CT contrast media extravasation: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:PMC4891405 gr1.png|thumb|Contrast extravasation of 120 ml into the biceps compartment. A and B, External and internal rotation radiographs of the arm approximately one hour after injection show a soft tissue collection of contrast material in the expected location of the biceps compartment that is completely contained with sharp margins.]] | |||
*Clinical (if no complication) | *Clinical (if no complication) | ||
*Consider plain films and/or CT, if concern for significant complication | |||
==Management== | ==Management== | ||
Revision as of 11:23, 25 November 2021
Background
- Complication of contrast-enhanced CT scanning
- May also occur from MRI, but rare given low volume used
- Ultrasound-guided IVs are at higher risk[1]
Epidemiology
- ~0.5% (range 0.13-0.68%) of cases
Clinical Features
- Swelling and/or blistering at injection site
Differential Diagnosis
Contrast induced complications
- Contrast induced allergic reaction
- Contrast-induced nephropathy
- CT contrast media extravasation
- Nephrogenic systemic fibrosis
Evaluation
Contrast extravasation of 120 ml into the biceps compartment. A and B, External and internal rotation radiographs of the arm approximately one hour after injection show a soft tissue collection of contrast material in the expected location of the biceps compartment that is completely contained with sharp margins.
- Clinical (if no complication)
- Consider plain films and/or CT, if concern for significant complication
Management
- Stop infusion immediately
- Remove IV canula
- Ice pack to affected area
- Elevate
- Consider hyaluronidase for iodinated contrast extravasation[2]
- Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)[3]
Complications
- 97% have minimal or no injury
- 79% have localized swelling after extravasation
- 24% had pain
- Large volumes (> 50 mL) of high-osmolar contrast media = highest risk
- skin ulceration
- soft-tissue necrosis
- compartment syndrome
Disposition
- May discharge after 2 hours with precautions, if no signs of complications.
See Also
External Links
References
- ↑ Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001
- ↑ https://pubmed.ncbi.nlm.nih.gov/22633726/
- ↑ https://pubmed.ncbi.nlm.nih.gov/22633726/