Computed tomography contrast media extravasation: treatment algorithm and immediate treatment by squeezing with multiple slit incisions

Kim, Sue Min; Cook, Kyung Hoon; Lee, Il Jae; Park, Dong Ha; Park, Myong Chul

doi:10.1111/iwj.12628

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Study by Tsai et al of 8 cases who developed vascular compromise with 50 -80 ml of non-ionic, low osmolarity extravasate demonstrated satisfactory healing using this method [66]. A similar study by Kim et al with 23 cases (no control group) of extravasate > 50 ml also showed satisfactory response after 1 week follow-up although there was immediate temporary mild blistering [67]. A similar technique whereby multiple stab incisions were made for large volume extravasations was found to be successful in a case report by Raveendran et al [68] Similar to other techniques, limited data available to support use of this, but the simplicity is attractive and more comparative data would help assess efficacy.…”

Section: Invasive Treatmentsmentioning

confidence: 77%

Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines

et al. 2022

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Need for a review Guidelines for management and prevention of contrast media extravasation have not been updated recently. In view of emerging research and changing working practices, this review aims to inform update on the current guidelines. Areas covered In this paper, we review the literature pertaining to the pathophysiology, diagnosis, risk factors and treatments of contrast media extravasation. A suggested protocol and guidelines are recommended based upon the available literature. Key Points • Risk of extravasation is dependent on scanning technique and patient risk factors. • Diagnosis is mostly clinical, and outcomes are mostly favourable. • Referral to surgery should be based on clinical severity rather than extravasated volume.

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Section: Invasive Treatmentsmentioning

confidence: 77%

Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines

et al. 2022

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“…Thirty-five papers were deemed eligible for inclusion after studies in which conservative management or no intervention were excluded. The requisite data were immediately available in 26 study reports 4,10,[19][20][21][22][23][24][25][26][27][28]11,[29][30][31][32][33][34][12][13][14][15][16][17][18] and the authors of the remaining nine studies 5,[35][36][37][38][39][40][41][42] were contacted twice with additional requests, mainly for exclusively paediatric extravasation data, and given at least two months to reply. Unfortunately, none of the authors were able to provide these data and those studies were excluded.…”

Section: Search Strategymentioning

confidence: 99%

Surgical Intervention for Paediatric Infusion-Related Extravasation Injury: A Systematic Review

Little

Dupré-Crochet

Wormald

et al. 2019

Preprint

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Objectives This systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine and summarize their outcomes. Methods We performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. All studies other than case reports were eligible for inclusion if the population was younger than 18 years old, there was a surgical intervention aimed at treating extravasation injury and they reported on outcomes. Risk of bias was graded according to the National Institutes of Health (NIH) study quality assessment tools. Results 26 studies involving 728 children were included. One before and after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking. Conclusion There is a lack of high quality evidence to support treatment of extravasation injury in children. A definitive trial of extravasation injuries, or a centralized extravasation register using a universal grading scheme and core outcome set with adequate follow up, are required to provide evidence to guide clinician decision-making.

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“…In 2016 Kim et al [5] published an account of 23 patients with contrast medium extravasation who reported severe pressure on the limb or cases in which the extravasation volume was greater than 50 ml. The squeezing technique was applied to all 23 patients, with extravasation volumes ranging from 5 to 140 ml.…”

Section: Manual Squeezing Techniquementioning

confidence: 99%

Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

Mandlik

Prantl

Schreyer

2018

Fortschr Röntgenstr

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Background Contrast extravasation events in daily radiological routine may lead to serious complications, especially during CT examinations. The resulting symptoms may vary from local pain up to skin ulcers, necrosis or even acute compartment syndrome.There are no uniformly accepted radiological guidelines or recommendations regarding detection and treatment of extravasation events and immanent complications in a timely manner. Method Systematic literature research considering the last 35 years via PubMed using search terms “contrast medium extravasation/paravasation”. Results In the literature, there are conservative management approaches of contrast media extravasation without major evidence base, such as unguent dressings, cooling or splinting. This therapy is mostly symptomatic. Additionally, various invasive techniques are described. We discuss these techniques in the context of contemporary literature, such as the hyaluronidase Injection into the site of extravasation, suction/aspiration technique including flushing of the affected tissue areas and the squeezing technique. However, most citations lack scientific evidence: many articles include anecdotal enumerations, case studies or cite publications from the era, when ionic high osmolar contrast media was state-of-the-art. Besides, many authors derive their extravasation management from studies, where agents other than contrast media were investigated. Conclusion After detailed literature review, we suggest early (plastic) surgical consultation when non-ionic, low-osmolar contrast medium extravasation is about 150 cc or more. In case of extravasation less than 150 cc but in presence of additional symptoms such as impaired perfusion or altered sensibility, the (plastic) surgeon should also be consulted instantly. We do not recommend any invasive first line therapy when contrast media extravasation is less than 150 cc and the patient presents no additional symptoms, besides swelling and local pain. Nevertheless continuous monitoring and accurate conservative management such as active cooling and elevation, splinting of the affected extremity are mandatory as early detection of critical symptoms helps to initiate prompt surgical intervention and avoid sequelae. Key Points Citation Format

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Computed tomography contrast media extravasation: treatment algorithm and immediate treatment by squeezing with multiple slit incisions

Cited by 9 publications

References 15 publications

Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines

Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines

Surgical Intervention for Paediatric Infusion-Related Extravasation Injury: A Systematic Review

Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

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