ICU pharmacology and drug infusions

IV compatibility, line management and extravasation

Reviewed Nov 2026·2 references
New· views rounded down, updated weekly

Give vasoactives through a dedicated labelled lumen, never Y-site unknown combinations, keep blood, parenteral nutrition and bicarbonate separate, and recognise extravasation early. Peripheral vasopressors are acceptable short-term with a good proximal vein, hourly checks and an extravasation plan.

At the bedside

Timed steps
  1. 1

    Dedicate

    Plan lumens

    Vasopressors/inotropes on one lumen (no boluses); sedation/analgesia on another; PN and blood products separate; label every line at the hub.

  2. 2

    Compatibility

    Check

    Use a compatibility chart before Y-siting; incompatible pairs include furosemide with midazolam or dobutamine, phenytoin with dextrose, pantoprazole with many drugs, ceftriaxone with calcium-containing fluids.

  3. 3

    Safe practice

    Peripheral vasopressor

    Large vein proximal to wrist/antecubital fossa, ultrasound-guided if needed, hourly site checks, plan central access if > 24-48 h or rising dose.

  4. 4

    Act fast

    Extravasation

    Stop infusion, aspirate through cannula, elevate, infiltrate phentolamine 5-10 mg in 10 mL SC; mark area and photograph.

  5. 5

    Product specifics

    Filters & sets

    Amiodarone and GTN in non-PVC or recommended sets; propofol sets changed every 12 h; insulin line primed to saturate binding.

Vasopressor extravasation

Phentolamine

SC infiltration
Dose
5-10 mg in 10 mL NS around the site within 12 h
Red flag · call your senior now
Blanching, coolness or pain at a peripheral vasopressor site.
Pitfall
Flushing a vasopressor line to 'clear' it, giving the patient a bolus.
Pitfall
Running phenytoin in dextrose (precipitates).
Pearl
Cardenas-Garcia 2015: extravasation in 2% of 734 patients receiving peripheral vasoactives, none with tissue injury after phentolamine and nitroglycerin paste.

References

  1. 1

    Kanji S, Lam J, Johanson C, et al. Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Crit Care Med. 2010;38(9):1890-1898

  2. 2

    Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10(9):581-585

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