[ccyoung]

How is toe necrosis managed in your instituitons when it is a result of levophed administration?

chelle

[BULLYDAWGRN]

amputation...

[meandragonbrett]

phentolamine or amputation. Please tell me there was a good reason for levo to be running through a PIV in a foot?

[Diary/Dairy]

I have seen toes get necrotic just from running pressors, not because it was run through the feet.

Amputation is about the only answer - you are using levo to preserve the vital organs......the periphery gets sacraficed.

[meandragonbrett]

Originally Posted by diarygirl512

I have seen toes get necrotic just from running pressors, not because it was run through the feet.

Amputation is about the only answer - you are using levo to preserve the vital organs......the periphery gets sacraficed.

I read the OP wrong. Read it as if the levo had infiltrated.

[Diary/Dairy]

No prob....

[cardiacRN2006]

I've had levo maxed out along with a slew of other pressors and have never seen a necrotic digit because of it.

But I agree, if it's necrotic, it might need to be amputated...

[nurseabc123]

Originally Posted by cardiacRN2006

I've had levo maxed out along with a slew of other pressors and have never seen a necrotic digit because of it.

But I agree, if it's necrotic, it might need to be amputated...

Happens all of the time. Necrotic toes, fingers, even tongues. Honestly, most of these patients die (that I have seen) and the management of necrotic digits really never becomes an issue.

edit: yeah, i forgot to add that these patients are usually septic, hit+, or in dic.

[Diary/Dairy]

I think I have seen necrosis more in septic patients - probably partially due to the DIC-like effect of all the microemboli...

[blueheaven]

Originally Posted by cardiacRN2006

I've had levo maxed out along with a slew of other pressors and have never seen a necrotic digit because of it.

But I agree, if it's necrotic, it might need to be amputated...

I've not seen it very often, but when it happens usually the person is on a totally outrageous dose (far above recommended dose). We have guideliines as far as maxing out on the pressors. We amputated the toes.