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Hirata I, Mazzotta A, Makvandi P, Cesini I, Brioschi C, Ferraris A, Mattoli V. Sensing Technologies for Extravasation Detection: A Review. ACS Sens 2023; 8:1017-1032. [PMID: 36912628 PMCID: PMC10043935 DOI: 10.1021/acssensors.2c02602] [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: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
Peripheral intravenous catheters are administered for various purposes, such as blood sampling or the infusion of contrast agents and drugs. Extravasation happens when the catheter is unintentionally directed outside of the vein due to movement of the intravascular catheter, enhanced vascular permeability, or occlusion of the upstream vein. In this article, extravasation and its mechanism are discussed. Subsequently, the sensorized devices (e.g., single sensor and multimodal detection) to identify the extravasation phenomena are highlighted. In this review article, we have shed light on both physiological and engineering points of view of extravasation and its detection approaches. This review provides an overview on the most recent and relevant technologies that can help in the early detection of extravasation.
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Affiliation(s)
- Ikue Hirata
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Arianna Mazzotta
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
- The
Biorobotics Institute, Scuola Superiore
Sant’Anna, Pontedera 56025, Italy
| | - Pooyan Makvandi
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Ilaria Cesini
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Chiara Brioschi
- IIT-Bracco
Joint Lab, Istituto Italiano di Tecnologia, 16163 Genova, Italy
- Bracco
S.p.A., 20134 Milano, Italy
| | - Andrea Ferraris
- IIT-Bracco
Joint Lab, Istituto Italiano di Tecnologia, 16163 Genova, Italy
- Bracco
S.p.A., 20134 Milano, Italy
| | - Virgilio Mattoli
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
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Kamada S, Mosier R, El-Khalili T, Triantis S, Yang R. Scoping Review of Early Intravenous Infiltration and Extravasation Detection Devices. JOURNAL OF INFUSION NURSING 2023; 46:97-106. [PMID: 36853872 DOI: 10.1097/nan.0000000000000499] [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: 03/01/2023]
Abstract
Failure to promptly detect intravenous (IV) infiltration can often lead to damaging effects, such as necrosis and compartment syndrome, which increase the length of hospital stay and cost of care. Currently, nurses periodically monitor the vascular access device (VAD) site and extremity for symptoms of swelling, blanching, and change in temperature. However, nurses are often unable to monitor the VAD site frequently enough to detect subtle symptoms that may present immediately following an infiltration or extravasation. Nurses need a highly sensitive way to rapidly detect IV infiltration to minimize the time between infiltration and intervention. This study reviews technologies with the potential to detect IV infiltration earlier and suggests priorities for future research in this area.
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Affiliation(s)
- Sneha Kamada
- Johns Hopkins University, Baltimore, Maryland (Mss. Kamada, Mosier, Triantis, and Mr El-Khalili); Maxillofacial Surgery and Dentistry, Johns Hopkins Hospital, Baltimore, Maryland (Dr Yang)
- Sneha Kamada is a fourth-year undergraduate student at Johns Hopkins University working toward a bachelor's and master's degree in biomedical engineering with a focus in immunoengineering. She is experienced in the design and development of medical devices for pediatric patients and orthopedic surgeons. She has previous grant-writing experience and has written a textbook chapter on institutional review board protocols for a translational handbook. She is currently working with an undergraduate team to develop a novel arthroscope to provide better visualization for posterior knee procedures
- Rebecca Mosier is a fourth-year undergraduate student at Johns Hopkins University working toward her bachelor's and master's degrees in biomedical engineering with a focus in biomedical data science. She has experience working with medical devices and data analytics to solve unmet needs for pediatric patients. She is interested in developing medical technologies to improve patient outcomes. Additionally, she is currently leading an undergraduate team in developing a novel temporary epicardial pacing wire to reduce morbidities after open-heart surgeries
- Taj El-Khalili is a third-year biomedical engineering student at Johns Hopkins University. For 3 years he has been designing a novel intravenous infiltration detection device with a team of fellow undergraduates and clinicians at the Johns Hopkins Hospital. In May of 2023 he will graduate with a B.S./M.S. degree and plans to attend medical school
