management of digital (toe) necrosis due to levophed

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

chelle

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Specializes in ICU/ER/TRANSPORT.

amputation...

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

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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.

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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.

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No prob....

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Specializes in Cardiac.

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...

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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.

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

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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.

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

Me too. I have seen it tons of times in DIC, but never r/t levo...

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Have you ever heard the saying, "levophed, leave them dead." I know it sounds harsh. The reason for this saying is because of the degree of constriction levophed causes to maintain blood pressure. It increases the svr so dramatically to ensure the blood is perfusing the heart/brain/etc. The first things that show the effect of this "clamping down" are the fingers, toes, earlobes. I have even seen the tip of a nose become cyanotic due to levophed. The pt. is obviously very sick if he/she requires high doses of levphed and may also be on other pressors such as neo, vasopressin or epi gtts. It is not unusual for a pt. that requires high doses of levophed to have necrotic digits, thus amputations.

:balloons:

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