Hypothesis: To estimate the risk of skin damage requiring medical/surgical intervention after accidental dilute norepinephrine extravasation (20 ug/ml) through peripheral IV lines.
Methods:
179,811 total cases undergoing general anesthesia reviewed at 2 sites in the Netherlands. 14,385 patients required a NE infusion through a PIV
Diagnosis of extravasation was made by faculty anesthesiologists, nurse anesthetists, or PACU nurses who were then required to file an adverse event report
Once an extravasation event was identified, a score was assigned to the infusion-related reaction
Results: Only 5 out of 14,385 patients receiving a NE infusion via PIV experienced extravasation. None of the patients required medical or surgical intervention or had permanent skin damage. The estimated risk of extravasation was 1-8 events per 10,000 patients.
Strengths:
Clinically relevant question
Large sample size
Reporting encouraged from multiple providers
Grading system of extravasation
Generalizability - No exclusion criteria
Weaknesses:
Results dependent upon incident reporting
Retrospective
Patient care in Netherlands may differ from other countries
Peripheral NE used much more commonly in Europe
Average BMI 24
More dilute NE concentration used than at other institutions
Key Point: Infusion of NE via a PIV is associated with a very low risk of serious complications.