 mg in 10 mL of saline injected into the area of extravasation within 12 hours, is the only pharmacological treatment for vasopressor extravasation approved by the Food and Drug Administration.
What would be used if dopamine infiltrates the tissues?
The treatment of dopamine-induced vasospasm includes reduction or cessation of the dopamine, use of systemic intravenous chlorpromazine 4 or nitroprusside, 3 local tissue infiltration with phentolamine, 5,12 and application of topical nitroglycerin.
What is dopamine extravasation?
Most adverse effects of dopamine are due to peripheral vasoconstriction after use of high dose dopamine infusion.[1] Even in low doses, extravasation of the drug leads to high local concentrations and can cause severe vasoconstriction and tissue ischemia.
Why does dopamine cause extravasation?
Significant local tissue injury was observed in both patients. Discussion: Dopamine infusion can cause tissue ischemia or necrosis secondary to vasospasm and extravasation. Most of the case reports in the literature have occurred when relatively high doses of dopamine were infused.
What is extravasation in medicine?
Extravasation refers to the leakage of injected drugs from blood vessels causing damage to the surrounding tissues. Common symptoms and signs of extravasation include pain, stinging or burning sensations, and edema around the intravenous (IV) injection site.
What is the frequency of extravasation of drugs?
Incidence. The frequency of extravasation in adults is reported to be between 0.1% and 6%.
What is local warming therapy?
The use of local warming therapy (dry heat) is based on the theory that it enhances vasodilation, thus enhancing the dispersion of the vesicant agent and decreasing drug accumulation in the local tissue. The use of local warming is recommended for the extravasation of non–DNA-binding vesicants.
How to stop IV fluids from extravasation?
At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig. 1). Open in a separate window.
Why is the incidence of drug leakage decreasing?
Some data suggest that the incidence is decreasing probably due to improvements in the infusion procedure, early recognition of the drug leakage, and training in management techniques. Risk factors. Risk factors can be classified under patient-related, procedure-related, and product or product-related factors.
How to diagnose extravasation?
Doctors diagnose extravasation by examining and inspecting the skin area around the cannula. If they suspect extravasation, they will stop the drug infusion and elevate the limb. Doing this as soon as possible should prevent serious complications from developing and stop the extravasation from escalating to a higher grade.
Why does extravasation decrease?
However, improvements in infusion techniques and a higher awareness among healthcare professionals of the early signs of extravasation are causing the rate to decrease. Extravasation has many possible causes, including: repeatedly using the same veins for cannulation. fragile veins.
What is the difference between extravasation and infiltration?
The difference between extravasation and infiltration is the type of solution that leaks into nearby tissue. Vesicant drugs are those that can cause tissue death, whereas non-vesicant drugs do not have this effect.
What are the symptoms of extravasation?
The symptoms of extravasation include a painful stinging or burning sensation, swelling, and skin discoloration. Read on to learn more about extravasation, its causes, and how doctors treat it.
How to tell if you have grade 3 extravasation?
If a person is showing signs of grade three extravasation, they should call a doctor or nurse immediately. Symptoms include: strong pain around the needle site. blocked canula. swelling. skin paler or more gray than usual, with or without nearby discoloration.
Can vesicants cause extravasation?
chemotherapy drugs. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the intravenous (IV) line. The symptoms of extravasation include a painful stinging or burning sensation, swelling, and skin discoloration.
What are the effects of extravasation of diagnostic and therapeutic substances?
Extravasations can lead to substantial morbidities including pain, decreased mobility, and permanent nerve, soft tissue, and/or tendon damage.
What are the different types of extravasation?
In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury.
What is the difference between infiltration and extravasation?
The definitions for extravasation and infiltration vary and are often deemed interchangeable. Extravasation is defined as the inadvertent extravenous administration of a medication or solution that has the potential for severe tissue or cellular damage into the surrounding tissue. 7 Extravasations are typically limited to materials that are known vesicants. Conversely, infiltration is defined as the inadvertent extravenous administration of any nonvesicant solution. Infiltrations may or may not cause a degree of local tissue inflammation or discomfort to the patient. 7 For the purpose of this review, the definitions just stated were used for the basis of differentiating the need for urgent intervention. These definitions should be considered with caution, however, because untreated infiltrations can still cause severe pain, discomfort, or compartment syndrome if left untreated for an extended period of time.
What is extravasation injury?
Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries.
Does contrast media cause extravasation?
Like other extravasation injuries, the ability of radiographic contrast media to produce extravasation injury largely depends on the volume of infiltrated contrast media and site of access. 61 Studies and case reports have demonstrated that contrast media with osmolalities of 1025–1420 mOsm/kg of water possess the highest risk for extravasation injury. 6 Higher osmolality magnetic resonance imaging contrast media may also pose high risks for tissue necrosis. The use of lower osmolality contrast media has emerged because it may reduce the risk of nephrotoxicity and aspiration injury compared with higher osmolality contrast media. 15 These lower osmolality agents have also largely reduced the risk of serious extravasation injury. In a retrospective review of more than 69,000 nonionic contrast media injections (290–780 mOsm/kg), infiltration rates occurred in as low as 0.7% of patients receiving contrast, with serious complications only occurring in one patient (0.2% of infiltrations). 61 Moderate ulceration can occur on larger (more than 150 ml) extravasations of low osmolality contrast media. Patients with contrast media infiltrations may experience pain on injection of the agent, swelling, edema, and erythema. Severe clinical manifestations, such as blistering and ulcerations, are rare but may often be delayed due to the inflammatory response to the infiltration, peaking at 24–48 hours; hyperalgesia may extend several weeks after the initial extravasation event. 6 Progressive pain, altered tissue perfusion, paresthesias, and blistering may predict a higher severity of injury. Whether to apply warm versus cold compresses to extravasation of nonionic, low osmolality contrast media remains an area of clinical debate. Extravasation has been managed successfully with warm compresses and elevation alone, despite relatively large extravasations and the presence of edema. Warm compresses and elevation may modify the viscosity of the infiltrated contrast, promote vasodilation, and encourage the removal of the contrast media into the circulation. 12 Some institutions endorse the use of cold compresses because they may prevent further inflammation, slow cellular metabolism, provide a degree of discomfort relief, and prevent cellular uptake of the contrast media. Animal studies suggest that cold application has the greatest chance of reducing contrast media ulcerations compared with warm compresses. 62
Is heparin used for intraarteriolar administration?
Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports.
Does dobutamine cause dermal necrosis?
Although known mostly for its chronotropic and inotropic properties as a β 1 -agonist, dobutamine has been reported to cause dermal necrosis on extravasation. 32 The agent does possess a degree of partial α-agonist activity, at around one fortieth the potency of norepinephrine. At high local tissue concentrations, the α 1 -agonism from dobutamine may be responsible for the cases of extravasation necrosis reported. Treatment of dobutamine extravasations remains speculative because reports of successful treatment are few. Terbutaline, as mentioned previously, has been successful for the reversal of a mixed dopamine and dobutamine extravasation. 31 Phentolamine and nitroglycerin remain reasonable treatment options for dobutamine extravasations.
