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Sun YX, Shang J, Cui Y, Zhang KJ, Li XT, Li DN, Gu XL, Tian XY, Sun N, Zhang L, You MN, Zhang XY, Sun YS. Impact of different concentration iodinated contrast media on pain and comfort in abdominal computed tomography. Eur J Radiol 2024; 179:111664. [PMID: 39121745 DOI: 10.1016/j.ejrad.2024.111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/04/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES To investigate whether high concentration iodinated contrast media (CM), compared with low concentration CM, could reduce pain and discomfort levels in patients who had level II and III venous conditions. METHODS This prospective, single-center study enrolled patients who had level II and III venous conditions and underwent abdominal contrast-enhanced CT scan between July 2021 and February 2022. The venous condition to establish peripheral venous access for CM injection was graded using the Intravenous Access Scoring system, of which level II and III indicated poor venous condition and difficult venous access. Patients received iomeprol 400 in high concentration group and ioversol 320 in low group at an identical iodine delivery rate of 1.12 gI/s. The primary outcomes were pain and comfort levels. The secondary outcomes included adverse events and image quality. Patients rated pain intensity via Numerical Rating Scale and comfort level via Visual Analogue Scale with higher scores indicating higher levels of pain and discomfort. Quantitative and qualitative image assessment were compared between two groups. Continuous variables were compared using Student's t test or Mann-Whitney U test. Categorical variables were compared using χ2 test, χ2 test for trend or Fisher's exact test. RESULTS A total of 206 patients (mean age, 60.13 ± 12.14 years; 81 males) were included with 99 in the high concentration group and 107 in the low concentration group. The high group had significantly lower pain scores (median 1 [IQR: 0-2] vs 2 (IQR 2-4), p < 0.001) and comfort scores (1 [IQR: 0-3] vs 3 [IQR: 2-5], p < 0.001) than the low group. Incidence of CM extravasation did not significantly differ (1.0 % vs 4.5 %, p = 0.214). No hypersensitivity reaction was observed. Qualitative assessment showed higher clarity scores of intrahepatic hepatic artery and portal vein in the high group. Quantitative assessment results were comparable between two groups. CONCLUSION High concentration iodinated CM could lower pain intensity and improve comfort levels without comprising image quality of CT scan. High concentration CM is a preferable choice in patients with poor venous conditions during contrast-enhanced CT scan.
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Affiliation(s)
- Yan-Xia Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Jing Shang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Yong Cui
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Ke-Jin Zhang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Xiao-Ting Li
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Dan-Ni Li
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Xiao-Lei Gu
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Xiao-Yu Tian
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
| | - Nan Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Lan Zhang
- MRI Department, The 1st Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Miao-Ning You
- Department of Breast Oncology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China.
| | - Xiao-Yan Zhang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China.
| | - Ying-Shi Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
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Pham TD, Tsunoyama T. Exploring Extravasation in Cancer Patients. Cancers (Basel) 2024; 16:2308. [PMID: 39001371 PMCID: PMC11240416 DOI: 10.3390/cancers16132308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Extravasation, the unintended leakage of intravenously administered substances, poses significant challenges in cancer treatment, particularly during chemotherapy and radiotherapy. This comprehensive review explores the pathophysiology, incidence, risk factors, clinical presentation, diagnosis, prevention strategies, management approaches, complications, and long-term effects of extravasation in cancer patients. It also outlines future directions and research opportunities, including identifying gaps in the current knowledge and proposing areas for further investigation in extravasation prevention and management. Emerging technologies and therapies with the potential to improve extravasation prevention and management in both chemotherapy and radiotherapy are highlighted. Such innovations include advanced vein visualization technologies, smart catheters, targeted drug delivery systems, novel topical treatments, and artificial intelligence-based image analysis. By addressing these aspects, this review not only provides healthcare professionals with insights to enhance patient safety and optimize clinical practice but also underscores the importance of ongoing research and innovation in improving outcomes for cancer patients experiencing extravasation events.
