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Gorski LA, Ong J, Van Gerpen R, Nickel B, Kokotis K, Hadaway L. Development of an Evidence-Based List of Non-Antineoplastic Vesicants: 2024 Update. JOURNAL OF INFUSION NURSING 2024; 47:290-323. [PMID: 39250767 DOI: 10.1097/nan.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Infiltration of a vesicant, called extravasation, can result in severe patient injuries. Recognition of vesicants and their relative risk of injury is essential to extravasation prevention, early recognition, and appropriate treatment. In this article, the Vesicant Task Force (VTF) updates the previously published Infusion Nurses Society (INS) vesicant list from 2017. The 2024 INS list diverges from earlier vesicant lists, such as the 2017 VTF list, by adopting a risk stratification approach based upon documented patient outcomes, in contrast to the reliance on expert consensus or only surrogate risk indicators, such as pH and osmolarity. The methodology used to create the updated list is explained, and the criteria for high- and moderate-risk vesicants and cautionary vesicants are defined.
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Affiliation(s)
- Lisa A Gorski
- Author Affiliations: Ascension at Home, Brentwood, Tennessee (Gorski); Bryan Medical Center, Lincoln, Nebraska (Ong); Retired from Bryan Medical Center, Lincoln, Nebraska (Van Gerpen); Omaha, Nebraska (Nickel); Retired from BD Medical, Munster, Indiana (Kokotis); Lynn Hadaway Associates, Inc., Milner, Georgia (Hadaway)
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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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Dien Esquivel MF, Miller E, Bijelić V, Barrowman N, Putnins R. CT contrast extravasation in children: a single-center experience and systematic review. Pediatr Radiol 2024; 54:34-42. [PMID: 37991500 DOI: 10.1007/s00247-023-05811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Extravasation of iodinated contrast material during computed tomography (CT) is a rare complication. A few patients may develop severe complications such as compartment syndrome. OBJECTIVE The purpose of this study was to retrospectively assess the prevalence, severity, management, and outcome of contrast extravasations in our institution and to perform a comparison to what has been reported in the existing literature. MATERIALS AND METHODS This is a research ethics board (REB)-approved retrospective study comprising 11 patients who had intravenous contrast-enhanced CT between 2019 and 2022 in a tertiary pediatric center, and experienced extravasation of iodinated contrast as a complication. Age, weight, sex, co-morbidities, angiocatheter size, venous access location, total contrast volume, flow rate, patient's symptoms, severity of injury, and management were collected. For the systematic review, PRISMA guidelines were followed. RESULTS Only 11 (0.3%) (0.17-0.54 (95%CI)) contrast extravasations occurred in a total of 3638 CTs performed with intravenous contrast during the same period in children. The median age (IQR) was 12.5 (10.0, 15.0) years. In our cohort, 1/11 patients developed compartment syndrome and required fasciotomy. The systematic review assessed 12 articles representing a population of 110 children with extravasations. Pooled prevalence from articles stratified by age was 0.32% (0.06-0.58% (95%CI)). Only three children experienced moderate to severe complications. CONCLUSIONS We confirm that severe complications of contrast extravasation are rare and can occur at any age. No strong associations were seen with the need for surgical consultation (including age, sex, weight, flow rate, injection site, catheter size, and type of contrast).
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Affiliation(s)
- Maria F Dien Esquivel
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada.
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Elka Miller
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vid Bijelić
- CHEO Research Institute, CHEO, University of Ottawa, Ottawa, ON, Canada
| | - Nick Barrowman
- CHEO Research Institute, CHEO, University of Ottawa, Ottawa, ON, Canada
| | - Rita Putnins
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
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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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Harris S, Crowley JR, Warden N. Radiopharmaceutical administration practices-Are they best practice? FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2023; 3:1244660. [PMID: 39355051 PMCID: PMC11440992 DOI: 10.3389/fnume.2023.1244660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/28/2023] [Indexed: 10/03/2024]
Abstract
Background The nuclear medicine community has stated that they are using best practices to gain venous access and administer radiopharmaceuticals, and therefore do not contribute to extravasations. We tested this hypothesis qualitatively and quantitatively by evaluating four different perspectives of current radiopharmaceutical administration practices: (1) clinical observations of nuclear medicine technologists on the job, (2) quality improvement (QI) projects, (3) a high-level survey of current practices in 10 acute care hospitals, (4) intravenous (IV) access site data for 29,343 procedures. These four areas were compared to the gold standard of pharmaceutical administration techniques. Results From clinical observations of radiopharmaceutical administrations in adult populations, technologists extensively used 24-gauge peripheral intravenous catheters (PIVCs) and butterfly needles. They also performed direct puncture (straight stick). Technologists predominantly chose veins in areas of flexion (hand, wrist, and antecubital fossa), rather than forearm vessels for IV access placement; in many circumstances, antecubital fossa vessels are chosen first, often without prior assessment for other suitable vessels. For selecting the injection vein, technologists sometimes used infrared vein finders but primarily performed blind sticks. Review of QI projects suggested that smaller gauge needles were contributing factors to extravasations. Additionally, the review of surveys from 10 hospitals revealed an absence of formalized protocols, training, knowledge, and skills necessary to ensure the safety/patency of IV devices prior to the administration of radiopharmaceuticals. Finally, findings from a review of IV access data for 29,343 procedures supported the observations described above. Conclusions We expect that nuclear medicine technologists have the best intentions when providing patient care, but many do not follow venous access best practices; they lack formal protocols, have not received the latest comprehensive training, and do not use the best placement tools and monitoring equipment. Thus, the presumption that most nuclear medicine technologists use best practices may not be accurate. In order to improve radiopharmaceutical administration and patient care, the nuclear medicine community should update technical standards to address the most recent peripheral IV access and administration best practices, provide technologists with vascular visualization tools and the proper training, develop and require annual vascular access competency, and provide active monitoring with center and patient-specific data to create ongoing feedback.
