1
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Sun YX, Shang J, Cui Y, Zhang KJ, Li XT, Li DN, Gu XL, Tian XY, Sun N, Zhang L, You MN, Zhang XY, Sun YS. Impact of different concentration iodinated contrast media on pain and comfort in abdominal computed tomography. Eur J Radiol 2024; 179:111664. [PMID: 39121745 DOI: 10.1016/j.ejrad.2024.111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/04/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES To investigate whether high concentration iodinated contrast media (CM), compared with low concentration CM, could reduce pain and discomfort levels in patients who had level II and III venous conditions. METHODS This prospective, single-center study enrolled patients who had level II and III venous conditions and underwent abdominal contrast-enhanced CT scan between July 2021 and February 2022. The venous condition to establish peripheral venous access for CM injection was graded using the Intravenous Access Scoring system, of which level II and III indicated poor venous condition and difficult venous access. Patients received iomeprol 400 in high concentration group and ioversol 320 in low group at an identical iodine delivery rate of 1.12 gI/s. The primary outcomes were pain and comfort levels. The secondary outcomes included adverse events and image quality. Patients rated pain intensity via Numerical Rating Scale and comfort level via Visual Analogue Scale with higher scores indicating higher levels of pain and discomfort. Quantitative and qualitative image assessment were compared between two groups. Continuous variables were compared using Student's t test or Mann-Whitney U test. Categorical variables were compared using χ2 test, χ2 test for trend or Fisher's exact test. RESULTS A total of 206 patients (mean age, 60.13 ± 12.14 years; 81 males) were included with 99 in the high concentration group and 107 in the low concentration group. The high group had significantly lower pain scores (median 1 [IQR: 0-2] vs 2 (IQR 2-4), p < 0.001) and comfort scores (1 [IQR: 0-3] vs 3 [IQR: 2-5], p < 0.001) than the low group. Incidence of CM extravasation did not significantly differ (1.0 % vs 4.5 %, p = 0.214). No hypersensitivity reaction was observed. Qualitative assessment showed higher clarity scores of intrahepatic hepatic artery and portal vein in the high group. Quantitative assessment results were comparable between two groups. CONCLUSION High concentration iodinated CM could lower pain intensity and improve comfort levels without comprising image quality of CT scan. High concentration CM is a preferable choice in patients with poor venous conditions during contrast-enhanced CT scan.
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Affiliation(s)
- Yan-Xia Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Jing Shang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Yong Cui
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Ke-Jin Zhang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Xiao-Ting Li
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Dan-Ni Li
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Xiao-Lei Gu
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Xiao-Yu Tian
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
| | - Nan Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
| | - Lan Zhang
- MRI Department, The 1st Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Miao-Ning You
- Department of Breast Oncology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China.
| | - Xiao-Yan Zhang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China.
| | - Ying-Shi Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing 100142, China
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2
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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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3
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Courchesne M, Manrique G, Bernier L, Moussa L, Cresson J, Gutzeit A, Froehlich JM, Koh DM, Chartrand-Lefebvre C, Matoori S. Gender Differences in Pharmacokinetics: A Perspective on Contrast Agents. ACS Pharmacol Transl Sci 2024; 7:8-17. [PMID: 38230293 PMCID: PMC10789139 DOI: 10.1021/acsptsci.3c00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/18/2024]
Abstract
Gender is an important risk factor for adverse drug reactions. Women report significantly more adverse drug reactions than men. There is a growing consensus that gender differences in drug PK is a main contributor to higher drug toxicity in women. These differences stem from physiological differences (body composition, plasma protein concentrations, and liver and kidney function), drug interactions, and comorbidities. Contrast agents are widely used to enhance diagnostic performance in computed tomography and magnetic resonance imaging. Despite their broad use, these contrast agents can lead to important adverse reactions including hypersensitivity reactions, nephropathy, and hyperthyroidism. Importantly, female gender is one of the main risk factors for contrast agent toxicity. As these adverse reactions may be related to gender differences in PK, this perspective aims to describe distribution and elimination pathways of commonly used contrast agents and to critically discuss gender differences in these processes.
