Background
Vasopressors are essential for hemodynamic support in critically ill patients and routinely administered via central venous catheters (CVCs). While extravasation is well described with peripheral intravenous access, vasopressor extravasation from CVCs is rarely reported. When it occurs, it may lead to tissue necrosis, secondary infection, and prolonged wound management.

Case report
We report the case of a 46-year-old male admitted with severe acute necrotizing pancreatitis complicated by acute kidney injury, respiratory failure, abdominal compartment syndrome, and circulatory instability requiring vasopressor support. The patient was transferred to the intensive care unit (ICU), where continuous renal replacement therapy was initiated via a right internal jugular vein catheter. A separate CVC for norepinephrine infusion (0.1–0.28 µg/kg/min) was inserted into the left internal jugular vein (LIJV).

Five days after insertion, local complications developed at the catheter site, including a 4×6 cm hematoma with skin maceration and progressive necrosis in the left supraclavicular region, suspected to be due to vasopressor extravasation. Catheter dysfunction with impaired aspiration and infusion was observed, confirmed by Ultrasound and chest X-ray. Consequently, it was removed, and a new CVC was inserted into the right femoral vein on the same day. Despite prompt catheter removal and initiation of local wound care, necrotic changes continued to progress.

The patient required prolonged local treatment, multiple antibiotic regimens due to secondary wound infection, and repeated surgical consultations. Ultimately, surgical debridement and vacuum-assisted closure (VAC) therapy were initiated Gradual wound healing with granulation and epithelialization was achieved, and the patient was discharged home 72 days after the initial detection of necrosis, without further complications.

Conclusions
Vasopressor extravasation from a CVC, although rare, can result in severe local complications. This case highlights the importance of meticulous CVC site monitoring, early recognition of catheter dysfunction, prompt removal and reinsertion at an alternative site. Increased awareness of this complication is essential to improve vascular access safety and prevent extensive tissue injury.