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Affiliation(s)
- Stephen Harris
- Vascular Wellness Management Solutions, Cary, NC, United States
| | - James R Crowley
- Department of Molecular Imaging, Carilion Clinic, Roanoke, VA, United States
| | - Nancy Warden
- Vascular Wellness Management Solutions, Cary, NC, United States
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Sunderland JJ, Graves SA, York DM, Mundt CA, Bartel TB. Response to "Critique and Discussion of 'Multicenter Evaluation of Frequency and Impact of Activity Infiltration in PET Imaging, Including Microscale Modeling of Skin-Absorbed Dose'". J Nucl Med 2023; 64:1664-1667. [PMID: 37678926 PMCID: PMC10586484 DOI: 10.2967/jnumed.123.266596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
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Bartholow TL. To tell or not to tell … the patient about potential harm. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2023; 3:1258960. [PMID: 39355038 PMCID: PMC11440947 DOI: 10.3389/fnume.2023.1258960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 10/03/2024]
Abstract
Extravasation, as distinct from infiltration, is when a potentially toxic agent (e.g., radiographic contrast, chemotherapy, anesthesia or radionuclide) is unintentionally administered to the surrounding tissue instead of directly into the vein. There is an expectation for vascular access in interventional medicine across nearly all specialties that this high frequency, study/treatment critical procedure needs to occur with rare failure and that this failure rate should be characterized in quality assurance. This opinion piece, written by a family practitioner who has served as the chief medical officer for a not-for-profit payer, reflects on our responsibility to be aware as clinicians of known potential harm and disclose to patients before a risk has occurred and if harm has occurred. In this paper, clinical obligations of reporting will be reviewed, which are necessary to maintain and enhance our trust with our patients. In the second half, the perspectives of a not-for-profit payer chief medical officer will be considered.
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Krysa JA, Pohar Manhas KJ, Loyola-Sanchez A, Casha S, Kovacs Burns K, Charbonneau R, Ho C, Papathanassoglou E. Mobilizing registry data for quality improvement: A convergent mixed-methods analysis and application to spinal cord injury. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:899630. [PMID: 37077292 PMCID: PMC10109451 DOI: 10.3389/fresc.2023.899630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
IntroductionThe rising prevalence of complex chronic conditions and growing intricacies of healthcare systems emphasizes the need for interdisciplinary partnerships to advance coordination and quality of rehabilitation care. Registry databases are increasingly used for clinical monitoring and quality improvement (QI) of health system change. Currently, it is unclear how interdisciplinary partnerships can best mobilize registry data to support QI across care settings for complex chronic conditions.PurposeWe employed spinal cord injury (SCI) as a case study of a highly disruptive and debilitating complex chronic condition, with existing registry data that is underutilized for QI. We aimed to compare and converge evidence from previous reports and multi-disciplinary experts in order to outline the major elements of a strategy to effectively mobilize registry data for QI of care for complex chronic conditions.MethodsThis study used a convergent parallel-database variant mixed design, whereby findings from a systematic review and a qualitative exploration were analyzed independently and then simultaneously. The scoping review used a three-stage process to review 282 records, which resulted in 28 articles reviewed for analysis. Concurrent interviews were conducted with multidisciplinary-stakeholders, including leadership from condition-specific national registries, members of national SCI communities, leadership from SCI community organizations, and a person with lived experience of SCI. Descriptive analysis was used for the scoping review and qualitative description for stakeholder interviews.ResultsThere were 28 articles included in the scoping review and 11 multidisciplinary-stakeholders in the semi-structured interviews. The integration of the results allowed the identification of three key learnings to enhance the successful design and use of registry data to inform the planning and development of a QI initiative: enhance utility and reliability of registry data; form a steering committee lead by clinical champions; and design effective, feasible, and sustainable QI initiatives.ConclusionThis study highlights the importance of interdisciplinary partnerships to support QI of care for persons with complex conditions. It provides practical strategies to determine mutual priorities that promote implementation and sustained use of registry data to inform QI. Learnings from this work could enhance interdisciplinary collaboration to support QI of care for rehabilitation for persons with complex chronic conditions.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Kiran J. Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adalberto Loyola-Sanchez
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Steve Casha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB, Canada
| | - Rebecca Charbonneau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Correspondence: Elizabeth Papathanassoglou
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Tsorxe IY, Hayes RB. Dose Estimation for Extravasation of 177Lu, 99mTc, and 18F. HEALTH PHYSICS 2023; 124:217-220. [PMID: 36719937 DOI: 10.1097/hp.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT Extravasation is the situation in which a nuclear medicine injection deposits some fraction of its radioactivity into the soft tissue rather than the bloodstream and may result in a large local radiation dose to tissue. An understanding of localized radiation dose from such unexpected events can be an important aspect of clinical radiation protection. The aim of this study was to estimate and assess absorbed radiation dose to localized soft tissue for hypothetical scenarios of radiopharmaceutical extravasation. Specifically, the goal was to understand whether a radiopharmaceutical extravasation could exceed the US Nuclear Regulatory Commission's medical event reporting limit of 0.5 Sv dose equivalent to tissue or levels at which tissue damage would be anticipated (1.0 Sv dose equivalent). We used the GATE Monte Carlo simulation software to calculate self-dose to spherical volumes containing uniformly distributed amounts of common radiopharmaceutical isotopes. Simulated volumes, radioactivity levels, and effective half-lives represented real-world nuclear medicine procedures. Chosen scenarios consisted of 50 mCi and 100 mCi 177Lu within 20 cm3 and 40 cm3 tissue volumes and a 60 min biological clearance half-time (59.6 min effective half-life), 6 mCi and 12 mCi 99mTc within 1 cm3 and 5 cm3 tissue volumes and a 120 min biological clearance half-time (90 min effective half-life), and 3 mCi and 6 mCi 18F within 1 cm3 and 5 cm3 tissue volumes with a 30 min biological clearance half-time (23.6 min effective half-life). We calculated absorbed doses to be between 5.5 Gy and 23.5 Gy for 177Lu, between 0.9 Gy and 12.4 Gy for 99mTc, and between 1.5 Gy and 16.2 Gy for 18F. Radiopharmaceutical extravasations can result in tissue doses that surpass both medical event reporting limits and levels at which deterministic effects are expected. Radiation safety programs should include identification, mitigation, dosimetry, and documentation of significant extravasation events.