- Sophia Triantis, BS, MSE, completed her bachelor's and master's of science degrees in biomedical engineering with a concentration in medical devices and imaging at Johns Hopkins University in 2021. Her experiences include the design and development of multiple medical devices to solve unmet needs in low-resource settings and for pediatric patients. She is interested in the development of simple, cost-effective medical technology that can expand access to quality care. She currently works at Hologic developing medical technology for breast cancer care
- Robin Yang, DDS, MD, has had the benefit of training as a dentist, an oral surgeon, and now a plastic surgeon. Having a diverse background of education has helped him evaluate clinical problems from various clinical points of view. His clinical interests include pediatric plastic surgery, pediatric craniofacial reconstruction, cleft lip/nose, cleft palate, orthognathic surgery, craniosynostosis, obstructive sleep apnea, and pediatric craniofacial trauma. He is currently in his first year as an attending plastic surgeon at Johns Hopkins Hospital. His career aspirations have always been to become a pediatric craniofacial surgeon-scientist. His research interests are focused on large data accumulation and automatic learning. Joining the faculty at Johns Hopkins has allowed him to start collaborations with the leaders in biomedical engineering. He hopes that his pilot grant will allow them to further their interests in automatic presurgical planning for craniofacial reconstruction
| | - Rebecca Mosier
- Johns Hopkins University, Baltimore, Maryland (Mss. Kamada, Mosier, Triantis, and Mr El-Khalili); Maxillofacial Surgery and Dentistry, Johns Hopkins Hospital, Baltimore, Maryland (Dr Yang)
- Sneha Kamada is a fourth-year undergraduate student at Johns Hopkins University working toward a bachelor's and master's degree in biomedical engineering with a focus in immunoengineering. She is experienced in the design and development of medical devices for pediatric patients and orthopedic surgeons. She has previous grant-writing experience and has written a textbook chapter on institutional review board protocols for a translational handbook. She is currently working with an undergraduate team to develop a novel arthroscope to provide better visualization for posterior knee procedures
- Rebecca Mosier is a fourth-year undergraduate student at Johns Hopkins University working toward her bachelor's and master's degrees in biomedical engineering with a focus in biomedical data science. She has experience working with medical devices and data analytics to solve unmet needs for pediatric patients. She is interested in developing medical technologies to improve patient outcomes. Additionally, she is currently leading an undergraduate team in developing a novel temporary epicardial pacing wire to reduce morbidities after open-heart surgeries
- Taj El-Khalili is a third-year biomedical engineering student at Johns Hopkins University. For 3 years he has been designing a novel intravenous infiltration detection device with a team of fellow undergraduates and clinicians at the Johns Hopkins Hospital. In May of 2023 he will graduate with a B.S./M.S. degree and plans to attend medical school
- Sophia Triantis, BS, MSE, completed her bachelor's and master's of science degrees in biomedical engineering with a concentration in medical devices and imaging at Johns Hopkins University in 2021. Her experiences include the design and development of multiple medical devices to solve unmet needs in low-resource settings and for pediatric patients. She is interested in the development of simple, cost-effective medical technology that can expand access to quality care. She currently works at Hologic developing medical technology for breast cancer care
- Robin Yang, DDS, MD, has had the benefit of training as a dentist, an oral surgeon, and now a plastic surgeon. Having a diverse background of education has helped him evaluate clinical problems from various clinical points of view. His clinical interests include pediatric plastic surgery, pediatric craniofacial reconstruction, cleft lip/nose, cleft palate, orthognathic surgery, craniosynostosis, obstructive sleep apnea, and pediatric craniofacial trauma. He is currently in his first year as an attending plastic surgeon at Johns Hopkins Hospital. His career aspirations have always been to become a pediatric craniofacial surgeon-scientist. His research interests are focused on large data accumulation and automatic learning. Joining the faculty at Johns Hopkins has allowed him to start collaborations with the leaders in biomedical engineering. He hopes that his pilot grant will allow them to further their interests in automatic presurgical planning for craniofacial reconstruction
