What is the treatment for pressor (pressure) IV (intravenous) extravasation?

Treatment for Pressor IV Extravasation

For pressor (vasopressor) extravasation, inject 5-10 mg of phentolamine diluted in 10-15 mL of saline into the extravasation site as soon as possible to prevent tissue necrosis and sloughing. 1, 2

Immediate Management Protocol

1. Stop the infusion immediately when extravasation is suspected
2. Leave the IV catheter in place initially
3. Aspirate as much of the extravasated solution as possible through the cannula
4. Administer phentolamine:
   • Dose: 5-10 mg diluted in 10-15 mL of saline
   • Route: Inject into the area of extravasation
   • Timing: Should be administered within 12 hours of extravasation, but sooner is better 2

Mechanism of Action

Phentolamine is an alpha-adrenergic antagonist that counteracts the intense vasoconstriction caused by vasopressors like norepinephrine, epinephrine, and phenylephrine. By blocking alpha receptors, it promotes vasodilation, restores blood flow to the affected tissue, and prevents ischemic necrosis 1.

Additional Supportive Measures

• Apply warm compresses to promote vasodilation (15-20 minutes every 4 hours for 24-48 hours) 3
• Elevate the affected limb to reduce swelling
• Administer analgesia as needed for pain control
• Document the incident thoroughly, including:
  • Patient identification
  • Date and time of extravasation
  • Name of drug extravasated
  • Signs and symptoms
  • Description of IV access
  • Extravasation area and approximate amount
  • Management steps taken 1

Follow-up Care

• Monitor the extravasation site regularly (daily or every 2 days during the first week)
• Continue monitoring until complete resolution of symptoms
• Watch for signs of progressive tissue damage: increased redness, edema, pain, blistering, or necrosis 1
• Consider surgical consultation if there is evidence of tissue necrosis or persistent pain

Risk Factors for Vasopressor Extravasation

Vasopressor extravasation is more common with:

• Peripheral IV administration (versus central venous access)
• Prolonged infusion duration
• Distal IV sites (hands, wrists, feet) 4
• High concentration of vasopressor solution

Prevention Strategies

• Use central venous access for vasopressor administration whenever possible
• If peripheral administration is necessary, use large veins in the forearm
• Avoid IV sites over joints, wrist, or dorsum of hand
• Monitor IV site frequently for signs of infiltration
• Consider adding phentolamine to vasopressor solutions (10 mg per liter) as a preventive measure 2

Common Pitfalls to Avoid

• Delaying treatment after extravasation is recognized
• Applying pressure to the extravasation site, which can worsen tissue damage
• Using cold compresses for vasopressor extravasations (warm compresses are preferred)
• Failing to document the incident properly
• Inadequate follow-up monitoring

The evidence strongly supports immediate intervention with phentolamine for vasopressor extravasation, as this can significantly reduce the risk of tissue necrosis and long-term complications that would negatively impact patient morbidity and quality of life 1, 2, 5.