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Affiliation(s)
- Tuan D. Pham
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
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3
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Privitera D, Geraneo A, Li Veli G, Parravicini G, Mazzone A, Rossini M, Sanfilippo M, Gubertini A, Airoldi C, Capsoni N, Busca E, Bassi E, Langer T, Dal Molin A. Complications related to short peripheral intravenous catheters in patients with acute stroke: a prospective, observational, single-cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03651-2. [PMID: 38805082 DOI: 10.1007/s11739-024-03651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Patients with acute stroke often require venous access to facilitate diagnostic investigations or intravenous therapy. The primary aim of this study was to describe the rate and type of complications associated with the placement of a short peripheral catheter (SPC) in patients with acute ischemic or hemorrhagic stroke. A prospective, observational, single-cohort study was conducted at Niguarda Hospital, Italy, with enrolment in the Emergency Department. Adult patients with an ischemic or hemorrhagic stroke requiring an SPC were enrolled. Complications, such as infiltration, occlusion, phlebitis and dislodgment, were recorded daily. Descriptive statistics were used, and the incidence rate ratio (IRR) was estimated to assess the difference in complications, considering catheter calibre, dominant side, exit site, limb, and limb mobility, ictus type (ischemic/haemorrhagic), impairment deficit (language, motor, visual) and EA-DIVA score. A total of 269 participants and 755 SPC were analysed. Removal of SPC due to at least one local complication occurred in 451 (60%). Dislodgment was the major cause of SPC removal (31%), followed by infiltration (18%), occlusion (6%), and phlebitis (5%). The SPC calibre (22G), exit-site other than antecubital and forearm, visual deficit and EA-DIVA ≥ 8 were associated with a higher rate of SPC complications: IRR, 1.71 [1.31; 2.31]; 1.27 [1.01; 1.60], 1.38 [1.06; 1.80], 1.30 [1.04; 1.64], respectively. No other differences in complication rates were observed according to the insertion site, i.e. dominant side, left side, plegic/hyposthenic limb, or exit site. This study provides novel insights into the frequency and types of complications associated with SPC in patients with acute stroke. Compared to the literature, a higher dislodgment rate was observed, being the first cause of SPC removal, whereas no differences in the number of infiltrations, occlusions, and phlebitis were recorded.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata Rome, Rome, Italy.
| | - Annalisa Geraneo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Greta Li Veli
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Parravicini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Mazzone
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Sanfilippo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Gubertini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Busca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
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Clement O, Romanini L, van der Molen AJ. Contrast media safety: update on recent ESUR-Contrast Media Safety Committee publications. Eur Radiol 2024:10.1007/s00330-024-10725-4. [PMID: 38787427 DOI: 10.1007/s00330-024-10725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Olivier Clement
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Paris, France.
| | | | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Rozo GAM, Leguízamo-Isaza JM, Bustamante MMY, Romero JA. Accounting for Both Patient-Related and Non-patient-Related Risk Factors for Contrast Media Extravasation. Acad Radiol 2024:S1076-6332(24)00224-1. [PMID: 38796402 DOI: 10.1016/j.acra.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/28/2024]
Affiliation(s)
| | - Juan Martín Leguízamo-Isaza
- Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá University Hospital, Bogotá D.C., Colombia; Universidad El Bosque, Diagnostic Radiology Residency Program, Bogotá, Colombia.
| | - Maria Monica Yepes Bustamante
- Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá University Hospital, Bogotá D.C., Colombia; Universidad El Bosque, Diagnostic Radiology Residency Program, Bogotá, Colombia
| | - Javier Andres Romero
- Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá University Hospital, Bogotá D.C., Colombia; Universidad El Bosque, Diagnostic Radiology Residency Program, Bogotá, Colombia
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Zhang Y, Yuan D, Qi K, Zhang M, Zhang W, Wei N, Li L, Lv P, Gao J, Liu J. Feasibility Analysis of Individualized Low Flow Rate Abdominal Contrast-Enhanced Computed Tomography in Chemotherapy Patients: Dual-Source Computed Tomography With Low Tube Voltage. J Comput Assist Tomogr 2024:00004728-990000000-00319. [PMID: 38693081 DOI: 10.1097/rct.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of the study is to investigate the feasibility of using dual-source computed tomography (CT) combined with low flow rate and low tube voltage for postchemotherapy image assessment in cancer patients. METHODS Ninety patients undergoing contrast-enhanced CT scans of the upper abdomen were prospectively enrolled and randomly assigned to groups A, B, and C (n = 30 each). In group A, patients underwent scans at 120 kVp with 448 mgI/kg. Patients in group B underwent scans at 100 kVp with 336 mgI/kg. Patient in group C underwent scans at 70 kVp with of 224 mgI/kg. Quantitative measurements including the CT number, standard deviation of CT number, signal-to-noise ratio, contrast-to-noise ratio, subjective reader scores, and the volume and flow rate of contrast agent were evaluated for each group. RESULTS There was no statistically significant difference in the subjective image scores within the three groups except for the kidney (all P > 0.05). Group C showed significantly higher CT values, lower noise levels, and higher signal-to-noise ratio and contrast-to-noise ratio values in the majority of the regions of interest compared to the other groups (P < 0.05). In group C, the contrast agent dose was decreased by 46% compared to group A (79.48 ± 12.24 vs 42.7 ± 8.6, P < 0.01), and the contrast agent injection rate was reduced by 22% (2.7 ± 0.41 vs 2.1 ± 0.4, P < 0.01). CONCLUSIONS The use of 70 kVp tube voltage combined with low iodine flow rates prove to be a more effective approach in solving the challenge of compromised blood vessels in postchemotherapy tumor patients, without reducing image quality and diagnostic confidence.
