Extravasación de medios de contraste intravenosos en el sitio de la punción: Protocolo de actuación

Compaña, Francisco Javier Pacheco; Vidal, B. Gago; Díaz, Cándido

doi:10.1016/j.rx.2014.02.003

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…Even if successfully placed, there is high risk of severe pain or venous rupture and contrast extravasation during injection as the fragile vein may not be able to withstand pressure and volume from the rapid contrast injection. Extravasation of intravenously administered iodinated contrast media into the surrounding subcutaneous tissue is a potentially serious complication that may lead to compartment syndrome, skin sloughing, and necrosis ( 8 9 10 ).…”

Section: Introductionmentioning

confidence: 99%

Two Small Intravenous Catheters for High-Rate Contrast Medium Injection for Computed Tomography in Patients Lacking Superficial Veins to Accommodate a Large Catheter

et al. 2018

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ObjectiveTo prospectively investigate the feasibility of using 2 small intravenous catheters for high-rate computed tomography (CT) contrast injection in patients lacking superficial veins capable of accommodating ≤ 20-gauge catheters.Materials and MethodsSixty-eight consecutive eligible adults referred for dynamic liver CT were enrolled; 58 had previously undergone liver CT, including 8 that experienced extravasation. Two 22- or 24-gauge catheters were placed in all patients after 2–5 venipunctures, and 2 mL/kg of contrast agent (370 mg I/mL) was split-administered through both catheters to achieve total flow rate of 4 mL/s. Patients' experience and examination success rate, defined as uneventful scans completed at 4 mL/s or at < 4 mL/s achieving standard image quality in all phases, were analyzed. Quantitative hepatic signal-to-noise and hepatic vascular contrast-to-noise ratios (CNRs) were compared with 30 control examinations scanned at 4 mL/s using an 18-gauge catheter.ResultsOne case each of extravasation and severe injection pain caused the examination to be aborted. Success rate was 88.2% (60/68; 54 patients scanned at 4 mL/s, 6 at 3.5–3.9 mL/s). Fifty-five of 58 patients (94.8%) that had past CT regarded the venipuncture as more tolerable than (n = 36) or similar to (n = 19) past experiences; 45 of 58 patients (77.6%) found contrast injection less painful than (n = 35) or similar to (n = 10) past experiences. When compared with control examinations, signal-to-noise ratio was similar in all phases (p ≥ 0.502), but the hepatic arterial CNR in arterial phase was slightly inferior (p ≤ 0.047).ConclusionUsing 2 small intravenous catheters can effectively achieve high-rate CT contrast injection in patients lacking adequate superficial veins.

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Section: Introductionmentioning

confidence: 99%

Two Small Intravenous Catheters for High-Rate Contrast Medium Injection for Computed Tomography in Patients Lacking Superficial Veins to Accommodate a Large Catheter

et al. 2018

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Medios de contraste basados en gadolinio de distribución extracelular

Soler-Fernández,

Méndez-Díaz,

Rodríguez-García

2024

Radiología

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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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Extravasación de medios de contraste intravenosos en el sitio de la punción: Protocolo de actuación

Cited by 5 publications

References 20 publications

Two Small Intravenous Catheters for High-Rate Contrast Medium Injection for Computed Tomography in Patients Lacking Superficial Veins to Accommodate a Large Catheter

Two Small Intravenous Catheters for High-Rate Contrast Medium Injection for Computed Tomography in Patients Lacking Superficial Veins to Accommodate a Large Catheter

Medios de contraste basados en gadolinio de distribución extracelular

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

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