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Affiliation(s)
- Myriam Courchesne
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Gabriela Manrique
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Laurie Bernier
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Leen Moussa
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Jeanne Cresson
- Clinical
Research Group, Klus Apotheke Zurich, 8032 Zurich, Switzerland
| | - Andreas Gutzeit
- Department
of Health Sciences and Medicine, University
of Lucerne, Frohburgstaße 3, 6002 Luzern, Switzerland
- Institute
of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, 6006 Lucerne, Switzerland
- Department
of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Dow-Mu Koh
- Cancer Research
UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Carl Chartrand-Lefebvre
- Radiology
Department, Centre Hospitalier de l’Université
de Montréal (CHUM), Montreal, Quebec H2X 3E4, Canada
- Centre
de Recherche du Centre Hospitalier de l’Université de
Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Simon Matoori
- Faculté
de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, 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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5
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Savage SA, Fox C, Goldie SJ. Compartment syndrome of the hand following
CT
contrast extravasation. ANZ J Surg 2022; 93:1360-1362. [DOI: 10.1111/ans.18155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Simon A. Savage
- Peninsula ClinicalSchool, Central Clinical School, Faculty of Medicine Monash University Melbourne Victoria Australia
| | - Carly Fox
- Department of Plastic Surgery Royal Melbourne Hospital Melbourne Victoria Australia
| | - Stephen J. Goldie
- Peninsula ClinicalSchool, Central Clinical School, Faculty of Medicine Monash University Melbourne Victoria Australia
- Department of Plastic Surgery Royal Melbourne Hospital Melbourne Victoria Australia
- College of Medicine and Public Health Flinders University Adelaide South Australia Australia
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6
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Diop B, Soh GT, Nde AFT, Sarr N, Ndoye AY, Sane JC. Hand compartment syndrome secondary to contrast media extravasation: A case report. Int J Surg Case Rep 2022; 98:107595. [PMID: 36063764 PMCID: PMC9482983 DOI: 10.1016/j.ijscr.2022.107595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Contrast media extravasation injury is a recognized complication of contrast media use. Compartmental syndrome of the hand secondary to contrast extravasation is exceptional. We describe a case of compartment syndrome of the hand secondary to contrast media extravasation. Case presentation We present a 47-year-old woman with a history of pulmonary embolism who was diagnosed of compartment syndrome of the left hand after injection of contrast medium during a CT scan. Whose first diagnosis was mild contrast medium extravasation injury 24 h before the compartment syndrome. Standard radiography showed an accumulation of contrast medium in the left hand. The patient underwent a fasciotomy and secondary healing. Follow-up showed good radiographic, clinical, and hand function after 2 months. Discussion The occurrence of hand compartment syndrome secondary to contrast media extravasation is rare. Most of the time, they are initially diagnosed as medium extravasation before the worsening of symptoms. Because of its unknown incidence, treatment is not codified. The goal of treatment is to save the limb and restore function. This can be achieved rapidly with early surgery because of the unpredictable course. Conclusion Contrast media injection is not a harmless gesture. Hand compartment syndrome after contrast extravasation is rare and is a severe injury, our experience with this case suggests that early surgery helps save the limb and restore function. Always fear a compartmental syndrome in case of extravasation of contrast medium. Contrast media injection is not a harmless gesture. Always fear a compartmental syndrome in case of extravasation of contrast medium Our experience suggests that early surgery helps save the limb and restore function
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Affiliation(s)
- Badara Diop
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal.
| | | | | | - Ndiamé Sarr
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | | | - Jean Claude Sane
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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7
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Thomas R, Vermaak L, Price G. Iodinated Contrast Media Extravasation Injuries: Should Osmolality and the Pattern of Distribution Affect Management?: A Literature Review and Case Report Comparison. EPLASTY 2022; 22:e23. [PMID: 35903426 PMCID: PMC9280047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Contrast media extravasation injuries are uncommon, and both conservative and surgical management approaches have been previously described. Over time the use of lower osmolar contrast solutions has prompted fewer complications, whereas the use of automated infusion systems has increased the overall incidence. Local radiology departments frequently have their own protocols for the initial management of extravasation injuries, but if the injury is considered more severe or results in soft tissue compromise, the plastic surgery department is often consulted. Surgical management options depend on the nature of the agent and the degree of extravasation. Stab incisions of the overlying skin followed by the application of pressure have been described for injuries which are more severe. METHODS Two cases were compared in the context of the prevailing literature. One of these was a large volume extravasation of an iodine-based imaging contrast agent with a diffuse distribution pattern, rendering it unsuitable for this method of evacuation. This is contrasted with a case with a more discrete collection better suited to acute evacuation. RESULTS This review found that current literature does not account for distribution patterns of extravasation medium in the decision-making process around surgical intervention. CONCLUSIONS A review of the relevant literature suggests that the pattern of distribution should be accounted for when considering surgical management.
