Contrast media extravasation
Updates to Article Attributes
Contrast media extravasation (CMEV) is a well-known complication of contrast-enhanced CT scanning 1. It can also occur in MRI studies, but the complications are rare given the low volume that are used.
Epidemiology
CT contrast extravasation occurs relatively infrequently, in ~0.5% (range 0.13-0.68%) of cases, but can have severe side effects associated with skin changes and possible skin necrosis.
Pathology
Nonionic low-osmolar contrast media is known to reduce the risk of severe soft tissue injury but risk of soft tissue injury is often related to the volume of CMEV 1.
Risk factors
- increased incidence with automated power injection because large volumes can extravasate in a short period of time 2
- with manual injection, extravasation is thought less likely, as there is direct supervision of contrast administration
- patient-related factors:
- elderly patients
- emaciated patients
- oedematous patients
- confused patients
- site of venous access:
- higher percentage of leakage in the venous access in the back of the hand, wrist, foot and ankle
- likely related to a smaller amount of subcutaneous tissue and the fact that veins are more fragile on these regions
- gauge of intravenous catheter: only if smaller caliber access (over 22G) is used; risk of leakage is the same for 18G and 20G 1
- high-osmolar contrast medium 2
Treatment and prognosis
The conduct after an episode of CMEV will vary according to the protocol of each radiology department, and might include:
- discontinue the contrast infusion and notify the radiologist immediately
- complete the acquisition of images of the CT series
- if the canula is still in place, could be possible to aspirate any residual drug, and after remove the IV canula
- apply ice pack to affected area and elevate the affected extremity to reduce swelling
- keep the patient under observation for at least 2 hours
- at some institutions, the policy is to require plastic surgery consultation for all patients whose extravasations involve 100 mL or more of contrast medium
- make contact with the doctor requesting the examination
- it is suggested to follow up the patient by the next few days until the resolution of local edema; this can be accomplished with a phone call to evaluate the regression of the signs and symptoms
- instruct the patient to notify staff if there is
- increasing swelling or pain over time
- blistering, ulceration, induration or other skin changes
- altered tissue perfusion and/or changes in sensation
Complications
Most CMEV result in minimal swelling or erythema and have no long-term sequelae 2. A large study found that more than 97% of patients with contrast extravasation had minimal or no injury and reported that 79% of patients had localized swelling after extravasation, 24% had pain and 8% were asymptomatic 3.
Large volumes (> 50 mL) of high-osmolar contrast media are known to induce significant tissue damage:
- skin ulceration
- soft-tissue necrosis
- compartment syndrome
See also
-<li>at some institutions, the policy is to require <strong>plastic surgery consultation</strong> for all patients whose extravasations involve 100 mL or more of contrast medium</li>- +<li>at some institutions, the policy is to require plastic surgery consultation for all patients whose extravasations involve 100 mL or more of contrast medium</li>
-</ul><h4>See also</h4><ul><li><a href="/articles/contrast-nephropathy">contrast nephropathy</a></li></ul>- +</ul>
Tags changed:
- safety
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