Extravasation and tissue necrosis secondary to central line infusions

A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters

“…Of the 325 events of tissue injury or vasopressor extravasation that occurred with vasopressor administration, 7 events resulted from administration via CVCs. These included 4 [5,16,18,76] local tissue injury events and 3 [28,67] extravasation of vasopressor solution events. Of the 4 local tissue injury events reported, 3 were of skin necrosis and 1 of gangrene.…”

“…The κ statistic for agreement between reviewers for the final inclusion of papers based on full references was 0.773. Of the 85 included references, 80 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][23][24][25][26][27][28][29][30][31][32][33][34][35]66, presented individual data and were made up of case studies and case series, while 5 [22,36,65,67,89] presented aggregate data and included 1 [67] randomized controlled trial and 4 [22,36,65,89] case series. None of these studies directly compared the administration of vasopressors via central or peripheral catheters with rates of tissue ischemia or extravasation.…”

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

“…61,114,159 Extravasation with no skin necrosis occurred in two cases, and skin necrosis with no extravasation occurred in two cases. Site of administration was internal jugular in one case and femoral in another (other articles did not report site).…”

Monitoring central venous pressure: a survey of British intensive care units

“…Catheter migration resulted in these being delivered subcutaneously with the patient dying after unexpected cardiac arrest. Davies et al [5] describe a case where extravasation of adrenaline lead to skin necrosis requiring a pectoralis major muscle flap to cover the defect.…”

“…It may result in the infusion of fluids or drugs in to the pleural space [2,3] or subcutaneously [4,5]. Bolton [4] reported a case where inotropes were administered via the proximal lumen of a CVC.…”