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This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

PHENTOLAMINE

Management of Extravasation Injuries

PLEASE NOTE THAT THERE ARE 2 PROTOCOLS

  1. Management of Non-vasoactive medications: HYALURONIDASE.
  2. Management of vasoactive medications: PHENTOLAMINE

Indication

  • the management of IV extravasations (leakage of an IV fluid out of a vein and into surrounding tissue)
  • for the management of extravasation due to vasoactive medications (eg. dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine)

Pharmacology

  • competitively blocks alpha - adrenergic receptors, thereby producing brief antagonism of circulating epinephrine and norepinephrine
  • this causes relaxation of vascular smooth muscle and the development of a hyperemic response (increase of blood flow)
  • phentolamine also stimulates beta adrenergic receptors and produces a positive inotropic (force of contraction) and chronotropic (rate) effect on the heart

Side Effects

  • CDV: hypotension, tachycardia, cardiac arrhythmias
  • GI: vomiting, diarrhea,
  • other: nasal congestion

Warning

  • use with caution in patients with renal impairment or gastritis

Dose

  • Add 1.8 mL sterile water to 0.2 mL of 5 mg/mL phentolamine

    FINAL CONCENTRATION=1 mg/2mL
     =0.5 mg/mL

  • infiltrate the area of extravasation with multiple small injections of the 0.5 mg/mL solution
  • use a 27g or smaller needle and change needles between each skin entry
  • do not inject a volume such that swelling of the area occurs
  • it has been suggested that a dose of 0.1 mg/kg (ie. 0.2 mL/kg of the 0.5 mg/mL solution) not be exceeded

Monitoring

  • blanching should reverse immediately
  • monitor site of extravasation closely; additional injections of phentolamine may be necessary

Treatment of Overdose

  • main clinical manifestations are hypotension, tachycardia, cardiac stimulation, and arrhythmias
  • norepinephrine (initial dose: 0.05 to 0.1 mcg/kg/min, then cautiously titrated in a continuous IV infusion to a maximum of 1 to 2 mcg/kg/min), is the pharmacological antagonist
  • do NOT use ephinephrine; this may cause a further fall in blood pressure

Supplied

  • 5 mg / mL, 1 mL ampoule
  • kept in refrigerator
  • trade name is "Rogitine(R)"

References

  1. "Rogitine" package insert, CIBA, Missauga, Ontario (P4824943)
  2. Flemmer L and Chan JSL : A pediatric protocol for management of extravasation injuries, Pediatric Nursing 1993; 19 : 355-8, 424.
  3. "Phentolamine" in Taketomo CK, Hodding JH and Kraus DM : Pediatric Dosing Handbook, 1998-99, 5th Edition, American Pharmaceutical Association.
  4. "Phentolamine" in American Hospital Formulary Service, American Society of Health System Pharmacist, Bethesda,MD,1996.



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