IV Amiodarone extravasation

[WAheartnurse]

I have noticed that many of our patients that receive amiodarone in a peripheral line have extravasation problems. A lot of patients. I have no ideas on numbers- I asked if we could track it to find out if it was worth making it a central line drug but that was not feasible. BTW it was diluted and given per pharmacy protocols so it was not like we were trying to give it too fast or too strong.

What is your experience?

Many of our patients had to have repeat lines inserted or the amiodarone stopped due to vein problems. Nasty, painful arms from extravasation- nothing permanent but just painful and often changed the course of treatment.

[MendedHeart]

Our MDs order PICC lines prior to IV Amio. We never infuse through a peripheral

[cardiacfreak, ADN]

I've worked telemetry at my hospital for 14 years and we use peripheral lines and I can't say we see a lot of extravasation however we always try to use a 20g catheter instead of a 22g. Personally I think the bolus we use which runs at 600ml/hr for 15 minutes is what causes the extravasation

[martymoose, BSN, RN]

I hate running amio thru a PIV. I feel like I have to watch the line like a hawk. If it does infiltrate, usually I've caught it early enough to have not caused too much trouble. I'd much prefer they have a central line or PICC.

[vera4130]

I think the problem is with less than stellar IVs, the ones that have been put in, backed out, adjusted, and reinserted. Those will blow, it's just a matter of how long. I have to use peripheral IVs every once in a while with Levophed. If the patient has one access and it's works, we use it very carefully until we can get more started. If they have a couple peripherals I'll go through and flush them HARD and see if they still work.

I work in a place where IV access can be difficult to get after hours if we need a central line. It's incredibly frustrating.

[Do-over, ASN, RN]

We use PIVs a lot, especially emergently. I watch them like a hawk, and if I don't have blood return I work on getting new lines.

[ChaseZ]

Just be smart about the PIV you are using. Make sure it has a good blood return and will take a hard flush. If not, start a new one. I hate putting IVs in the AC but if the patient is getting Amio, Dobutrex, etc I will throw an 18 or 20 in the AC or Basilic if possible. There is a big difference between a 22 in the thumb and a 18 in a deep vein.

As much as I love PICCs I do not think they are necessary solely for Amio.

[rnin0513]

If we must do it thru a PIV, we always start an additional line w/an 18g.

[ron27]

we use PIV for amio infusion and we have few cases of extravasation so far.

[IVRUS, BSN, RN]

Amiodarone has a pH of 4.1. So when the vessel breaks down and allows the solution to permeate the SQ tissue, or the catheter erodes through the vessel, tissue necrosis can result, and unfortunately, this may not be readily apparent. (Continued monitoring is a must).

If a were needing to give this med peripherally, USE the smallest gauge IV catheter possible!!!

Why would one put in an 18 g in the ACF???... that is crazy and you are looking for a lawsuit!

An huge 18g will damage the smooth tunica intima of the vein and start the process of phelbitis, thrombus and the vessel breaking down.

I would choose a 22g in the forearm or small 24g in the metacarpal vein before I'd go there! Also if the patient is needing a damaging drug such as this, be proactive and put in a PICC or another type of central line.

The NCBI from the National Institute of Health states,

"extravasation is not uncommon with peripheral vein infusions and care should be taken to minimise the risk of tissue necrosis by only administering amiodarone infusions via a central vein.​"

[lilund27]

We use microfilters on our PIV lines running Amiodarone. It helps but its not 100%

[Stcroix, ASN, PhD, RN]

Yes, been some nasty arms with amiodorone. Still, we run them but I keep an eye on them always. I agree with the use of a small IV, as it does less initial damage.