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Affiliation(s)
- Yicun Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Dian Yuan
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Ke Qi
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Mengyuan Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Weiting Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Nannan Wei
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | | | - Peijie Lv
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Jianbo Gao
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Jie Liu
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
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Rašiová M, Schlager O, Heiss C, Brodmann M, Olinic DM, Boc V, Buso G, Belch J, Mazzolai L, Madaric J. Adverse reactions after intravascular iodinated contrast media administration and their management. VASA 2024; 53:193-203. [PMID: 38651340 DOI: 10.1024/0301-1526/a001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Endovascular interventions and diagnostic examinations using iodinated contrast media (ICM) are standard of care in current vascular medicine. Although ICM use is generally considered safe, it may be associated with adverse reactions, vary from minor disturbances to rare, but severe life-threatening complications. This position paper of European Society of Vascular Medicine integrates current knowledge and summarizes the key information related to the use of intravascular ICM, serving as recommendation on prevention and management of acute, late, and very late adverse reactions. It should help the health professionals in all fields of vascular medicine to make decisions in daily practice for safe use of contrast media.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, Faculty of Medicine, University of Pavol Jozef Šafárik, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Vascular Department, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, United Kingdom
| | | | - Dan Mircea Olinic
- Department of Interventional Cardiology, Medical Clinic No. 1, Emergency County Hospital, Cluj-Napoca, Romania
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - Jill Belch
- Division of Molecular and Clinical Medicine, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madaric
- Department of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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8
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Liu W, Wang P, Zhu H, Tang H, Wang X, Guan H, Wang C, Qiu Y, Peng A, He L. Risk Factors for Contrast Media Extravasation in Intravenous Contrast-Enhanced Computed Tomography: An Observational Cohort Study. Acad Radiol 2024; 31:1792-1798. [PMID: 38307790 DOI: 10.1016/j.acra.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
RATIONALE AND OBJECTIVES To identify the risk factors for contrast media (CM) extravasation and provide effective guidance for reducing its incidence. MATERIALS AND METHODS We observed adult inpatients (n = 38 281) who underwent intravenous contrast-enhanced computed tomography between January 1, 2018, and December 31, 2022. Risk factors for CM extravasation were evaluated using univariate and multivariate logistic regression. RESULTS Among the 38 281 inpatients who underwent enhanced computed tomography angiography, 3885 received peripherally inserted central venous catheters (PICCs) and 34 396 received peripheral short catheters. In 3885 cases of PICCs, no CM extravasation occurred, but in five cases, ordinary PICCs that are unable to withstand high pressure were mistakenly used; three of those patients experienced catheter rupture, and eventually, all five patients underwent unplanned extubation. Among 34 396 cases of peripheral short catheters, 224 (0.65%) had CM extravasation. Female sex (odds ratio [OR]=1.541, 95% confidence interval [CI]: 1.111-2.137), diabetes (OR=2.265, 95% CI: 1.549-3.314), venous thrombosis (OR=2.157, 95% CI: 1.039-4.478), multi-site angiography (OR=9.757, CI: 6.803-13.994), and injection rate ≥ 3 mL/s (OR=6.073, 95% CI: 4.349-8.481) were independent risk factors for CM extravasation. Due to peripheral vascular protection measures in patients with malignant tumor, there was a low incidence of CM extravasation (OR=0.394, 95% CI: 0.272-0.570). CONCLUSION Main risk factors for CM extravasation are female, diabetes, venous thrombosis, multi-site angiography, and injection rate ≥ 3 mL/s. However, patients with malignant tumor have a low incidence of CM extravasation. CLINICAL IMPACT Analysis of these risk factors can help reduce the incidence of CM extravasation.