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Kohl P. Transparency - a patient-centric view on radiopharmaceutical extravasations. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2023; 3:1127692. [PMID: 39355019 PMCID: PMC11440838 DOI: 10.3389/fnume.2023.1127692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/09/2023] [Indexed: 10/03/2024]
Abstract
Most radiopharmaceuticals are intravenously administered during nuclear medicine imaging or therapy procedures. When a nuclear medicine clinician delivers some or all of a radioactive drug into a patient's healthy tissue rather than the vein as intended, a patient experiences an extravasation. Radiopharmaceutical extravasations provide zero patient benefit and considerable potential downsides, depending on the severity of the extravasations. What nuclear medicine patients want and need regarding the administration of radiopharmaceuticals is transparency. And yet in the year 2023, little transparency exists regarding these extravasations. From the patient perspective, transparency regarding extravasations is essential to improving care, ensuring radiation protection, reducing health inequities, and untangling the deeply disturbing and irregular relationship between the nuclear medicine community and their regulating body, The U.S. Nuclear Regulatory Commission. Transparency is also critical to help address many other questions regarding radiopharmaceutical extravasations.
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Affiliation(s)
- Pam Kohl
- Independent Researcher, Raleigh, NC, United States
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Shigematsu S, Oda S, Sakabe D, Matsuoka A, Hayashi H, Taguchi N, Kidoh M, Nagayama Y, Nakaura T, Murakami M, Hatemura M, Hirai T. Practical Preventive Strategies for Extravasation of Contrast Media During CT: What the Radiology Team Should Do. Acad Radiol 2022; 29:1555-1559. [PMID: 35246376 DOI: 10.1016/j.acra.2022.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to assess the effectiveness of practical preventive strategies (i.e., venous vulnerability assessment and prevention scan protocol rules) taken by our radiology team (radiology nurses, radiology technicians, radiologists) on reducing extravasation of contrast media (ECM) during CT. MATERIALS AND METHODS A total of 73,931 patients who underwent contrast-enhanced CT scans between January 2013 and December 2019 were retrospectively included. Venous vulnerability assessment by the radiology team began in 2015, and prevention scan protocol rules for the prevention of ECM were added in 2017. We defined each period as follows: 2013-2014, no prevention (Period A); 2015-2016, early prevention (Period B, venous vulnerability assessment only); and 2017-2019: late prevention (Period C, venous vulnerability assessment with prevention scan protocol rules). The incident reports, radiology reports, and medical records of patients in whom ECM occurred were reviewed. We compared the frequency of ECM during each period. RESULTS ECM occurred in 0.39% (292/73,931) of the patients. The frequencies of ECM for Periods A, B, and C were 0.62% (121/19,505), 0.43% (89/20,847), and 0.24% (82/33,579), respectively. There were significant differences in the frequencies of ECM among the three periods (Chi-squared test, p < 0.01). CONCLUSION Implementation of venous vulnerability assessment and prevention scan protocol rules by a radiology team can be a practical and simple solution to reduce the risk of ECM during CT.
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Affiliation(s)
- Shinsuke Shigematsu
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Daisuke Sakabe
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Ayumi Matsuoka
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Narumi Taguchi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Michiyo Murakami
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Masahiro Hatemura
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
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Roditi G, Khan N, van der Molen AJ, Bellin MF, Bertolotto M, Brismar T, Correas JM, Dekkers IA, Geenen RWF, Heinz-Peer G, Mahnken AH, Quattrocchi CC, Radbruch A, Reimer P, Romanini L, Stacul F, Thomsen HS, Clément O. Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines. Eur Radiol 2022; 32:3056-3066. [PMID: 35175378 PMCID: PMC9038843 DOI: 10.1007/s00330-021-08433-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2021] [Accepted: 10/14/2021] [Indexed: 01/28/2023]
Abstract
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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Affiliation(s)
- Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Nadir Khan
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-France Bellin
- University Paris-Saclay, AP-HP, University Hospital Bicêtre, Service de Radiologie, BioMaps, Le Kremlin-Bicêtre, France
| | | | - Torkel Brismar
- Department of Clinical Science, Intervention and Technology, Unit of Radiology, Karolinska Institutet and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Jean-Michel Correas
- Université de Paris, AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Paris, France
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany
| | - Carlo C Quattrocchi
- Imaging Center, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Alexander Radbruch
- Department of Radiology, Clinic for Diagnostic and Interventional Neuroradiology, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | - Henrik S Thomsen
- Department of Radiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Olivier Clément
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, 20 Rue LeBlanc, 75015, Paris, France.
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van Veelen NM, Link BC, Donner G, Babst R, Beeres FJP. Compartment syndrome of the forearm caused by contrast medium extravasation: A case report and review of the literature. Clin Imaging 2020; 61:58-61. [PMID: 31978761 DOI: 10.1016/j.clinimag.2020.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/30/2019] [Accepted: 01/13/2020] [Indexed: 11/15/2022]
Abstract
Compartment syndrome is a rare but serious complication of contrast medium extravasation. To avoid permanent damage, it is important to recognize the symptoms quickly and immediately initiate treatment. We report a patient, who developed compartment syndrome of the forearm after extravasation of contrast medium and review the available literature on this subject. To our knowledge this is the first reported case of compartment syndrome of the forearm due to contrast medium application for a trauma CT in a patient that had no direct trauma to the affected limb.
