Risk of contrast extravasation with vascular access in computed tomography.

Area of Science:

• Radiology and Imaging
• Vascular Access
• Patient Safety

Background:

• Intravenous (IV) contrast administration is common in diagnostic computed tomography (CT) imaging.
• Extravasation of IV contrast can lead to local skin and soft tissue reactions.
• Understanding risk factors for extravasation is crucial for patient safety.

Purpose of the Study:

• To evaluate the risk of contrast extravasation based on the anatomical location of the IV catheter during contrast-enhanced CT imaging.
• To compare extravasation rates between upper arm and non-upper arm IV catheter placements.

Main Methods:

• Retrospective cohort study over 26 months at a single institution.
• Analysis of 14,558 contrast administrations for CT imaging.
• Calculation of contrast extravasation rates by IV catheter location, using relative risk (RR) and absolute risk reduction (ARR).

Main Results:

• Overall extravasation rate was 0.34% (49 events).
• Upper arm IV catheters (n=283) had a higher extravasation rate (2.8%) compared to non-upper arm catheters (n=14,275; 0.28%).
• Upper arm placement showed a 10.1-fold increased relative risk of extravasation.

Conclusions:

• IV catheter placement in upper arm vessels is associated with a slightly increased risk of extravasation compared to non-upper arm locations.
• Point-of-care ultrasound (POCUS)-guided upper arm IV cannulation can be a viable option when other peripheral vascular access is limited.