{
  "id": "medical/iv-dobutamine-extravasation",
  "signature": "AI instructs administration of dobutamine through a peripheral IV without monitoring for extravasation, ignoring risk of tissue necrosis",
  "signature_zh": "AI指示通过外周静脉输注多巴酚丁胺而不监测外渗，忽略组织坏死风险",
  "regex": "(?i)(dobutamine|dobutrex).*(peripheral|PIV|IV site|extravasation|infiltration).*(safe|okay|fine|no need)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Dobutamine is a vesicant catecholamine; extravasation can cause severe local vasoconstriction, ischemia, and tissue necrosis requiring surgical debridement. Guidelines mandate administration via central line or peripherally inserted central catheter (PICC) for infusions >6 hours or concentrations >2 mg/mL. Peripheral IV is only acceptable for short-term (<6h) infusion with strict monitoring every 30 minutes.",
  "root_cause_type": "generic",
  "root_cause_zh": "多巴酚丁胺是发疱性儿茶酚胺类药物；外渗可导致严重的局部血管收缩、缺血和组织坏死，需手术清创。指南要求通过中心静脉或经外周中心静脉导管（PICC）输注，若输注时间>6小时或浓度>2 mg/mL。外周静脉仅可接受短期（<6小时）输注，且需每30分钟严格监测。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Suggesting that diluting dobutamine to a lower concentration reduces extravasation risk enough for peripheral use",
      "why_fails": "Dilution reduces but does not eliminate risk; even low doses can cause vasoconstriction if extravasation occurs. Central access is still recommended for prolonged infusions.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "Telling staff to 'just watch the site' without a formal monitoring protocol",
      "why_fails": "Extravasation can occur silently; without scheduled checks (every 30 min for peripheral, every hour for central), early signs may be missed, leading to severe injury.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "Recommending use of a butterfly needle for short-term dobutamine infusion",
      "why_fails": "Butterfly needles are rigid and increase risk of vessel puncture and extravasation; a short peripheral catheter (18-20G) is preferred if peripheral is unavoidable.",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "For dobutamine infusion >6 hours or concentration >2 mg/mL: insert a central line (subclavian, IJ, or PICC). For short-term peripheral use (<6h, <2 mg/mL): use a 20G or larger catheter in a large vein (antecubital, forearm), secure well, and check site every 30 minutes for pallor, swelling, or pain. Document site condition hourly.",
      "success_rate": 0.9,
      "how": "For dobutamine infusion >6 hours or concentration >2 mg/mL: insert a central line (subclavian, IJ, or PICC). For short-term peripheral use (<6h, <2 mg/mL): use a 20G or larger catheter in a large vein (antecubital, forearm), secure well, and check site every 30 minutes for pallor, swelling, or pain. Document site condition hourly.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If extravasation is suspected: stop infusion immediately, disconnect IV, elevate extremity, apply warm compress (not cold, as cold worsens vasoconstriction), and administer phentolamine 5-10 mg diluted in 10 mL saline subcutaneously around the extravasation site within 12 hours. Notify provider and document.",
      "success_rate": 0.85,
      "how": "If extravasation is suspected: stop infusion immediately, disconnect IV, elevate extremity, apply warm compress (not cold, as cold worsens vasoconstriction), and administer phentolamine 5-10 mg diluted in 10 mL saline subcutaneously around the extravasation site within 12 hours. Notify provider and document.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "For dobutamine infusion >6 hours or concentration >2 mg/mL: insert a central line (subclavian, IJ, or PICC). For short-term peripheral use (<6h, <2 mg/mL): use a 20G or larger catheter in a large vein (antecubital, forearm), secure well, and check site every 30 minutes for pallor, swelling, or pain. Document site condition hourly.",
    "If extravasation is suspected: stop infusion immediately, disconnect IV, elevate extremity, apply warm compress (not cold, as cold worsens vasoconstriction), and administer phentolamine 5-10 mg diluted in 10 mL saline subcutaneously around the extravasation site within 12 hours. Notify provider and document."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.ins1.org/ins-standards-of-practice/",
  "official_doc_section": null,
  "error_code": "INS-2021-DOB",
  "verification_tier": "ai_generated",
  "confidence": 0.84,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2024-08-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}