UMEM Educational Pearls

Category: Critical Care

Title: Vasopressor extravasation

Keywords: norepinephrine, epinephrine, epinephrine, dopamine, phentolamine (PubMed Search)

Posted: 8/26/2008 by Mike Winters, MD (Updated: 10/22/2020)
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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