Evaluation of Vasoactive Medication Extravasation Management at a Large Academic Medical Center

Introduction: Extravasation is a known complication of peripheral administration of intravenous (IV) and, to a lesser extent, intraosseous (IO) medications. Although central access is preferred, vasoactive medications may be initiated peripherally to provide urgent hemodynamic support. When extravasation occurs, prompt treatment with phentolamine may reduce ischemia and necrosis of the surrounding tissue. Phentolamine administration is often delayed and need for surgical management is not well described. The purpose of this study is to describe the management of vasoactive medication extravasation and characteristics of patients who experience this event.


Methods: This was a single-center, retrospective analysis of patients with a consult to the burn service for vasoactive medication extravasation between 7/1/2024 and 12/31/2024. The primary endpoint is to characterize overall treatment of extravasation. Secondary endpoints include number/types of surgical interventions required, time to surgical intervention, time to phentolamine administration, and location of extravasation.


Results: Thirty-nine patients were included in this study. Median age was 64 years (IQR 56.5-72), 64.5% were female, and median SOFA score within 24 hours of extravasation was 8 (IQR 5.5-12). Most patients (56.4%) were admitted to the medical intensive care unit (ICU) at time of extravasation followed by burn/trauma (12.8%), neuro (12.8%), cardiac (7.7%), surgical (5.1%), and pediatric (2.6%) ICUs. One patient (2.6%) experienced an extravasation intraoperatively. Extravasations occurred from a peripheral IV (94.9%), central venous catheter (2.6%), and IO (2.6%). Two (5.1%) patients did not receive phentolamine and one (2.6%) had an undocumented administration time. Median time from extravasation to phentolamine was 150 minutes (IQR 83-239). Only one patient (2.6%) who did not receive phentolamine required surgical intervention.


Conclusions: Phentolamine was administered shortly after recognition of vasoactive medication extravasation in most patients. One patient required surgical intervention and did not receive phentolamine which supports the importance of prompt antidote administration. More than half of the patients were admitted to the medical ICU which requires further investigation into specific risk factors in this population.