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Phentolamine Mesylate

Regitine

Phentolamine mesylate (Regitine) is an antihypertensive agent useful in the treatment of vasopressor


extravasation to avoid or minimize necrosis.

USE
Treatment of Peripheral Extravasation

Criteria for installation of Regitine:


• Patients with confirmed extravasation of sympathomimetic agents: especially dopamine, dobutamine,
epinephrine and norephinephrine, as they can cause tissue necrosis and/or tissue sloughing.
• Initiate treatment as soon as possible after discovery of extravasation - preferably within 12 hours. A
physician's order is required.
• Performed by Critical Care RN, IV RN, ED RN, or Intermediate Care RN using aseptic technique.
Equipment: (2) 5 mg vials phentolamine
5 to 20 mls normal saline
3 ml syringe
10 ml syringe
(4 to 6) 25 gauge needles (5/8")
Alcohol prep pads
1 package sterile 4"x4"s
1" tape
Procedure for IV site extravasation:
1. Explain procedure to patient.
1. Dilute phentolamine with normal saline (1 mg/ml). Amount will depend on extent of
extravasation.
1. Disconnect IV tubing from hub of catheter. Attempt to aspirate infiltrated medication. Quantity, if
any, will be small.
1. Slowly instill 1/3 ml phentolamine via IV catheter. Monitor BP during procedure.
1. Using 25-gauge needle, start at the outer edge of the affected area and infiltrate phentolamine
subcutaneously, following a clock-like pattern, working inward. Change needles after 2 or 3 sites.
Gently prep sites. Try to cover all areas of the extravasation; vary depth of the injections.
(Maximum of 10 mg total dose)
1. Remove IV catheter; apply gauze dressing. Document in IV assessment
1. Assess site frequently during the next 12 to 24 hours and once a shift for 72 hours. Check for signs
and symptoms of tissue necrosis.
2. Document the site assessment, intervention and response. Document in integumentary assessment
3. Patient's blood pressure should be monitored during and after procedure.

Procedure for digit extravasation such as from an Epipen stick:


1. Dilute 5 mg phentolamine vial with 1ml normal saline to make 5mg/ml concentration
2. Mix 0.5ml (2.5mg phentolamine) with 0.5 ml of 1% lidocaine to make a 2.5mg/ml concentration
3. Average dose is 1-2 mg to treat Epipen extravastion of digit
4. Inject into puncture site or multiple sites
5. Immediate hyperemia signals success of treatment

Reference:
1. MICROMEDEX® Healthcare Series1974-2010 Thomson Healthcare.
2. (drug insert)
3. Emergency Medicine News: Volume 27(3) March 2005 p50

Approved by P&T 10/2010