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miércoles, 7 de septiembre de 2016

Peripheral vasopresors

PulmCrit - September 7, 2016 by Josh Farkas
"Until recently I believed that prolonged vasopressor administration requires a central line, to avoid extravasation. I lumped together all vasopressors, treating them all as equal. I used the occurrence of an extravasation reaction fromone vasopressor as evidence that all vasopressors could cause extravasation reactions (the fallacy of inappropriate generalization). Upon closer examination, these beliefs aren’t supported by evidence (1)..."

  • It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line. However, available evidence doesn’t support this.
  • Concentrated solutions of epinephrine and phenylephrine are safe for subcutaneous administration, suggesting that extravasation of diluted solutions into the skin should be tolerated.
  • There are no reports of skin necrosis following extravasation of phenylephrine or epinephrine infused into the arm.
  • It may be safe to infuse peripheral phenylephrine or epinephrine for days, with the use of a simple protocol to avoid extravasation injury.
  • The risks versus benefits of central line insertion should be considered on an individual basis, rather than assuming that every patient on a vasopressor requires central access.