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Treatments for Norepinephrine Extravasation

Extravasation is a term used for infiltration of IV fluids or medication into surrounding tissue rather than the intended vein. Although the mistake is uncommon, when it does occur, it can present both immediate and long-term problems.

Norepinephrine is a vasoconstrictor that stimulates the heart while dilating coronary arteries to increase blood flow. It is known to improve survival rates among patients who have suffered a myocardial infarction.

  1. The Use of Norepinephrine

    • Norepinephrine is used to treat shock and low blood pressure (hypotension) usually resulting from an accident, medical treatment or surgery. It is commonly used during emergency situations when the administration of CPR is required. Norepinephrine is contraindicated for breastfeeding mothers, pregnant women and those suffering from asthma or high blood pressure.

    Dangers of Norepinephrine Extravasation

    • Extravasation can cause pain, skin inflammation and swelling; result in skin blisters or ulcers; and inhibit or negate the use of the site in future venous usage. It severe cases, it can result in destruction of healthy tissue and nerve or joint damage that may require surgical intervention ranging from removal of dead tissue to complete amputation. At its worst, extravasation causes permanent deformity or can even result in death.

      Because norepinephrine constricts the veins, its extravasation presents additional dangers. It can easily result in vein leakage or permanent damage to the vein wall, which could render the vein temporarily unusable or result in its complete destruction. The use of norepinephrine can also result in decreased heart rate (bradycardia), heart attack, insufficient blood flow, tissue necrosis and vascular stroke.

    Signs of Norepinephrine Extravasation

    • Extravasation alone is evidenced by burning and swelling at the IV site. In severe cases it can result in capillary dilatation, infection or hives. Norepinephrine extravasation can present itself through additional symptoms such as aphasia, arrhythmia, chest or back pain, confusion, convulsions, difficulty breathing, dizziness, headache, loss of balance, nausea, numbness, sweating, unexplained weakness and vomiting.

    Treating a Norepinephrine Extravasation

    • A few timely steps can prevent permanent damage, if norepinephrine extravasation is discovered quickly. These include discontinuing the IV, assessing the injection site for tissue breakdown and contacting a physician for treatment orders. Moist compresses, applied to the site may also be helpful in certain situations, but should not be done without the physician's approval. Whenever possible, the injection site should be elevated.

      Norepinephrine extravasation must be treated within 12 hours in order for it to be effective. The area, including the injection site and surrounding tissues, should be injected with 5 and 10 mg of phentolamine diluted in 10 to 15 mL of saline solution. Phentolamine offers resistance to block norepinephrine from causing skin, tissue and vein damage.

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