| | - Taj El-Khalili
- Johns Hopkins University, Baltimore, Maryland (Mss. Kamada, Mosier, Triantis, and Mr El-Khalili); Maxillofacial Surgery and Dentistry, Johns Hopkins Hospital, Baltimore, Maryland (Dr Yang)
- Sneha Kamada is a fourth-year undergraduate student at Johns Hopkins University working toward a bachelor's and master's degree in biomedical engineering with a focus in immunoengineering. She is experienced in the design and development of medical devices for pediatric patients and orthopedic surgeons. She has previous grant-writing experience and has written a textbook chapter on institutional review board protocols for a translational handbook. She is currently working with an undergraduate team to develop a novel arthroscope to provide better visualization for posterior knee procedures
- Rebecca Mosier is a fourth-year undergraduate student at Johns Hopkins University working toward her bachelor's and master's degrees in biomedical engineering with a focus in biomedical data science. She has experience working with medical devices and data analytics to solve unmet needs for pediatric patients. She is interested in developing medical technologies to improve patient outcomes. Additionally, she is currently leading an undergraduate team in developing a novel temporary epicardial pacing wire to reduce morbidities after open-heart surgeries
- Taj El-Khalili is a third-year biomedical engineering student at Johns Hopkins University. For 3 years he has been designing a novel intravenous infiltration detection device with a team of fellow undergraduates and clinicians at the Johns Hopkins Hospital. In May of 2023 he will graduate with a B.S./M.S. degree and plans to attend medical school
- Sophia Triantis, BS, MSE, completed her bachelor's and master's of science degrees in biomedical engineering with a concentration in medical devices and imaging at Johns Hopkins University in 2021. Her experiences include the design and development of multiple medical devices to solve unmet needs in low-resource settings and for pediatric patients. She is interested in the development of simple, cost-effective medical technology that can expand access to quality care. She currently works at Hologic developing medical technology for breast cancer care
- Robin Yang, DDS, MD, has had the benefit of training as a dentist, an oral surgeon, and now a plastic surgeon. Having a diverse background of education has helped him evaluate clinical problems from various clinical points of view. His clinical interests include pediatric plastic surgery, pediatric craniofacial reconstruction, cleft lip/nose, cleft palate, orthognathic surgery, craniosynostosis, obstructive sleep apnea, and pediatric craniofacial trauma. He is currently in his first year as an attending plastic surgeon at Johns Hopkins Hospital. His career aspirations have always been to become a pediatric craniofacial surgeon-scientist. His research interests are focused on large data accumulation and automatic learning. Joining the faculty at Johns Hopkins has allowed him to start collaborations with the leaders in biomedical engineering. He hopes that his pilot grant will allow them to further their interests in automatic presurgical planning for craniofacial reconstruction
| | - Sophia Triantis
- Johns Hopkins University, Baltimore, Maryland (Mss. Kamada, Mosier, Triantis, and Mr El-Khalili); Maxillofacial Surgery and Dentistry, Johns Hopkins Hospital, Baltimore, Maryland (Dr Yang)
- Sneha Kamada is a fourth-year undergraduate student at Johns Hopkins University working toward a bachelor's and master's degree in biomedical engineering with a focus in immunoengineering. She is experienced in the design and development of medical devices for pediatric patients and orthopedic surgeons. She has previous grant-writing experience and has written a textbook chapter on institutional review board protocols for a translational handbook. She is currently working with an undergraduate team to develop a novel arthroscope to provide better visualization for posterior knee procedures
- Rebecca Mosier is a fourth-year undergraduate student at Johns Hopkins University working toward her bachelor's and master's degrees in biomedical engineering with a focus in biomedical data science. She has experience working with medical devices and data analytics to solve unmet needs for pediatric patients. She is interested in developing medical technologies to improve patient outcomes. Additionally, she is currently leading an undergraduate team in developing a novel temporary epicardial pacing wire to reduce morbidities after open-heart surgeries
