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Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous
Carolyn L Wang1, Richard H Cohan, James H Ellis
1Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109-0030, USA.
Insights
Extravasation of nonionic iodinated contrast medium is rare and usually causes no serious harm. Severe complications typically only occur with large injected volumes.
Area of Science:
- Radiology
- Medical Imaging
- Patient Safety
Background:
- Intravenous contrast media are essential for many diagnostic imaging procedures.
- Extravasation, or leakage, of contrast medium can occur during injection.
- Understanding the risks associated with contrast extravasation is crucial for patient care.
Purpose of the Study:
- To assess the incidence of nonionic iodinated contrast medium extravasations.
- To analyze the management strategies employed for these events.
- To determine the clinical outcomes following contrast medium extravasation.
Main Methods:
- Retrospective review of 69,657 intravenous contrast injections for CT scans.
- Analysis of incident reports, radiology reports, and medical records.
- Data collection on patient demographics, extravasation volume, symptoms, and treatment.
Main Results:
- Extravasation occurred in 0.7% of patients (475/69,657).
- Most extravasations resulted in minimal or no adverse effects.
- Severe complications were rare and associated with large extravasated volumes (>50 mL in adults).
Conclusions:
- Extravasation of nonionic iodinated contrast medium is infrequent.
- Moderate or severe adverse effects are uncommon.
- Large extravasated volumes are the primary risk factor for significant complications.
Purpose:
To determine retrospectively the frequency, management, and outcomes of extravasations of intravenously injected nonionic iodinated contrast medium.
Materials And Methods:
Institutional review board approval was obtained, and the requirement for informed consent was waived. The study was HIPAA compliant. For 69,657 intravenous injections of nonionic iodinated contrast medium for computed tomographic examinations between January 1, 2000, and March 31, 2005, the incident reports, radiology reports, and medical records of patients in whom contrast medium extravasations occurred were reviewed. Data collected included patient age, catheter gauge, injection site, volume extravasated, patient symptoms, severity of injury, treatment, whether or not the plastic surgery service was consulted and any additional treatment that service instituted, and patient outcome.
Results:
Extravasations occurred in 475 (0.7%) of 69 657 patients, and follow-up information was available for 442 adults (280 women, 162 men; mean age, 57 years) and 17 children (nine girls, eight boys; mean age, 6 years). Extravasated volumes ranged from 3 to 150 mL. Symptoms usually consisted of swelling and/or pain. The plastic surgery service was consulted for 38 adults and six children and provided additional treatment in eight patients (seven adults, one child). Among adults, 432 had minimal or no adverse effects, nine had moderate adverse effects, and one had a severe complication (75 mL of contrast material extravasated into the hand, causing compartment syndrome). Only one moderate or severe complication in an adult resulted from an extravasation of less than 50 mL. Fifteen children had minimal or no adverse effects, one had moderate adverse effects, and one had a severe complication (18 mL of contrast material extravasated into the arm, causing brachial plexopathy).
Conclusion:
Extravasation of nonionic iodinated contrast medium results only rarely in moderate or severe adverse effects, and these usually occur only when large volumes of contrast medium are involved.
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