Skin Necrosis after a Low-Dose Vasopressin Infusion through a Central Venous Catheter for Treating Septic Shock

Abstract

This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter.

Risk Factors of Vasopressor-Induced Symmetrical Peripheral Gangrene

“…When needed, skin microcirculation should be assessed using noninvasive techniques, such as capillaroscopy, laser Doppler flowmeter, and transcutaneous measurement of oxygen tension, because the condition can progress rapidly. 16 Preoccupation with distal ischemic changes should be avoided and attention should be focused on correcting the underlying cause(s) of ischemic phenomenon. 17 Up to date, there is no relevant consensus for treatment of SPG.…”

Retiform purpura and ischemic limb gangrene with pulses

“…In our case, the focal facial skin infection was very likely the cause of the toxic shock syndrome (TSS) and the resultant DIC, which subsequently led to shock, microvascular thrombi in various organs, retiform purpura, and dry gangrene in the limbs [3,4]. Furthermore, the vasoconstriction due to multiple vasopressors may have aggravated the development of ischemic necrosis and limb gangrene [5].…”

Comparing the effect of arginine vasopressin on ear and finger photoplethysmography

“…Ventricular arrhythmias and skin necrosis [12,13] have been described during administration of intrauterine AVP, but none of our patients in this study showed evidence of circulatory or skin compromise.…”