What are the considerations for Calcium Chloride infusion via peripheral intravenous (IV) line?

From the Guidelines

Administration of calcium chloride through a peripheral intravenous (IV) line is generally not recommended due to the risk of tissue injury and thrombophlebitis 1. However, in emergency situations, calcium chloride can be administered peripherally at a dose of 20 mg/kg (0.2 mL/kg) of 10% calcium chloride over 5 to 10 minutes, followed by a potential infusion of 20 to 50 mg/kg per hour if a beneficial effect is observed 1.

Key Considerations

• It is essential to monitor serum ionized calcium concentration to prevent hypercalcemia 1.
• A central venous catheter is the preferred route for calcium chloride administration, but if not available, a secure peripheral IV can be used with caution 1.
• The IV site should be closely monitored for signs of complications, such as infiltration or thrombophlebitis.
• In cases where peripheral administration is necessary, it is crucial to use a large vein, such as the antecubital fossa, to minimize the risk of complications.

Dosing and Administration

• The dose of calcium chloride for peripheral administration is 20 mg/kg (0.2 mL/kg) of 10% calcium chloride over 5 to 10 minutes 1.
• The infusion rate can be titrated to 20 to 50 mg/kg per hour based on the patient's response and serum ionized 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. Should perivascular infiltration occur, I.V. administration at that site should be discontinued at once.

The considerations for Calcium Chloride infusion via peripheral intravenous (IV) line are:

• Preferably administered in a central or deep vein to minimize the risk of perivascular infiltration and local reactions 2
• Slow injection (not to exceed 1 mL/min) to reduce the risk of adverse reactions such as tingling sensations, calcium taste, and local "burning" sensation 2, 2
• Monitor for signs of perivascular infiltration and discontinue administration at the site if it occurs 2
• Risk of local reactions, including peripheral vasodilatation, "burning" sensation, and moderate fall in blood pressure 2

From the Research

Considerations for Calcium Chloride Infusion via Peripheral Intravenous (IV) Line

• The administration of calcium chloride via peripheral IV line has been evaluated in several studies, with a focus on its safety and feasibility 3, 4.
• A retrospective chart review of 72 administrations of 10% calcium chloride via peripheral venous catheters found a low incidence of infusion-related adverse events (6%), with no permanent tissue injury or serious complications 3.
• Another study of 222 patients who received compounded calcium chloride admixtures for peripheral IV administration found a low incidence of infusion site reactions (1.8%), with most reactions being mild or moderate 4.
• However, a case report of four patients who developed skin necrosis after IV calcium chloride administration highlights the potential risks of extravasation and the importance of proper administration techniques 5.
• The use of calcium chloride via peripheral IV line is generally not recommended, except in emergency situations where central access is not available, and should be done with caution and close monitoring 6.
• When administering calcium chloride via peripheral IV line, it is essential to use a large vein, dilute the solution in an appropriate volume, and monitor the patient for signs of infusion-related adverse events 5, 6.
• The choice of flushing and locking solution for peripheral IV access devices may also impact the safety and effectiveness of calcium chloride administration, with preservative-free 0.9% sodium chloride being a potential alternative to heparin saline solution 7.