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Peripheral vasopressor extravasation — FRCA Final MCQ

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HardICUPeripheral vasopressor extravasationFRCA Final

A 61-year-old man is intubated for severe community-acquired pneumonia. He is deeply sedated and receives vasopressors. On day four he has positive blood cultures, a swollen cool right hand around a peripheral noradrenaline cannula, and blistering at the insertion site. What is the most likely cause of the complication?

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Correct answer: B — Peripheral vasopressor extravasation causing local ischaemia

A cool swollen hand with blistering around a peripheral noradrenaline cannula suggests vasopressor extravasation and local ischaemia. Embolus is possible but the cannula-site changes and vasopressor infusion make extravasation the best answer. Contact dermatitis would not cause a cool threatened hand. Management includes stopping the infusion, aspirating through the cannula where possible, limb elevation, antidote/local protocol and urgent plastic or vascular review if severe.

Reference: NICE sepsis guidance NG253; Faculty of Intensive Care Medicine vasopressor safety guidance