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Affiliation(s)
- Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Pinghu Wang
- Hunan Provincial Maternal and Child Healthcare Hospital, Changsha, Hunan, People's Republic of China
| | - Hui Zhu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Hui Tang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiaoying Wang
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Hongmei Guan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Chengxiang Wang
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Yao Qiu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - An Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Xiangya Changde Hospital, Changde, Hunan, People's Republic of China.
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9
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Iacobellis F, Di Serafino M, Russo C, Ronza R, Caruso M, Dell’Aversano Orabona G, Camillo C, Sabatino V, Grimaldi D, Rinaldo C, Barbuto L, Verde F, Giacobbe G, Schillirò ML, Scarano E, Romano L. Safe and Informed Use of Gadolinium-Based Contrast Agent in Body Magnetic Resonance Imaging: Where We Were and Where We Are. J Clin Med 2024; 13:2193. [PMID: 38673466 PMCID: PMC11051151 DOI: 10.3390/jcm13082193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which are classifiable according to their structures (cyclic or linear) or biodistribution (extracellular-space agents, target/specific-agents, and blood-pool agents). The aim of this review is to illustrate the commercially available MRI contrast agents, their effect on imaging, and adverse reaction on the body, with the goal to lead to their proper selection in different clinical contexts. When we have to choose between the different GBCAs, we have to consider several factors: (1) safety and clinical impact; (2) biodistribution and diagnostic application; (3) higher relaxivity and better lesion detection; (4) higher stability and lower tissue deposit; (5) gadolinium dose/concentration and lower volume injection; (6) pulse sequences and protocol optimization; (7) higher contrast-to-noise ratio at 3.0 T than at 1.5 T. Knowing the patient's clinical information, the relevant GBCAs properties and their effect on body MRI sequences are the key features to perform efficient and high-quality MRI examination.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Camilla Russo
- Neuroradiology Unit, Department of Neuroscience Santobono-Pausilipon Children’s Hospital, 80122 Naples, Italy;
| | - Roberto Ronza
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Martina Caruso
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Costanza Camillo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Dario Grimaldi
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Luigi Barbuto
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Francesco Verde
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuliana Giacobbe
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Enrico Scarano
- Department of Radiology, “San Carlo” Hospital, 85100 Potenza, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
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Liu W, Wang P, Zhu H, Tang H, Guan H, Wang X, Wang C, Qiu Y, He L. Contrast media extravasation injury: a prospective observational cohort study. Eur J Med Res 2023; 28:458. [PMID: 37880738 PMCID: PMC10598951 DOI: 10.1186/s40001-023-01444-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To identify the risk factors for moderate and severe contrast media extravasation and provide effective guidance to reduce the degree of extravasation injuries. METHODS We observed 224 adult patients who underwent contrast media extravasation at Xiangya Hospital of Central South University, Hunan Provincial Maternal and Child Healthcare Hospital, and Xiangya Changde Hospital, Hunan Province between January 1, 2018 and December 31, 2022. Risk factors for moderate extravasation injuries were evaluated using univariate and multivariate logistic regression. RESULTS Among 224 patients, 0 (0%) had severe, 18 (8.0%) had moderate, and 206 (92.0%) had mild contrast media extravasation injury. Multivariate logistic regression analysis revealed malignant tumors (odds ratio [OR] = 6.992, 95% confidence interval [CI]: 1.674-29.208), Iohexol (OR = 9.343, 95% CI 1.280-68.214), large-volume (> 50 mL) extravasation (OR = 5.773, 95% CI 1.350‒24.695), and injection site (back of the hand) (OR = 13.491, 95% CI 3.056-59.560) as independent risk factors for moderate injury. CONCLUSION Risk factors for moderate contrast media extravasation injury are malignant tumors, iohexol, large-volume (> 50 mL) extravasation, and back-of-the-hand injection. Analysis of these risk factors can help reduce the degree of injury after extravasation. CLINICAL RELEVANCE STATEMENT High-risk patients with extravasation support should choose the appropriate contrast media type, avoiding back-of-the-hand injections. We recommend that patients with cancer be implanted with a high-pressure resistant central venous catheter and receive effective measures to timely detect and reduce extravasation.
