EXTRAVASATION INJURY ASSOCIATED WITH LOW-DOSE DOPAMINE

OBJECTIVE: TO describe the occurrence of extravasation in two patients receiving low-dose dopamine infusions. CASE SUMMARY: Intravenous dopa mine was infused peripherally tin the antecubital fossa) to two patien ts in the cardiac intensive care unit in an attempt to enhance renal b lood perfusion and urine output. Dopamine extravasation occurred in bo th patients while the low dose (<3 mu g/kg/min) was infused. Significa nt local tissue injury was observed in both patients, DISCUSSION: Dopa mine infusion can cause tissue ischemia or necrosis secondary to vasos pasm and extravasation. Most of the case reports in the literature hav e occurred when relatively high doses of dopamine were infused. Only o ne reported extravasation-induced injury with low-dose dopamine. Altho ugh low-dose dopamine has a vasodilatory effect in selected tissues, h igh concentrations achieved locally as a result of extravasation can s till cause severe vasoconstriction and ischemic tissue injury. CONCLUS IONS: Low-dose dopamine therapy should be administered with similar pr ecautions as high-dose dopamine. A central intravenous access should b e placed for dopamine infusion whenever possible. If this approach is not feasible, dopamine should be infused only peripherally through a l ong intravenous catheter into a large vein. A 5-cm angiocatheter that is 20 gauge or larger is recommended for peripheral dopamine infusion in our institution. The infusion site should be inspected frequently f or early detection of extravasation, and changed to a central or a per ipherally inserted central catheter as soon as possible, especially in patients at high risk for extravasation.