Extravasation
Because severe local adverse effects may occur, extravasation of norepinephrine must be avoided.b
The site of infusion should be checked frequently for free flow and the infused vein should be observed for blanching.b
Risk of tissue damage is apparently very slight if infused through a plastic catheter deep into an antecubital vein.b
Avoid injection into leg veins, especially in geriatric patients or those with occlusive vascular diseases, arteriosclerosis, diabetes mellitus, or Buerger's disease.b
If blanching is observed in the infused vein or if therapy is to be prolonged, changing the injection site periodically may be advisable.b
Extravasation Treatment
If extravasation occurs, 10-15 mL of sodium chloride solution containing 5-10 mg of phentolamine mesylate should be infiltrated (using a syringe with a fine hypodermic needle) liberally throughout the affected area, which is identified by a cold, hard, and pallid appearance.b
當發生外滲時，可以給予5-10mg的phentolamine配在10-15mL的生理食鹽水中，給予表層注射，並在外滲部位冰敷。
Immediate and conspicuous local hyperemic changes occur if the area is infiltrated within 12 hours, but such treatment is ineffective when given >12 hours after extravasation; therefore, phentolamine should be administered as soon as possible after extravasation is noted.b
Addition of 5-10 mg of phentolamine to each L of infusion fluid containing norepinephrine may prevent sloughing of tissue, if extravasation occurs, without altering the pressor effects of norepinephrine; however, IV injection of phentolamine is not an effective antidote after extravasation has occurred.b
In severe hypotension after MI: Thrombosis in the infused vein and perivenous reactions and necrosis may be prevented by adding enough heparin to the norepinephrine infusion to supply 100-200 units of heparin per hour.b
藥師應monitoring的點:
(1) Peripheral circulation (extremities)---->是否ischaemia(黑掉)
(2) extravasation (Infusion site):注射部位外滲
(3) Blood pressure
(4) ECG/pulse
(5) arrhythmias患者小心hypercapnia和hypoxia
reference
b. AHFS drug information 2004. McEvoy GK, ed. Norepinephrine. Bethesda, MD: American Society of Health-System Pharmacists; 2004:1270-3.
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