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Affiliation(s)
- Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Pinghu Wang
- Breast Surgery Department, Hunan Provincial Maternal and Child Healthcare Hospital, Changsha, Hunan, People's Republic of China
| | - Hui Zhu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Hui Tang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Hongmei Guan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiaoying Wang
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Chengxiang Wang
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Yao Qiu
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
- Xiangya Changde Hospital, Changde, Hunan, People's Republic of China.
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Jarman AF, Mumma BE, White R, Dooley E, Yang NT, Taylor SL, Newgard C, Morris C, Cloutier J, Maughan BC. Sex differences in guideline-consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18-49. Acad Emerg Med 2023; 30:896-905. [PMID: 36911917 PMCID: PMC10497718 DOI: 10.1111/acem.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is a frequent diagnostic consideration in emergency department (ED) patients, yet diagnosis is challenging because symptoms of PE are nonspecific. Guidelines recommend the use of clinical decision tools to increase efficiency and avoid harms from overtesting, including D-dimer screening in patients not at high risk for PE. Women undergo testing for PE more often than men yet have a lower yield from testing. Our study objective was to determine whether patient sex influenced the odds of received guideline-consistent care. METHODS We performed a retrospective cohort study at two large U.S. academic EDs from January 1, 2016, to December 31, 2018. Nonpregnant patients aged 18-49 years were included if they presented with chest pain, shortness of breath, hemoptysis, or syncope and underwent testing for PE with D-dimer or imaging. Demographic and clinical data were exported from the electronic medical record (EMR). Pretest risk scores were calculated using manually abstracted EMR data. Diagnostic testing was then compared with recommended testing based on pretest risk. The primary outcome was receipt of guideline-consistent care, which required an elevated screening D-dimer prior to imaging in all non-high-risk patients. RESULTS We studied 1991 discrete patient encounters; 37% (735) of patients were male and 63% (1256) were female. Baseline characteristics, including revised Geneva scores, were similar between sexes. Female patients were more likely to receive guideline-consistent care (70% [874/1256] female vs. 63% [463/735] male, p < 0.01) and less likely to be diagnosed with PE (3.1% [39/1256] female vs. 5.3% [39/735] male, p < 0.05). The most common guideline deviation in both sexes was obtaining imaging without a screening D-dimer in a non-high-risk patient (75% [287/382] female vs. 75% [205/272] male). CONCLUSIONS In this cohort, females were more likely than males to receive care consistent with current guidelines and less likely to be diagnosed with PE.
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Affiliation(s)
- Angela F Jarman
- Department of Emergency Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Richard White
- Department of Internal Medicine, Division of Rheumatology, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Emily Dooley
- University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Nuen Tsang Yang
- Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Sandra L. Taylor
- Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Craig Newgard
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Cynthia Morris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Jared Cloutier
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Brandon C Maughan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
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12
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Nawras M, Alyousif Z, Beran A, Elsamaloty H. The relationship between iodinated contrast material temperature and adverse reactions: A meta-analysis of 307,329 injections. Clin Imaging 2023; 100:54-59. [PMID: 37216743 DOI: 10.1016/j.clinimag.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The effect of iodinated contrast material (CM) temperature on injection pressures and viscosity has been well established. However, the effect of extrinsic warming of CM on allergic reactions and extravasations remains unclear. The purpose of this study is to compare the rates of allergic reactions and extravasations between warmed CM to room temperature CM. METHODS We conducted a comprehensive systematic search using PubMed, Embase, and Web of Science databases for all studies that assess the impact of warmed CM on adverse reactions. The primary outcomes of our study were allergic reaction and extravasation rates. We calculated weighted pooled odds ratios (OR) and 95% confidence intervals (CI) for all outcomes using the random-effects model. A P-value <0.05 was considered statistically significant. We conducted subgroup analyses based on the viscosity of the CM. RESULTS A total of five studies, including 307,329 CM injections (86,676 at room temperature and 220,653 warmed to 37 °C), were included in the analysis. For high viscosity CM, pre-warming was associated with significantly lower allergic reaction rates (OR: 0.59, 95% CI: 0.49-0.72, P < 0.00001). There was no significant difference in rates of extravasation for high viscosity CM (OR: 0.53, 95% CI: 0.20-1.43, P = 0.21). DISCUSSION Our meta-analysis suggests that warming CM to 37 °C is a safe and effective approach to reduce the risk of allergic reactions and physiologic reactions during injection of high-viscosity CM. However, there was no significant difference in extravasation rates between warmed and room temperature CM, regardless of viscosity.