- Taj El-Khalili is a third-year biomedical engineering student at Johns Hopkins University. For 3 years he has been designing a novel intravenous infiltration detection device with a team of fellow undergraduates and clinicians at the Johns Hopkins Hospital. In May of 2023 he will graduate with a B.S./M.S. degree and plans to attend medical school
- Sophia Triantis, BS, MSE, completed her bachelor's and master's of science degrees in biomedical engineering with a concentration in medical devices and imaging at Johns Hopkins University in 2021. Her experiences include the design and development of multiple medical devices to solve unmet needs in low-resource settings and for pediatric patients. She is interested in the development of simple, cost-effective medical technology that can expand access to quality care. She currently works at Hologic developing medical technology for breast cancer care
- Robin Yang, DDS, MD, has had the benefit of training as a dentist, an oral surgeon, and now a plastic surgeon. Having a diverse background of education has helped him evaluate clinical problems from various clinical points of view. His clinical interests include pediatric plastic surgery, pediatric craniofacial reconstruction, cleft lip/nose, cleft palate, orthognathic surgery, craniosynostosis, obstructive sleep apnea, and pediatric craniofacial trauma. He is currently in his first year as an attending plastic surgeon at Johns Hopkins Hospital. His career aspirations have always been to become a pediatric craniofacial surgeon-scientist. His research interests are focused on large data accumulation and automatic learning. Joining the faculty at Johns Hopkins has allowed him to start collaborations with the leaders in biomedical engineering. He hopes that his pilot grant will allow them to further their interests in automatic presurgical planning for craniofacial reconstruction
| | - Robin Yang
- Johns Hopkins University, Baltimore, Maryland (Mss. Kamada, Mosier, Triantis, and Mr El-Khalili); Maxillofacial Surgery and Dentistry, Johns Hopkins Hospital, Baltimore, Maryland (Dr Yang)
- Sneha Kamada is a fourth-year undergraduate student at Johns Hopkins University working toward a bachelor's and master's degree in biomedical engineering with a focus in immunoengineering. She is experienced in the design and development of medical devices for pediatric patients and orthopedic surgeons. She has previous grant-writing experience and has written a textbook chapter on institutional review board protocols for a translational handbook. She is currently working with an undergraduate team to develop a novel arthroscope to provide better visualization for posterior knee procedures
- Rebecca Mosier is a fourth-year undergraduate student at Johns Hopkins University working toward her bachelor's and master's degrees in biomedical engineering with a focus in biomedical data science. She has experience working with medical devices and data analytics to solve unmet needs for pediatric patients. She is interested in developing medical technologies to improve patient outcomes. Additionally, she is currently leading an undergraduate team in developing a novel temporary epicardial pacing wire to reduce morbidities after open-heart surgeries
- Taj El-Khalili is a third-year biomedical engineering student at Johns Hopkins University. For 3 years he has been designing a novel intravenous infiltration detection device with a team of fellow undergraduates and clinicians at the Johns Hopkins Hospital. In May of 2023 he will graduate with a B.S./M.S. degree and plans to attend medical school
- Sophia Triantis, BS, MSE, completed her bachelor's and master's of science degrees in biomedical engineering with a concentration in medical devices and imaging at Johns Hopkins University in 2021. Her experiences include the design and development of multiple medical devices to solve unmet needs in low-resource settings and for pediatric patients. She is interested in the development of simple, cost-effective medical technology that can expand access to quality care. She currently works at Hologic developing medical technology for breast cancer care
- Robin Yang, DDS, MD, has had the benefit of training as a dentist, an oral surgeon, and now a plastic surgeon. Having a diverse background of education has helped him evaluate clinical problems from various clinical points of view. His clinical interests include pediatric plastic surgery, pediatric craniofacial reconstruction, cleft lip/nose, cleft palate, orthognathic surgery, craniosynostosis, obstructive sleep apnea, and pediatric craniofacial trauma. He is currently in his first year as an attending plastic surgeon at Johns Hopkins Hospital. His career aspirations have always been to become a pediatric craniofacial surgeon-scientist. His research interests are focused on large data accumulation and automatic learning. Joining the faculty at Johns Hopkins has allowed him to start collaborations with the leaders in biomedical engineering. He hopes that his pilot grant will allow them to further their interests in automatic presurgical planning for craniofacial reconstruction