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Affiliation(s)
- Nicole M van Veelen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland.
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Georg Donner
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland.
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14
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Stowell JR, Rigdon D, Colglazier R, Filler L, Orosco D, Connell M, Akhter M, Mitchell C. Risk of contrast extravasation with vascular access in computed tomography. Emerg Radiol 2020; 27:253-258. [PMID: 31919617 DOI: 10.1007/s10140-020-01752-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Diagnostic computed tomography (CT) imaging, utilizing intravenous (IV) contrast administration, has become increasingly common. Potential IV contrast-associated complications include local skin and soft tissue reactions due to extravasation. The goal of this study is to describe the risk of contrast extravasation based on IV catheter anatomic location in patients receiving contrast-enhanced CT imaging. METHODS The study was conducted as a retrospective cohort study of patients receiving contrast-enhanced CT imaging performed over a 26-month period at a single institution. The rate of contrast extravasation was calculated by IV catheter vessel anatomic location and compared by relative risk (RR) and absolute risk reduction (ARR). RESULTS Of 17,767 contrast administrations for CT imaging studies performed, 14,558 met study inclusion criteria. Forty-nine (0.34%) extravasation events were identified. Forty-one (0.28%, 95% CI 0.21-0.39%) extravasation events were observed in 14,275 peripheral IV catheters placed in a non-upper arm location. Eight (2.8%, 95% CI 1.3-5.3%) extravasation events were observed in 283 IV catheters placed, most commonly with point-of-care ultrasound (POCUS) guidance, in upper arm vessels (RR 10.1, 95% CI 4.69-21.8). Non-upper arm located IV catheters were associated with an ARR of 2.54% (95% CI 0.61-4.47%) when compared to upper arm catheters. CONCLUSIONS IV catheter placement in upper arm vessels is associated with a relatively minimal increase in extravasation risk when compared to catheters placed in a non-upper arm location. In patients without alternative available peripheral vascular access, POCUS-guided upper arm IV cannulation may be an appropriate approach.
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Affiliation(s)
- Jeffrey R Stowell
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA.
- Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA.
- Department of Emergency Medicine, Creighton University School of Medicine, 7500 Mercy Rd, Omaha, NE, 68124, USA.
| | - Daniel Rigdon
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Roy Colglazier
- Department of Radiology, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Levi Filler
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Daniel Orosco
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Mary Connell
- Department of Radiology, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
| | - Murtaza Akhter
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
- Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA
- Department of Emergency Medicine, Creighton University School of Medicine, 7500 Mercy Rd, Omaha, NE, 68124, USA
| | - Carl Mitchell
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA
- Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA
- Department of Emergency Medicine, Creighton University School of Medicine, 7500 Mercy Rd, Omaha, NE, 68124, USA
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15
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Barrera CA, White AM, Shepherd AM, Mecca P, Biko DM, Saul D, Otero HJ. Contrast Extravasation using Power Injectors for Contrast-Enhanced Computed Tomography in Children: Frequency and Injury Severity. Acad Radiol 2019; 26:1668-1674. [PMID: 31138458 DOI: 10.1016/j.acra.2019.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 04/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the safety of power injectors for contrast-enhanced computed tomography (CT) in children, namely: the prevalence and injury severity of contrast extravasations related to power injectors and the factors associated with these events. METHODS The need to obtain informed consent was waived for this HIPAA-compliant and IRB approved retrospective study. Around 2429 contrast-enhanced CT performed with a power injector were identified during a 3-year period. Data collected included patient demographic, power injector, and contrast agent information. The patients' symptoms, severity of injury and treatment with contrast extravasation were recorded. Around 1496 cases (823 boys, 673 girls) were included in the analysis. Independent-sample t test and Chi-square were used. For a sub-analysis using the extravasation cases, nonparametric tests were used. RESULTS The mean age was 9.5 ± 6.1 years. The most common access site, catheter site, and contrast agent used were the antecubital fossa, 22 gauge and Iohexol. The mean peak pressure was 68.9 ± 62.3 psi and the flow rate was 1.7 ± 0.9 mL/s. Eighteen cases of contrast extravasation were identified with a mean age of 11.2 ± 6.2 years. There were seven mild, six moderate, and five severe. Cases with extravasation had significantly higher peak pressure (p < 0.001) and flow rate (p < 0.001) compared to those without extravasation. Patients who received Iohexol-350 had significantly more contrast extravasation compared to those who used Iohexol-300 (p = 0.03). However, after post-hoc correction, only peak pressure (p < 0.01) and flow rate (p = 0.01) remained significant. CONCLUSION The use of power injectors in children undergoing contrast-enhanced CT is associated with a low rate of extravasation and of long-term injury.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Ammie M White
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Ashley M Shepherd
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Patricia Mecca
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - David Saul
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
| | - Hansel J Otero
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104
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16
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Wong TZ, Benefield T, Masters S, Kiser JW, Crowley J, Osborne D, Mawlawi O, Barnwell J, Gupta P, Mintz A, Ryan KA, Perrin SR, Lattanze RK, Townsend DW. Quality Improvement Initiatives to Assess and Improve PET/CT Injection Infiltration Rates at Multiple Centers. J Nucl Med Technol 2019; 47:326-331. [PMID: 31182666 PMCID: PMC6894099 DOI: 10.2967/jnmt.119.228098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/28/2019] [Indexed: 12/29/2022] Open
Abstract
PET/CT radiotracer infiltration is not uncommon and is often outside the imaging field of view. Infiltration can negatively affect image quality, image quantification, and patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control and quality assurance. Our objectives were to quantify infiltration rates, determine associative factors for infiltration, and assess whether rates could be reduced at multiple centers and then sustained. Methods: A “design, measure, analyze, improve, and control” quality improvement methodology requiring novel technology was used to try to improve PET/CT injection quality. Teams were educated on the importance of quality injections. Baseline infiltration rates were measured, center-specific associative factors were analyzed, team meetings were held, improvement plans were established and executed, and rates remeasured. To ensure that injection-quality gains were retained, real-time feedback and ongoing monitoring were used. Sustainability was assessed. Results: Seven centers and 56 technologists provided data on 5,541 injections. The centers’ aggregated baseline infiltration rate was 6.2% (range, 2%–16%). On the basis of their specific associative factors, 4 centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). Ongoing injection monitoring showed sustainability. Significant variation was found in center- and technologist-level infiltration rates (P < 0.0001 and P = 0.0020, respectively). Conclusion: A quality improvement approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve and sustain injection quality. Because PET/CT images help guide patient management, the monitoring and improvement of radiotracer injection quality are important.
