Prospective Study of Access Site Complications of Automated Contrast Injection With Peripheral Venous Access in MDCT

Wienbeck, Susanne; Fischbach, Roman; Kloska, Stephan P.; Seidensticker, Peter; Osada, Noriaki; Heindel, Walter; Juergens, Kai Uwe

doi:10.2214/ajr.09.3739

Cited by 68 publications

(89 citation statements)

References 23 publications

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“…Most published series suggest an extravasation rate of less than 1% for intravenous injection of iodinated contrast media for CT scanning. 11,12 Most contrast extravasations are small volume, and symptoms resolve with conservative treatment. Unfortunately, the ultimate degree of injury cannot be determined at initial examination.…”

Section: Intravascular Contrast Administrationmentioning

confidence: 99%

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

Pasternak

Williamson

2012

Mayo Clinic Proceedings

148

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Iodinated contrast agents have been in use since the 1950s to facilitate radiographic imaging modalities. Physicians in almost all specialties will either administer these agents or care for patients who have received these drugs. Different iodinated contrast agents vary greatly in their properties, uses, and toxic effects. Therefore, clinicians should be at least superficially familiar with the clinical pharmacology, administration, risks, and adverse effects associated with iodinated contrast agents. This primer offers the non-radiologist physician the opportunity to gain insight into the use of this class of drugs.

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Section: Intravascular Contrast Administrationmentioning

confidence: 99%

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

Pasternak

Williamson

2012

Mayo Clinic Proceedings

148

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“…However, the occurrence of extravasation is not declining, only the incidence of consequential damage, meaning that severe complications in the form of tissue necrosis and compartment syndrome can still occur even after extravasation in small volumes [41,42]. Since there are no clear risk criteria for the development of complications with serious consequences, and since these cases are rarities, it is important to remain vigilant with all contrast medium extravasations and to regularly check the incidence in your own department in order to eliminate possible sources of risk.…”

Section: Discussionmentioning

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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“…Confirmation of reflux from the injection route has been reported as a safety countermeasure during power injection [3,[9][10][11]. In some reports, the saline test injection was performed manually [2,3,12].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the new injection program ‘saline test injection mode’ for use power injector in pediatric contrast CT

Abe

Mizuno

Tani

et al. 2013

Australas Phys Eng Sci Med

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To improve the safety of the use of a power injector for pediatric contrast CT, we newly developed a saline test injection mode for a power injector and investigated its usefulness. We used an injection route and investigated the relationship of the injection pressure to the injection rate of saline and the contrast medium. From this relationship, we investigated it was possible to estimate the change of pressure injection of contrast medium from the pressure change of saline injection. The correlation between the saline test injection pressure and the contrast medium injection pressure was investigated in 64 clinical cases. The detection rate of side effects from the saline test injection was investigated in 473 patients. Regarding the correlation between the injection rate and pressure for both saline and contrast, the pressure rose as the rate increased. The contrast medium injection pressure could be estimated from the correlation observed with saline. The clinical data were obtained had a relationship similar to that with phantom data. The detection rate of side effects from the saline test injection was 4.4 % in the clinical cases. In these cases, examinations were completed by re-establishing an injection route or administering hypnotics. Our results suggest that contrast medium pressure can be estimated from a saline test injection, thus aiding in prediction of the risk of injection abnormality. Reactions to injections could be observed in the present study, facilitating the prevention of examination failure. Countermeasures can be taken against the cause of the reaction, and the examination can be performed after confirming the absence of a reaction to injection. Therefore, a saline test injection may be useful in pediatric contrast CT.

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Prospective Study of Access Site Complications of Automated Contrast Injection With Peripheral Venous Access in MDCT

Cited by 68 publications

References 23 publications

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

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

Effectiveness of the new injection program ‘saline test injection mode’ for use power injector in pediatric contrast CT

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