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Munthuli A, Intanai J, Tossanuch P, Pooprasert P, Ingpochai P, Boonyasatian S, Kittithammo K, Thammarach P, Boonmak T, Khaengthanyakan S, Yaemsuk A, Vanichvarodom P, Phienphanich P, Pongcharoen P, Sakonlaya D, Sitthiwatthanawong P, Wetchawalit S, Chakkavittumrong P, Thongthawee B, Pathomjaruwat T, Tantibundhit C. Extravasation Screening and Severity Prediction from Skin Lesion Image using Deep Neural Networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1827-1833. [PMID: 36086628 DOI: 10.1109/embc48229.2022.9871115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Extravasation occurs secondary to the leakage of medication from blood vessels into the surrounding tissue during intravenous administration resulting in significant soft tissue injury and necrosis. If treatment is delayed, invasive management such as surgical debridement, skin grafting, and even amputation may be required. Thus, it is imperative to develop a smartphone application for predicting extravasation severity from skin image. Two Deep Neural Network (DNN) architectures, U-Net and DenseNet-121, were used to segment skin and lesion, and to classify extravasation severity. Sensitivity and specificity for predicting between asymptomatic and abnormal cases were 77.78 and 90.24%. For each severity in abnormal cases, mild extravasation attained the highest F1-score of 0.8049, followed by severe extravasation of 0.6429, and moderate extravasation of 0.6250. The F1-score of moderate-to-severe extravasation classification can improve by applying the our proposed rule-based for multi-class classification. These findings proposed a novel and feasible DNN approach for screening extravasation from skin images. The implementation of DNN-based applications on mobile devices has a strong potential for clinical application in low-resource countries. Clinical relevance- The application can serve as a valuable tool in monitoring when extravasation occurs during intravaneous administration. It can also help in the scheduling process across worksite to reduce the risks associated with working shifts.
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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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Lim R, Damalerio RB, Bong CL, Tan SK, Cheng MY. Novel Conformal Skin Patch with Embedded Thin-Film Electrodes for Early Detection of Extravasation. SENSORS 2021; 21:s21103429. [PMID: 34069128 PMCID: PMC8156920 DOI: 10.3390/s21103429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Extravasation is a complication of intravenous (IV) cannulation in which vesicant drugs leak from a vein into the surrounding subcutaneous tissue. The severity of extravasation depends on the type, concentration, and volume of drugs that accumulate in the subcutaneous tissue. Rapid detection of extravasation can facilitate prompt medical intervention, minimizing tissue damage, and preventing adverse events. In this study, we present two portable sensor patches, namely gold- and carbon-based sensing patches, for early detection of extravasation. The gold-based sensor patch detected extravasated fluid of volume as low as 2 mL in in vivo animal models and human clinical trials; the patch exhibited a resistance change of 41%. The carbon-based sensor patch exhibited a resistance change of 51% for 2 mL of extravasated fluid, and fabrication throughput and cost-effectiveness are superior for this patch compared with the gold-based sensing patch.
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Affiliation(s)
- Ruiqi Lim
- Institute of Microelectronics, A*STAR (Agency for Science, Technology and Research), Singapore 138634, Singapore; (R.L.); (R.B.D.)
| | - Ramona B. Damalerio
- Institute of Microelectronics, A*STAR (Agency for Science, Technology and Research), Singapore 138634, Singapore; (R.L.); (R.B.D.)
| | - Choon Looi Bong
- KK Women’s & Children’s Hospital, Singapore 229899, Singapore; (C.L.B.); (S.K.T.)
| | - Swee Kim Tan
- KK Women’s & Children’s Hospital, Singapore 229899, Singapore; (C.L.B.); (S.K.T.)
| | - Ming-Yuan Cheng
- Institute of Microelectronics, A*STAR (Agency for Science, Technology and Research), Singapore 138634, Singapore; (R.L.); (R.B.D.)
- Correspondence:
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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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7
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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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