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Affiliation(s)
- Terence Z Wong
- Duke University, Durham, North Carolina.,University of North Carolina, Chapel Hill, North Carolina
| | - Thad Benefield
- University of North Carolina, Chapel Hill, North Carolina
| | - Shane Masters
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina
| | | | | | - Dustin Osborne
- Radiology/Molecular Imaging and Translational Research, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Osama Mawlawi
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
| | | | - Pawan Gupta
- Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA Health, Los Angeles, California
| | - Akiva Mintz
- Columbia University Medical Center, New York, New York
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17
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Lattanze RK, Osman MM, Ryan KA, Frye S, Townsend DW. Usefulness of Topically Applied Sensors to Assess the Quality of 18F-FDG Injections and Validation Against Dynamic Positron Emission Tomography (PET) Images. Front Med (Lausanne) 2018; 5:303. [PMID: 30443549 PMCID: PMC6221940 DOI: 10.3389/fmed.2018.00303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Infiltrations of 18F-fluorodeoxyglucose (FDG) injections affect positron emission tomography/computed tomography (PET/CT) image quality and quantification. A device using scintillation sensors (Lucerno Dynamics, Cary, NC) provides dynamic measurements acquired during FDG uptake to identify and characterize radioactivity near the injection site prior to patient imaging. Our aim was to compare sensor measurements against dynamic PET image acquisition, our proposed reference in assessing injection quality during the uptake period. Methods: Subjects undergoing routine FDG PET/CT imaging were eligible for this Institutional Review Board approved prospective study. After providing informed consent, subjects had sensors topically placed on their arms. FDG was injected into subjects' veins directly on the PET imaging table. Dynamic images of the injection site were acquired during 45 min of the uptake period. These dynamic image acquisitions and subjects' routine standard static images were evaluated by nuclear medicine physicians for abnormal FDG accumulation near the injection site. Sensor measurements were interpreted independently by Lucerno staff. Dynamic image acquisition interpretation results were compared to the sensor measurement interpretations and to static image interpretations. Results: Twenty-four subjects were consented and enrolled. Data from 21 subjects were gathered. During dynamic image acquisition review, physicians interpreted 4 subjects with no FDG accumulation at the injection site, whereas 17 showed evidence of accumulation. In 10 of the 17 cases that showed FDG accumulation, the FDG presence at the injection site resolved completely during uptake corresponding to venous stasis, the temporary sequestration of blood from circulation. Static image interpretation agreed with dynamic images interpretation in 11/21 (52%) subjects. Sensor measurement interpretations agreed with the dynamic images interpretations in 18/21 (86%) subjects. Conclusions: Sensor measurements can be an effective way to identify and characterize infiltrations and venous stasis. Comparable to an infiltration, venous stasis may produce spurious and clinically meaningful measurement bias and possibly even scan misinterpretation. Since the quality and quantification of PET/CT studies are of clinical importance, sensor measurements acquired during the FDG uptake may prove to be a useful quality control measure to reduce infiltration rates and potentially improve patient care. Registration: Clinicaltrials.gov, Identifier: NCT03041090.
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Affiliation(s)
| | - Medhat M. Osman
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, St. Louis, MO, United States
| | | | - Sarah Frye
- Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, United States
| | - David W. Townsend
- ASTAR-NUS Clinical Imaging Research Centre (ASTAR), Singapore, Singapore
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18
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Silva HCDS, Bitencourt AGV, Chojniak R. Extravasation of iodinated contrast medium in cancer patients undergoing computed tomography. Radiol Bras 2018; 51:236-241. [PMID: 30202127 PMCID: PMC6124592 DOI: 10.1590/0100-3984.2017.0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the incidence of extravasation of
iodinated contrast medium (ICM) at the site of intravenous injection in
oncology patients submitted to computed tomography (CT). Materials and Methods This was a retrospective, descriptive, single-center study that evaluated all
patients who underwent CT with ICM administration and presented ICM
extravasation, at a cancer center, between January 2010 and December
2015. Results During the study period, we evaluated a total of 99,076 ICM injections and
identified 199 cases of extravasation, the incidence rate therefore being
0.20%. Among the patients who presented extravasation, the mean age was
59.22 years and 60% were female. The extravasation was classified as mild in
94.10% of the patients and as moderate in 5.90%. There were no cases of
severe extravasation in the sample. Conclusion The incidence of ICM extravasation in cancer patients submitted to CT in the
present study was similar to that reported for the general population,
according to other studies in the literature. The vast majority of cases of
extravasation were considered mild, and no severe cases were observed in the
study sample.
