Possible Dopamine Infiltration - what to do?

[KaraAnne]

Recently in our ICU, we received a patient from cath lab. The patient arrived during the day shift at 4pm. According to the day shift RN, the patient arrived with a dopamine bag hanging, not connected to any of the patient's IVs. The right arm was swollen around the IV AC site and a moderate size bruise at AC site. The cath lab nurse charted the dopamine was infusing to the PIV in the left hand and NS was infusing to the right AC that had possibly infiltrated, so that PIV was d/c'd at 2pm, cardiologist notified, and no new orders. The PIV in the left hand was intact and only slight red. Our day shift RN (who is new to critical care) seemed to think that the dopamine possibly could have be infusing through the RAC PIV. Soon after arival to the unit, the patient soon began to complain of pain in her right hand. Only a pain med was ordered for the patient.

As the day progressed into night, the patient's right arm became very tight and the bruise enlarged, extending from the inner mid-bicep to the inner mid-forearm. Her hand became severely mottled and the patient continued complained of pain in her hand. However, the patient had a +2 radial pulse. The patient was unable to localize pinprick stimuli from the mid-forearm down. Around the AC site, the skin looked translucent from what I could see through and around the bruise.

After multiple new MD consults were done over the phone, the possibility of compartment syndrome was discussed. Our hospital only has one MD in house at night and a teleICU physician that is located in another city. The vascular surgeon spoke with the hospitalist over the phone and looked at pics the hospitalist sent him. The vascular surgeon decided/agreed that regitine should be administered to the right arm around the site as we were quickly closing in on our 12hr deadline (it was 11pm) for administration of regitine. He also requested an US, arterial and venous, in the morning and an ACE wrap around the entire arm. About 2 hours after the regitine was administered, the patient stated the pain in her right hand had eased but not resolved completely, and the amount of tightness in the right arm decreased slightly.

The cath lab maintained their story that the dopamine was infusing to the left hand (not the RAC) - which is a problem in itself. Does anyone have any information on the administration of regitine into an area without any dopamine infiltration? Any comments or thoughts are welcome.

Just a side note, I have personally received two separate patients from our cath lab with a dopamine infiltration without any communication of the event from the cath lab team. However, in those instances, I was able to administer the regitine in a more timely fashion.