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8
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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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9
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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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10
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Cost-Utility Analysis of Imaging for Surveillance and Diagnosis of Hepatocellular Carcinoma. AJR Am J Roentgenol 2019; 213:17-25. [PMID: 30995098 DOI: 10.2214/ajr.18.20341] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The purpose of this study is to compare imaging-based surveillance and diagnostic strategies in patients at risk for hepatocellular carcinoma (HCC) while taking into account technically inadequate examinations and patient compliance. MATERIALS AND METHODS. A Markov model simulated seven strategies for HCC surveillance and diagnosis in patients with cirrhosis: strategy A, ultrasound (US) for surveillance and CT for diagnosis; strategy B, US for surveillance and complete MRI for diagnosis; strategy C, US for surveillance and CT for inadequate or positive surveillance; strategy D, US for surveillance and complete MRI for inadequate or positive surveillance; strategy E, surveillance and diagnosis with CT followed by complete MRI for inadequate surveillance; strategy F, surveillance and diagnosis with complete MRI followed by CT for inadequate surveillance; and strategy G, surveillance with abbreviated MRI followed by CT for inadequate surveillance or complete MRI for positive surveillance. Two compliance scenarios were evaluated: optimal and conservative. For each scenario, the most cost-effective strategy was based on a willingness-to-pay threshold of $50,000 (Canadian) per quality-adjusted life year (QALY). Sensitivity analyses were performed. RESULTS. Base-case analysis revealed that strategy E was the most cost-effective when compliance was optimal ($13,631/QALY), and strategy G was the most cost-effective when compliance was conservative ($39,681/QALY). Sensitivity analyses supported the base-case analysis in the optimal compliance scenario, but several parameters altered the most cost-effective strategy in the conservative compliance scenario. CONCLUSION. In an optimal compliance scenario, CT for HCC surveillance and diagnosis and complete MRI for inadequate CT was most cost-effective. In a conservative compliance scenario, abbreviated MRI may be an alternative to US-based surveillance.
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11
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Misaka T, Sakamoto T, Yamada C, Takenaka S, Nakatsuka T, Nambu H, Uemura M. [Acquisition of Pulmonary Vein and Left Atrium with Trigger Angiography Non-contrast Enhanced MRI in Diastolic Phase]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:454-459. [PMID: 31105094 DOI: 10.6009/jjrt.2019_jsrt_75.5.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this study was to compare the image quality and the visibility of trigger angiography non-contrast enhanced (TRANCE) in diastolic phase and 3D balanced steady-state free precession (3D SSFP) sequences for the evaluation of pulmonary vein (PV) and left atrium (LA). METHODS About 10 volunteers underwent TRANCE and 3D SSFP imaging on 1.5 T MRI. Axial images were reconstructed and regions of interest were positioned on the right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), LA, and left atrial appendage (LAA). Contrast-to-noise ratio (CNR) between each part and muscle were calculated and compared between two sequences. The two observers independently scored the image quality of each image on the basis of PV, LA, and LAA anatomy and contour using a five-point scale, which scores were averaged and compared. RESULTS CNRs on RSPV, RIPV, LSPV, LIPV, LA, and LAA were significantly higher in TRANCE sequence compared with 3D SSFP sequence. On visual assessment, TRANCE showed significantly higher scores in RSPV, RIPV, LSPV, LIPV compared with 3D SSFP sequence. CONCLUSIONS TRANCE provides higher image quality in PVs and LA compared with 3D SSFP on 1.5 T MRI. On visual assessment, TRANCE provides better visibility of PVs anatomy and contour compared with 3D SSFP.