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Affiliation(s)
| | | | - Rubens Chojniak
- MD, PhD, Radiologist, Director of the Imaging Department of A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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19
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Ko CH, Tay SY, Chang HC, Chan WP. Large-volume iodinated contrast medium extravasation: low frequency and good outcome after conservative management in a single-centre cohort of more than 67,000 patients. Eur Radiol 2018; 28:5376-5383. [PMID: 29948071 DOI: 10.1007/s00330-018-5514-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim was to retrospectively investigate the frequency and outcome of large-volume iodinated contrast medium (CM) extravasation in our institution and to compare our management protocol to current practice. METHODS Institutional review board approval was obtained, and informed consent was waived because the study was retrospective. From January 2008 to September 2016, radiological examinations with intravenous non-ionic iodinated CM administration were performed in 67,129 patients. Contrast medium extravasation events on CT scans and intravenous pyelograms but not on angiograms were included. All data were collected prospectively and stratified according to age, injection method (manual vs auto-injection), prevention of extravasation by various means (including intercom alarm), management of extravasation (routine application of silver sulfadiazine ointment, clobetasol propionate cream, and damp gauze at room temperature), etc. RESULTS: The incidence of large-volume CM extravasation was very low (0.04% [27/67,129] overall; 0.03% related to manual injection [age range, 59-92 years; mean, 75.4 years], and 0.045% related to auto-injection [age range, 36-86 years; mean, 65.8 years]). The CM extravasation volume in majority of patients was 20-40 ml in 5 of 9 patients (55.6%) in the manual injection group and 14 of 18 (77.8%) in the auto-injection group. Swelling and pain were the most common symptoms. No patient developed severe signs or needed surgical intervention. CONCLUSIONS Results show a very low incidence of large-volume CM extravasation without severe complications or sequelae. The casual effect between our protocols and good outcome cannot be scrutinised thoroughly because the study lacks a control group and is retrospective. KEY POINTS • The incidence of large-volume contrast medium extravasation (≥20 ml) was 0.04%. • No patient needed surgical intervention, and most recovered within 7 days. • Each element of our management protocol contributed to good outcome.
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Affiliation(s)
- Chih-Hsiang Ko
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Road, Sec 3, Taipei, 116, Taiwan, Republic of China.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China
| | - Shee Yen Tay
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Road, Sec 3, Taipei, 116, Taiwan, Republic of China.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China
| | - Hsiu-Chin Chang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Road, Sec 3, Taipei, 116, Taiwan, Republic of China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Road, Sec 3, Taipei, 116, Taiwan, Republic of China. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China.
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20
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Hwang EJ, Shin CI, Choi YH, Park CM. Frequency, outcome, and risk factors of contrast media extravasation in 142,651 intravenous contrast-enhanced CT scans. Eur Radiol 2018; 28:5368-5375. [DOI: 10.1007/s00330-018-5507-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
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21
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Sonis JD, Gottumukkala RV, Glover M, Yun BJ, White BA, Kalra MK, Otrakji A, Raja AS, Prabhakar AM. Implications of iodinated contrast media extravasation in the emergency department. Am J Emerg Med 2018; 36:294-296. [DOI: 10.1016/j.ajem.2017.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/06/2017] [Indexed: 11/27/2022] Open
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22
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Ding S, Meystre NR, Campeanu C, Gullo G. Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:87-116. [PMID: 29324560 PMCID: PMC5771689 DOI: 10.11124/jbisrir-2017-003348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To identify risk factors and interventions preventing or reducing contrast medium extravasation. INTRODUCTION Computed tomography (CT) is a radiological examination essential for the diagnosis and monitoring of many diseases. It is often performed with the intravenous (IV) injection of contrast agents. Use of these products can result in a significant complication, extravasation, which is the accidental leakage of IV material into the surrounding tissue. Patients may feel a sharp pain and skin ulceration or necrosis may develop. INCLUSION CRITERIA This review considered studies that included patients (adults and children) undergoing a CT with IV administration of contrast media. The risk factors considered were patient demographics, comorbidities and medication history. This review also investigated any strategies related to: contrast agent, injection per se, material used for injection, apparatus used, healthcare professionals involved, and patient risk assessment performed by the radiology personnel. The comparators were other interventions or usual care. This review investigated randomized controlled trials and non-randomized controlled trials. When neither of these were available, other study designs, such as prospective and retrospective cohort studies, case-control studies and case series, were considered for inclusion. Primary outcomes considered were: extravasation frequency, volume, severity and complications. METHODS The databases PubMed, CINAHL, Embase, the Cochrane Register of Controlled Trials, Web of Science PsycINFO, ProQuest Dissertations and Theses A&I, TRIP Database and ClinicalTrials.gov were searched to find both published and unpublished studies from 1980 to September 2016. Papers were assessed by two independent reviewers for methodological validity using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted using the standardized data extraction tool from JBI SUMARI. In one case, quantitative data from two cohort studies were pooled in a statistical meta-analysis. However, generally, statistical pooling was not possible due to heterogeneity of the interventions, populations of interest or outcomes. Accordingly, the findings have been presented in narrative form. RESULTS Fifteen articles were selected from a total of 2151 unique studies identified. Two were randomized controlled trials and 13 were quasi-experimental and observational studies. The quality of these studies was judged to be low to moderate. Some patient characteristics, such as female sex and inpatient status, appeared to be risk factors for extravasation. Additionally, injection rate, venous access site and catheter dwelling time could affect the volume extravasated. Preliminary studies seemed to indicate the potential of extravasation detection accessories to identify extravasation and reduce the volume extravasated. The other interventions either did not result in significant reduction in the frequency/volume of extravasation, or the results were mixed across the studies. CONCLUSIONS The majority of the studies included in this review evaluated the outcomes of extravasation frequency and volume. Given the quality of the primary studies, this systematic review identified only potential risk factors and interventions. It further highlighted the research gap in this area and the importance of conducting trials with solid methodological designs.
