Extravasation Risk Using Ultrasound‐guided Peripheral Intravenous Catheters for Computed Tomography Contrast Administration

Abstract

Objective Ultrasound guided intravenous catheter (USGIV) insertion is increasingly being used for administration of intravenous contrast for computed tomography (CT) scans. The goal of this investigation was to evaluate the risk of contrast extravasation among patients receiving contrast through USGIV catheters. Methods A retrospective observational study of adult patients who underwent a contrast-enhanced CT scan at a tertiary-care emergency department during a recent 64-month period was conducted. The unadjusted prevalence of contrast extravasation was compared between patients with an USGIV and those with a standard peripheral IV inserted without ultrasound. Then, a two-stage sampling design was used to select a subset of the population for a multivariable logistic regression model evaluating USGIVs as a risk factor for extravasation while adjusting for potential confounders. Results In total, 40,143 patients underwent a contrasted CT scan, including 364 (0.9%) who had contrast administered through an USGIV. Unadjusted prevalence of extravasation was 3.6% for contrast administration through USGIVs and 0.3% for standard IVs (relative risk: 13.9, 95% CI: 7.7 to 24.6). After adjustment for potential confounders, CT contrast administered through USGIVs was associated with extravasation (adjusted odds ratio: 8.6; 95% CI: 4.6, 16.2). No patients required surgical management for contrast extravasation; one patient in the standard IV group was admitted for observation due to extravasation. Conclusions Patients who received contrast for a CT scan through an USGIV had a higher risk of extravasation than those who received contrast through a standard peripheral IV. Clinicians should consider this extravasation risk when weighing the risks and benefits of a contrast-enhanced CT scan in a patient with USGIV vascular access.

Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions

“…No statistically significant heterogeneity was detected with a Chi-square value of 0.89 ( P = 0.35) and an I 2 of 0%. The effect of gender was also emphasized in a multivariate logistic regression by Rupp et al 40 Being a female was associated with an increased risk of extravasation, as indicated by the adjusted odds ratio of 1.8 (95% CI: 1.1–2.9).…”

“…Among the citations that had data on the relevant outcomes, there was one randomized control trial, 37 one pseudo-randomized trial, 36 one quasi-experimental trial, 19 and one pre-post study, 31 with the remainder being cohort 9 , 23 , 26 , 27 , 28 , 34 , 40 , 42 or case series designs. 38 , 39 , 41 Studies other than clinical trials were included when they related to a different outcome, population of interest or intervention.…”

“…In the literature, this variable was considered in relation with two outcomes: extravasation frequency 26 , 40 , 42 and volume of extravasate. 28 …”

“… 42 The third study focused on episodes of hospitalization in the previous year and intravenous drug use. 40 Because of this heterogeneity, we did not perform a meta-analysis.…”

“…According to a recent study, the patients at highest risk of extravasation are those recently hospitalized (adjusted OR = 2.0; 95% CI: 1.3–3.1) or with a history of IV drug use (adjusted OR = 5.8; 95% CI: 1.7–19.9). 40 …”