From the Guidelines
Calcium Chloride administration through a Peripheral Intravenous (IV) line is not recommended due to the risk of severe tissue injury from infiltration.
Key Considerations
- The administration of calcium chloride via a central venous catheter is preferred to minimize the risk of tissue injury 1.
- If a central venous catheter is not available, calcium gluconate can be infused through a secure peripheral IV as an alternative 1.
- The use of calcium chloride through a peripheral IV line requires caution and careful monitoring to prevent hypercalcemia and tissue injury 1.
- A secure peripheral venous access is necessary if calcium chloride is to be administered through a peripheral IV line, as emphasized in the management of calcium channel blocker poisoning in adults 2.
Administration Guidelines
- If calcium chloride is administered through a peripheral IV line, the dose should be 20 mg/kg (0.2 mL/kg) of 10% calcium chloride intravenously over 5 to 10 minutes, with monitoring of serum ionized calcium concentration to prevent hypercalcemia 1.
- For continuous infusion, the dose can range from 20 to 50 mg/kg per hour, depending on the clinical response and serum calcium levels 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 10% Calcium Chloride Injection, USP is administered only by slow intravenous injection (not to exceed 1 mL/min), preferably in a central or deep vein.
The administration of Calcium Chloride through a Peripheral Intravenous (IV) line is not recommended as the preferred route is a central or deep vein. However, it does not explicitly state that it is unsafe to administer through a peripheral IV line, but it does advise precautions for intravenous therapy should be observed. Given the information, the safest approach would be to avoid using a peripheral IV line if possible, due to the potential for local "burning" sensation and perivascular infiltration as mentioned in 3.
From the Research
Safety of Calcium Chloride Administration through Peripheral IV Line
- The administration of calcium chloride through a peripheral intravenous (IV) line has been evaluated in several studies, with varying results 4, 5, 6, 7.
- A retrospective study published in 2022 found that the administration of 10% calcium chloride via peripheral venous catheters may be feasible and carries a low incidence of documented complications, with only 6% of patients experiencing infusion-related adverse events 4.
- However, another study published in 2007 reported cases of skin necrosis after intravenous calcium chloride administration, highlighting the importance of administering the solution into large veins or via a central line, and diluting it in an appropriate volume of solution 5.
- A study published in 2014 found that compounded calcium chloride admixtures for peripheral intravenous administration were associated with a low incidence of IV infusion site reactions, with only 1.8% of patients experiencing moderate to severe reactions 6.
- The use of calcium chloride for emergency treatment of hyperkalaemia has also been discussed, with some studies suggesting that the dose should be given in terms of mmol/L or mEq or mg of calcium ions to minimize the risk of error 8.
- Overall, the safety of calcium chloride administration through a peripheral IV line depends on various factors, including the concentration of the solution, the rate of administration, and the patient's individual characteristics 4, 5, 6, 7.
Factors Affecting Safety
- Concentration of the solution: Higher concentrations of calcium chloride may increase the risk of infusion-related adverse events 4, 5.
- Rate of administration: Rapid administration of calcium chloride may increase the risk of infusion-related adverse events 4, 5.
- Patient characteristics: Patients with certain medical conditions, such as renal failure, may be at higher risk of infusion-related adverse events 5.
- Administration technique: Administering the solution into large veins or via a central line, and diluting it in an appropriate volume of solution, may reduce the risk of infusion-related adverse events 5.