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Affiliation(s)
- Sandrine Ding
- Department of Technical Medical Radiology, Haute École de Santé Vaud (HESAV), University of Applied Sciences Western Switzerland (HES-SO), Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence, Lausanne, Switzerland
| | - Nicole Richli Meystre
- Department of Technical Medical Radiology, Haute École de Santé Vaud (HESAV), University of Applied Sciences Western Switzerland (HES-SO), Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence, Lausanne, Switzerland
| | - Cosmin Campeanu
- Department of Technical Medical Radiology, Haute École de Santé Vaud (HESAV), University of Applied Sciences Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Giuseppe Gullo
- Department of Radiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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23
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Conner B, Ash R, Allen W, Brown T, Hill J, Hook M, Fishback S. Preventing Intravenous Contrast Extravasation in CT: A Simple Solution. J Am Coll Radiol 2017; 14:1326-1332. [PMID: 28739321 DOI: 10.1016/j.jacr.2017.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/15/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Brandy Conner
- Department of Radiology, The University of Kansas Medical Center, Kansas City, Kansas.
| | - Ryan Ash
- Department of Radiology, The University of Kansas Health System, Kansas City, Kansas
| | - Wendy Allen
- Department of Radiology, The University of Kansas Health System, Kansas City, Kansas
| | - Travis Brown
- Department of Radiology, The University of Missouri-Kansas City, Kansas City, Missouri
| | - Jacqueline Hill
- Department of Radiology, The University of Kansas Medical Center, Kansas City, Kansas
| | - Marcus Hook
- Department of Radiology, The University of Vermont Medical Center, Burlington, Vermont
| | - Shelby Fishback
- Department of Radiology, The University of Kansas Health System, Kansas City, Kansas
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24
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Karády J, Panajotu A, Kolossváry M, Szilveszter B, Jermendy ÁL, Bartykowszki A, Károlyi M, Celeng C, Merkely B, Maurovich-Horvat P. The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial. Eur Radiol 2017; 27:4538-4543. [PMID: 28540480 PMCID: PMC5635079 DOI: 10.1007/s00330-017-4866-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/20/2017] [Accepted: 04/03/2017] [Indexed: 11/25/2022]
Abstract
Objectives Contrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA. Methods Patients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol. Results 2,445 consecutive patients were enrolled (mean age 60.6 ± 12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p = 0.034). Conclusions Four-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA. Key Points • Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. • The saline pacer bolus substantially reduces the risk of CM extravasation. • The implementation of four-phasic injection-protocol is at no cost.
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Affiliation(s)
- Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Ádám L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Andrea Bartykowszki
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Mihály Károlyi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Csilla Celeng
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, 1122, Budapest, Hungary.
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Chen QL, Zhao XY, Wang XM, Lv N, Zhu LL, Xu HM, Zhou Q. Retrospective analysis of non-laboratory-based adverse drug reactions induced by intravenous radiocontrast agents in a Joint Commission International-accredited academic medical center hospital in China. Ther Clin Risk Manag 2017; 13:565-573. [PMID: 28490883 PMCID: PMC5414727 DOI: 10.2147/tcrm.s134265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The authors retrospectively analyzed the pattern and characteristics of non-laboratory-based adverse drug reactions (ADRs) induced by intravenous radiocontrast agents in a large-scale hospital in China during 2014-2015. There were 314 ADR cases among 118,208 patients receiving enhanced CT or MRI examinations. The frequency of moderate/severe ADRs defined by Chinese Society of Radiology (ie, severe vomiting, systematic urticaria, facial swelling, dyspnea, vasovagal reaction, laryngeal edema, seizure, trembling, convulsions, unconsciousness, shock, death, and other unexpected adverse reactions) was rare (0.0431%), whereas the mild ADRs were uncommon (0.2225%) and accounted for 83.76% of ADRs. Frequency of ADRs induced by iodinated contrast agents was related with examination site, sex, and type of patient settings (P<0.01) and was higher compared with gadolinium contrast agents (0.3676% vs 0.0504%, P<0.01). From 2014 to 2015, frequencies of total and moderate/severe ADRs induced by iodinated contrast agents decreased significantly (0.4410% vs 0.2947%, P<0.01; 0.0960% vs 0.0282%, P<0.01, respectively). Frequency of ADRs differed among different iodinated contrast and gadolinium contrast (P<0.05) agents. Iopromide's ADR frequency in 2014 was significantly higher compared with iopamidol, ioversol, or iohexol (P<0.01). Frequency of moderate/severe ADRs induced by iodixanol was 4.1-5.4 times that of iohexol, iopromide, or iopamidol. Rash was the predominant ADR subtype (84.39%) and occurred more frequently with iodixanol compared with iohexol, iopamidol, or ioversol (P<0.01). Overall, 21.97% of ADR cases had allergy history or atopy traits, and these cases experienced ADRs earlier than the negative ones (17.19 min vs 85.34 min, P<0.01). The mean time to onset of ADRs was increased in patients receiving iodixanol compared with other iodinated contrast agents (323.77 min vs 42.36 min, P<0.01). Overall, 37.26% of ADRs occurred within 5 min and 84.08% of ADRs occurred within 30 min. Efficient quality improvement in decreasing ADRs induced by radiocontrast agents has been achieved by multidisciplinary collaboration.
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Affiliation(s)
| | | | | | - Na Lv
- Department of Quality Management
| | | | - Hui-Min Xu
- Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Quan Zhou
- Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Power Injection Through Ultrasound-Guided Intravenous Lines: Safety and Efficacy Under an Institutional Protocol. J Emerg Med 2016; 52:16-22. [PMID: 27765438 DOI: 10.1016/j.jemermed.2016.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND After an index case of contrast-associated compartment syndrome, an urban hospital instituted a protocol limiting high-speed injection to intravenous (IV) lines started proximal to the forearm and testing those lines before contrast injection. OBJECTIVE In this article, we estimate the safety and efficacy of high-speed injection using this protocol in patients with IV lines inserted under ultrasound guidance. METHODS In an ambispective study, we enrolled prospective cohorts of ED patients requiring high-speed radiographic contrast media injection (≥3.5 mL/sec) into two groups: those with IV lines placed under ultrasound guidance and those with IV lines placed using traditional inspection and palpation. We also performed a retrospective review involving those groups. In addition, we reviewed hospital records for all patients with compartment syndrome between January 2010 and December 2011. We calculated 95% confidence intervals using normal approximation or exact calculation. RESULTS Between November 2013 and August 2014, the ED referred 32 patients to the Department of Radiology for computed tomography angiography involving high-speed contrast injection through ultrasound-guided IV lines. Of these, 25 of 32 (78%) had successful injection (7 failed in the Department of Radiology) vs. 26 of 27 (96%) with catheters inserted using traditional methods (risk difference 0.18 [95% confidence interval -0.01 to 0.38]). Based on retrospective records, we estimated 79 additional cases. We found no cases of compartment syndrome during either period, for an incidence estimate of 0 per 100 cases (95% confidence interval 0-3). CONCLUSION A hospital policy for high-speed contrast injection through ultrasound-guided IV lines has a safe record. However, 22% of patients with ultrasound-guided IV lines were refused for CT.