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Affiliation(s)
- Mohamad Nawras
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
| | - Zakaria Alyousif
- University of Toledo College of Health and Human Services, Toledo, OH, USA
| | - Azizullah Beran
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Haitham Elsamaloty
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA; University of Toledo Department of Radiology, Toledo, OH, USA
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13
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Hoang VT, Hoang TH, Trinh CT, Hoang NT. Contrast agent extravasation in external jugular vein. Am J Emerg Med 2023:S0735-6757(23)00244-9. [PMID: 37179217 DOI: 10.1016/j.ajem.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Viet Nam.
| | - The Huan Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Viet Nam
| | - Cong Thao Trinh
- Department of Radiology, FV Hospital, Ho Chi Minh City, Viet Nam
| | - Ngoc Thanh Hoang
- Department of Radiology, University of Medicine and Pharmacy, Hue, Viet Nam
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Stefanos SS, Kiser TH, MacLaren R, Mueller SW, Reynolds PM. Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline. Pharmacotherapy 2023; 43:321-337. [PMID: 36938775 DOI: 10.1002/phar.2794] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 03/21/2023]
Abstract
Extravasation is the leakage of intravenous solutions into surrounding tissues, which can be influenced by drug properties, infusion techniques, and patient-related risk factors. Although peripheral administration of vesicants may increase the risk of extravasation injuries, the time and resources required for central venous catheter placement may delay administration of time-sensitive therapies. Recent literature gathered from the growing use of peripheral vasopressors and hypertonic sodium suggests low risk of harm for initiating these emergent therapies peripherally, which may prevent delays and improve patient outcomes. Physiochemical causes of tissue injury include vasoconstriction, pH-mediated, osmolar-mediated, and cytotoxic mechanisms of extravasation injuries. Acidic agents, such as promethazine, amiodarone, and vancomycin, may cause edema, sloughing, and necrosis secondary to cellular desiccation. Alternatively, basic agents, such as phenytoin and acyclovir, may be more caustic due to deeper tissue penetration of the dissociated hydroxide ions. Osmotically active agents cause cellular damage as a result of osmotic shifts across cellular membranes in addition to agent-specific toxicities, such as calcium-induced vasoconstriction and calcifications or arginine-induced leakage of potassium causing apoptosis. A new category has been proposed to identify absorption-refractory mechanisms of injury in which agents such as propofol and lipids may persist in the extravasated space and cause necrosis or compartment syndrome. Pharmacological antidotes may be useful in select extravasations but requires prompt recognition and frequently complex administration strategies. Historically, intradermal phentolamine has been the preferred agent for vasopressor extravasations, but frequent supply shortages have led to the emergence of terbutaline, a β2 -agonist, as an acceptable alternative treatment option. For hyperosmolar and pH-related mechanisms of injuries, hyaluronidase is most commonly used to facilitate absorption and dispersion of injected agents. However, extravasation management is largely supportive and requires a protocolized multidisciplinary approach for early detection, treatment, and timely surgical referral when required to minimize adverse events.
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Affiliation(s)
- Sylvia S Stefanos
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Scott W Mueller
- Department of Pharmacy, University of Colorado Health, Aurora, Colorado, USA
| | - Paul M Reynolds
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
- Department of Pharmacy, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
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Hama Y, Tate E. MRI findings of iatrogenic extravasation of gadolinium-based contrast agents in patients with cancer. Acta Radiol 2022; 64:1439-1442. [PMID: 36221814 DOI: 10.1177/02841851221129152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) findings after subcutaneous extravasation of gadolinium-based contrast agent (GBCA) have not been investigated in detail. PURPOSE To present the MRI findings of iatrogenic extravasation and to evaluate the characteristic findings. MATERIAL AND METHODS In this retrospective study of 16,039 patients with cancer, 11 patients had significant extravasation of macrocyclic GBCA, and 7 of the 11 had MRI of the injection site. Characteristic MRI findings as well as symptoms and changes over time were evaluated. RESULTS The forearms or antecubital fossa felt cold in all seven cases, and 3 (43%) patients felt pain at the injection sites. Fat-suppressed T1-weighted images showed a mosaic pattern of the extravasate with mixed high and low signal in the subcutaneous tissue in 7 (100%) cases. Contrast enhancement of the fascia toward the proximal portion was observed in 3 (43%) cases. There was no subfascial deep extension. On T2-weighted images, GBCAs were observed as low-signal fluid collection on the fascia, with linear spread to the dermis and subcutaneous tissue. Four patients underwent daily MRI scans, all of whom had their contrast disappeared within three days. CONCLUSION Macrocyclic GBCA disappears from subcutaneous tissue quickly after extravasation and is unlikely to cause serious sequelae.
