Severe phlebitis and cutaneous necrosis following peripheral administration of high-concentration potassium chloride: A case report and vascular access management implications

Electrolyte imbalance management is crucial in diverse clinical scenarios, with intravenous potassium repletion often required. High-concentration infusions can pose severe complications if extravasation occurs, leading to phlebitis, local tissue damage, or in severe cases, cutaneous necrosis. This risk is elevated in geriatric patients due to factors like reduced tissue elasticity and sensitivity. We report a case of phlebitis and skin necrosis in an elderly woman after peripheral KCl infusion (6% [800 mmol/L]). A woman in her early 70 s presented with obstructive jaundice and critically low potassium levels. A peripheral intravenous administration of 6% KCl was initiated to rectify hypokalemia. Due to superficial venous site selection and the patient's reduced sensitivity, phlebitis developed unnoticed, leading to cutaneous necrosis. Management involved medication discontinuation, cannula removal, application of a magnesium sulfate dressing, limb elevation, and a hydrogel dressing. Despite initial necrosis, wound debridement, ongoing dressings, and moderate hand exercises led to a complete wound resolution. This case underscores the importance of careful selection and monitoring of infusion sites during administration of irritant solutions like concentrated KCl, particularly in geriatric patients. Patient-specific factors, pharmacological implications, and the necessity for adequate vascular assessment are emphasized. Further, the case highlights the necessity for prompt and multifaceted management strategies to handle complications, including patient and caregiver education, careful wound management, and proactive nursing care. The event underscores the need for established protocols regarding the administration of high-risk drugs to prevent severe sequelae.