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Nicola R, Shaqdan KW, Aran S, Prabhakar AM, Singh AK, Abujudeh HH. Contrast Media Extravasation of Computed Tomography and Magnetic Resonance Imaging: Management Guidelines for the Radiologist. Curr Probl Diagn Radiol 2016; 45:161-4. [DOI: 10.1067/j.cpradiol.2015.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022]
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Mansouri M, Aran S, Shaqdan KW, Abujudeh HH. Rating and Classification of Incident Reporting in Radiology in a Large Academic Medical Center. Curr Probl Diagn Radiol 2016; 45:247-52. [PMID: 27020256 DOI: 10.1067/j.cpradiol.2016.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/11/2016] [Indexed: 12/30/2022]
Abstract
The purpose of this article is to provide a rate of safety incident report of adverse events in a large academic radiology department and to share the various types that may occur. This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved study. Consent requirement was waived. All incident reports from April 2006-September 2012 were retrieved. Events were further classified as follows: diagnostic test orders, identity document or documentation or consent, safety or security or conduct, service coordination, surgery or procedure, line or tube, fall, medication or intravenous safety, employee general incident, environment or equipment, adverse drug reaction (ADR), skin or tissue, and diagnosis or treatment. Overall rates and subclassification rates were calculated. There were 10,224 incident reports and 4,324,208 radiology examinations (rate = 0.23%). The highest rates of the incident reports were due to diagnostic test orders (34.3%; 3509/10,224), followed by service coordination (12.2%; 1248/10,224) and ADR (10.3%; 1052/4,324,208). The rate of incident reporting was highest in inpatient (0.30%; 2949/970,622), followed by emergency radiology (0.22%; 1500/672,958) and outpatient (0.18%; 4957/2,680,628). Approximately 48.5% (4947/10,202) of incidents had no patient harm and did not affect the patient, followed by no patient harm, but did affect the patient (35.2%, 3589/10,202), temporary or minor patient harm (15.5%, 1584/10,202), permanent or major patient harm (0.6%, 62/10,202), and patient death (0.2%, 20/10,202). Within an academic radiology department, the rate of incident reports was only 0.23%, usually did not harm the patient, and occurred at higher rates in inpatients. The most common incident type was in the category of diagnostic test orders, followed by service coordination, and ADRs.
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Affiliation(s)
- Mohammad Mansouri
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shima Aran
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Khalid W Shaqdan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hani H Abujudeh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Mansouri M, Aran S, Shaqdan KW, Abujudeh HH. How often are Patients Harmed When They Visit the Computed Tomography Suite? A Multi-year Experience, in Incident Reporting, in a Large Academic Medical Center. Eur Radiol 2015; 26:2064-72. [PMID: 26560719 DOI: 10.1007/s00330-015-4061-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/27/2015] [Accepted: 10/06/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our goal is to present our multi-year experience in incident reporting in CT in a large medical centre. METHODS This is an IRB-approved, HIPAA-compliant study. Informed consent was waived for this study. The electronic safety incident reporting system of our hospital was searched for the variables from April 2006 to September 2012. Incident classifications were diagnostic test orders, ID/documentation, safety/security/conduct, service coordination, surgery/procedure, line/tube, fall, medication/IV safety, employee general incident, environment/equipment, adverse drug reaction, skin/tissue and diagnosis/treatment. RESULTS A total of 1918 incident reports occurred in the study period and 843,902 CT examinations were performed. The rate of safety incident was 0.22 % (1918/843,902). The highest incident rates were due to adverse drug reactions (652/843,902 = 0.077 %) followed by medication/IV safety (573/843,902 = 0.068 %) and diagnostic test orders (206/843,902 = 0.024 %). Overall 45 % of incidents (869/1918) caused no harm and did not affect the patient, 33 % (637/1918) caused no harm but affected the patient, 22 % (420/1918) caused temporary or minor harm/damage and less than 1 % (10/1918) caused permanent or major harm/damage or death. CONCLUSION Our study shows a total safety incident report rate of 0.22 % in CT. The most common incidents are adverse drug reaction, medication/IV safety and diagnostic test orders. KEY POINTS • Total safety incident report rate in CT is 0.22 %. • Adverse drug reaction is the most common safety incident in CT. • Medication/IV safety is the second most common safety incident in CT.
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Affiliation(s)
- Mohammad Mansouri
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders Building, Room 210, Boston, 02114, MA, USA
| | - Shima Aran
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders Building, Room 210, Boston, 02114, MA, USA
| | - Khalid W Shaqdan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders Building, Room 210, Boston, 02114, MA, USA
| | - Hani H Abujudeh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders Building, Room 210, Boston, 02114, MA, USA. .,Department of Radiology, Cooper University Hospital of Rowan University, One Cooper Plaza, Camden, 08103, NJ, USA.
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30
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Safety incident reporting in emergency radiology: analysis of 1717 safety incident reports. Emerg Radiol 2015; 22:623-30. [DOI: 10.1007/s10140-015-1336-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/24/2015] [Indexed: 12/22/2022]
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