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Affiliation(s)
| | | | - Chiharu Yamada
- Department of Radiology, Kindai University Nara Hospital
| | | | | | - Hidekazu Nambu
- Department of Radiology, Kindai University Nara Hospital
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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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Abstract
BACKGROUND This systematic review combines data from multiple papers on contrast media extravasation to identify factors contributing to increased extravasation risk. METHODS Data were extracted from 17 papers reporting 2191 extravasations in 1,104,872 patients (0.2%) undergoing computed tomography (CT) or magnetic resonance imaging (MRI). RESULTS Extravasation rates were 0.045% for gadolinium-based contrast agents (GBCA) and nearly 6-fold higher, 0.26% for iodinated contrast agents. Factors associated with increased contrast media extravasations included: older age, female gender, using an existing intravenous (IV) instead of placing a new IV in radiology, in-patient status, use of automated power injection, high injection rates, catheter location, and failing to warm up the more viscous contrast media to body temperature. CONCLUSION Contrast media extravasation is infrequent but nearly 6 times less frequent with GBCA for MRI compared with iodinated contrast used in CT.
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Affiliation(s)
| | | | - Jeffery H. Newhouse
- Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine
- Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY
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Safety of coronary CT angiography and functional testing for stable chest pain in the PROMISE trial: A randomized comparison of test complications, incidental findings, and radiation dose. J Cardiovasc Comput Tomogr 2017; 11:373-382. [PMID: 28838846 DOI: 10.1016/j.jcct.2017.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/25/2017] [Accepted: 08/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) and functional testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. METHODS We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and functional testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other functional tests if randomized to the functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. RESULTS Of 9470 patients, none had major and <1% had minor complications (CTA: 0.8% [37/4633] vs. functional: 0.6% [27/4837]). CTA identified more incidental findings (11.6% [539/4633] vs. 0.7% [34/4837], p < 0.001), most commonly pulmonary nodules (9.4%, 437/4633). CTA had similar 90-day cumulative radiation dose to functional testing. However, in the subgroup whose physicians intended nuclear stress (CTA 3147; nuclear 3203), CTA had lower median index test (8.8 vs. 12.6 mSv, p < 0.001) and 90-day cumulative (11.6 vs. 13.1 mSv, p < 0.001) dose, independent of patient characteristics. The lowest nuclear doses employed 1-day Tc-99m protocols (12.2 mSv). The lowest CTA doses were at sites performing ≥500 CTAs/year (6.9 mSv) and with advanced (latest available) CT scanners (5.5 mSv). CONCLUSION Complications were negligibly rare for both CTA and functional testing. CTA detects more incidental findings. Compared to nuclear stress testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550).
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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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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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Alami Z, Nasri S, Ahid S, Kacem HH. Extravasation of contrast medium during CT examination: an observational case-control study. Pan Afr Med J 2015; 20:89. [PMID: 26090047 PMCID: PMC4450038 DOI: 10.11604/pamj.2015.20.89.3276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/20/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Extravasation is an adverse reaction to intravenous injection of contrast medium (CM) during CT examination. The objectives of this study are to determine the frequency, management and outcomes of extravasations and to assess risk factors for extravasation. Methods Every incident of extravasation which occurred between March 2012 and March 31, 2013 was recorded in an extravasation form. Ethics Committee approval was obtained and the patients gave their consent to participate in the study. Data collected in the form included patients’ age, sex, comorbidities, symptoms, CM used, injection mode, site and rate, extravasated volume, location of extravasation, severity of injury, treatment and patient outcome. Each case was matched with 4 controls of the same age ± 5 years and the same gender when possible. Results Extravasation occurred in 18 (7 women, 11 men) out of 2,000 injections of CM (0.9%) with a median age of 53 (10-78) years. Automated injection was performed in all cases with a mean rate of 1.7ml/s. Large extravasated volumes (≥ 50ml) were more observed in patients undergoing CT angiography (28.6% vs. 6.6%, although not significant P=0.112). Multivariate analysis revealed a significant association between patients with cardiac diseases and extravasation (OR: 7.3, 95% CI (1.09-49.05), P=0.04) whereas the injection rate is a protective factor from extravasation (P=0.002). Conclusion Extravasation of CM results in mild to moderate adverse effects in all cases. Our study suggests that patients with cardiac disease are more predisposed to contrast extravasation than others. Further and larger studies are needed to confirm this trend.
