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Phentolamine for vasopressor extravasation
I was recently informed of a case from an another institution in which a patient was started on a vasopressor medication via a peripheral IV while attempts at central access where attempted. The patient unfortunately suffered permanent extremity ischemia due to significant extravasation of the vasopressor medication into the soft tissue.
- Phentolamine is reportedly the antidote for vasopressor extravasation into the skin and soft tissues (the evidence is not robust and limited primarily to case reports and animal data)
- Phentolamine is a non-specific alpha-blocking agent that inhibits vasoconstriction and theoretically improves blood flow through the affected area
- Take 5-15 mg of phentolamine and mix in 10 mL of normal saline - inject this into the affected area as soon as possible
- Give the patient concurrent IVFs in the event of some systemic absorption