From the FDA Drug Label
To prevent sloughing and necrosis in areas in which extravasation has occurred, infiltrate the ischemic area as soon as possible, using a syringe with a fine hypodermic needle with 5 to 10 mg of phentolamine mesylate in 10 to 15 mL of 0. 9% Sodium Chloride Injection in adults.
The agent beneficial for peripheral vein damage after noradrenaline (norepinephrine) injection is phentolamine mesylate. It is used to prevent sloughing and necrosis in areas where extravasation has occurred, by infiltrating the ischemic area with 5 to 10 mg of phentolamine mesylate in 10 to 15 mL of 0.9% Sodium Chloride Injection in adults 1.
From the Research
Peripheral Vein Damage after Noradrenaline Injection
- The risk of extravasation should be taken into account when administering noradrenaline (norepinephrine) peripherally, with phentolamine being the first pharmacological line of treatment 2, 3.
- Phentolamine is used to treat extravasation injuries caused by vasopressors such as noradrenaline 4.
- Historically, intradermal phentolamine has been the preferred agent for vasopressor extravasations, but frequent supply shortages have led to the emergence of terbutaline, a β2-agonist, as an acceptable alternative treatment option 4.
- The use of peripheral noradrenaline in children seems to be carried out without obvious complications, and the incidence of thrombophlebitis, cellulitis, tissue necrosis, limb ischemia, and gangrene appears to be low 2, 3.
- Peripheral administration of noradrenaline may be a safe alternative during surgery, if the drug is administered correctly 5.
Management of Extravasation Injuries
- Extravasation management is largely supportive and requires a protocolized multidisciplinary approach for early detection, treatment, and timely surgical referral when required to minimize adverse events 4.
- Pharmacological antidotes may be useful in select extravasations but require prompt recognition and frequently complex administration strategies 4.
- Hyaluronidase is most commonly used to facilitate absorption and dispersion of injected agents for hyperosmolar and pH-related mechanisms of injuries 4.
Safety of Peripheral Norepinephrine Administration
- Implementing a protocol for peripheral administration of norepinephrine can safely avoid central venous catheter (CVC) use and reduce the frequency of CVC placement 6.
- The incidence of extravasation events with peripheral norepinephrine administration is relatively low, and most extravasations cause no or minimal tissue injury 6.