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Affiliation(s)
- Yukihiro Hama
- Department of Radiology, Tokyo-Edogawa Cancer Centre, Edogawa Hospital, Tokyo, Japan
| | - Etsuko Tate
- Department of Radiology, Tokyo-Edogawa Cancer Centre, Edogawa Hospital, Tokyo, Japan
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Lemos RDCPB, Arreguy-Sena C, Melo LDD, Brandão MAG, Braga LM, Krempser P. PUNÇÃO VENOSA PERIFÉRICA E CONTRASTE NOS EXAMES RADIOLÓGICOS: REPRESENTAÇÕES SOCIAIS ANCORADAS NOS ESTRESSORES DE NEUMAN. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0030pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RESUMO Objetivo: discutir as representações sociais sobre a punção venosa periférica e o uso de meios de contraste de pessoas submetidas a exames radiológicos, referenciando-se no conceito de estressores. Método: pesquisa qualitativa, delineada na abordagem processual da Teoria das Representações Sociais, realizada com 57 usuários submetidos a exames de Tomografia Computadorizada e Ressonância Magnética em um Hospital Universitário de Juiz de Fora, Minas Gerais, Brasil. Realizaram-se entrevistas individuais em profundidade desencadeadas por questões norteadoras em janeiro de 2019. Os conteúdos das entrevistas foram transcritos na íntegra e realizou-se análise de conteúdo em três etapas (pré-análise, exploração do material e tratamento/interpretação dos resultados). A análise temático-categorial estabelecida a partir das dimensões e origens representacionais possibilitou a discussão dos achados ancorada nos conceitos de estressores, permitindo a identificação de três categorias baseadas nos estressores intrapessoais, interpessoais e transpessoais. Resultados: a punção e o exame foram representados pelas vivências individuais, grupais, com profissionais e ambiente terapêutico, classificados nas categorias: itinerário e concepções sobre punção e exames contrastados, com base em estressores intrapessoais; relações compartilhadas sobre a punção e o exame, fundamentadas em estressores interpessoais e vivências no ambiente terapêutico de um serviço de diagnóstico por imagem, a partir dos estressores transpessoais. Conclusão: as representações sociais foram significadas por exame, resultado e impactos na vida, retratando estressores alicerçados em imagens/sentimentos de dúvida e comportamentos positivos justificados racionalmente, que explicitam respostas humanas a conteúdos reificados, possibilitando a reestruturação do cuidado em saúde e em enfermagem.
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Lemos RDCPB, Arreguy-Sena C, Melo LDD, Brandão MAG, Braga LM, Krempser P. PERIPHERAL VENOUS PUNCTURE AND CONTRAST IN RADIOLOGICAL EXAMS: SOCIAL REPRESENTATIONS ANCHORED IN NEUMAN’S STRESSORS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0030en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
ABSTRACT Objective: to discuss the social representations about peripheral venipuncture and the use of contrast media of people submitted to radiological examinations, referring to stressor concept. Method: this is qualitative research, outlined in the procedural approach of the Social Representation Theory, carried out with 57 users undergoing computed tomography and magnetic resonance imaging at a university hospital in Juiz de Fora, Minas Gerais, Brazil. In-depth individual interviews triggered by guiding questions were conducted in January 2019. The contents of the interviews were fully transcribed and content analysis was carried out in three stages (pre-analysis, material exploration and treatment/interpretation of results). We established thematic analysis based on the dimensions and representational origins, which made it possible to discuss the findings anchored in the concepts of stressors, allowing the identification of three categories based on intrapersonal, interpersonal and transpersonal stressors. Results: puncture and examination were represented by individual, group, professional and therapeutic environment experiences, classified into the following categories: itinerary and conceptions on puncture and contrasted examinations based on intrapersonal stressors; shared relationships on puncture and examination, based on interpersonal stressors; and experiences in the therapeutic environment of a diagnostic imaging service, based on transpersonal stressors. Conclusion: the social representations were signified by examination, results and impacts on life, portraying stressors based on images/feelings of doubt and positive behaviors rationally justified, which explain human responses to reified content, enabling the restructuring of health care and nursing.
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