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Affiliation(s)
- Zayneb Alami
- Pharmacovigilance Unit, Mohamed VI University Hospital, Department of Pharmacology, Medical and Pharmacy School, University Mohammed the First, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohamed VI University Hospital, Medical and Pharmacy School, University Mohammed the First, Oujda, Morocco
| | - Samir Ahid
- Pharmacoepidemiology and Pharmacoeconomics Research Team. Mohammed V Rabat University, Morocco
| | - Hanane Hadj Kacem
- Department of Radiology, Mohamed VI University Hospital, Medical and Pharmacy School, University Mohammed the First, Oujda, Morocco
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Shaqdan K, Aran S, Thrall J, Abujudeh H. Incidence of contrast medium extravasation for CT and MRI in a large academic medical centre: A report on 502,391 injections. Clin Radiol 2014; 69:1264-72. [DOI: 10.1016/j.crad.2014.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/28/2014] [Accepted: 08/06/2014] [Indexed: 11/17/2022]
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Abstract
Extravasation injuries are common emergencies in clinical practice. If they are not recognized and treated promptly, they can lead to deleterious functional and cosmetic outcomes. There is a vast range of agents involved in these injuries and marked paucity of evidence to support their specific management. Following an extensive literature review, we outline management principles for clinicians involved in the care of patients with extravasation injuries. Key parameters in deciding appropriate management plans include the volume/toxicity of the agent, the necrosis interval of the injury, patient-related factors, as well as the facilities and expertise available in the setting of individual cases of extravasation.
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Affiliation(s)
- I Goutos
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
| | - L K Cogswell
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
| | - H Giele
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
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20
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Evaluation of a near-infrared-type contrast medium extravasation detection system using a swine model. J Comput Assist Tomogr 2014; 38:285-92. [PMID: 24448506 DOI: 10.1097/rct.0000000000000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To refine the development and evaluate the near-infrared (NIR) extravasation detection system and its ability to detect extravasation during a contrast-enhanced computed tomography (CT) examination. MATERIALS AND METHODS The NIR extravasation detection system projects the NIR light through the surface of the human skin then, using its sensory system, will monitor the changes in the amount of NIR that reflected, which varies based on absorption properties.Seven female pigs were used to evaluate the contrast media extravasation detection system, using a 20-gauge intravenous catheter, when injected at a rate of 1 mL/s into 4 different locations just under the skin in the thigh section. Using 3-dimensional CT images, we evaluated the extravasations between time and volume, depth and volume, and finally depth and time to detect. RESULTS We confirmed that the NIR light, 950-nm wavelength, used by the extravasation detection system is well absorbed by contrast media, making changes easy to detect. The average time to detect an extravasation was 2.05 seconds at a depth of 2.0 mm below the skin with a volume of 1.3 mL, 2.57 seconds at a depth between 2.1 and 5 mm below the skin and a volume of 3.47 mL, 10.5 seconds for depths greater than 5.1 mm and a volume of 11.1 mL. The detection accuracy was significantly deteriorated when the depth exceeded 5.0 mm (Tukey-Kramer, P < 0.05) CONCLUSIONS: The extravasation system detection system that is using NIR has a high level of detection sensitivity. The sensitivity enables the system to detect extravasation at depths less than 2 mm with a volume of 1.5 mL and at depths less than 5 mm with a volume of 3.5 mL. The extravasation detection system could be suitable for use during examinations.
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Lessons learned from 118,970 multidetector computed tomographic intravenous contrast material administrations: impact of catheter dwell time and gauge, catheter location, rate of contrast material administration, and patient age and sex on volume of extravasate. J Comput Assist Tomogr 2013; 37:286-8. [PMID: 23493221 DOI: 10.1097/rct.0b013e31828211da] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine the impact of catheter dwell time and gauge, catheter location, rate of contrast material administration, and patient age and sex on volume of extravasate at intravenous contrast-enhanced multidetector computed tomography. METHODS Incident reports were reviewed for all extravasation events that occurred in adult patients between March 2006 and December 2009 at 2 institutions. Patient age and sex; catheter dwell time, gauge, and location; rate of contrast material administration; and estimated volume of extravasated contrast material were recorded. RESULTS Three hundred thirty extravasation events were recorded for the 118,970 contrast material administrations (0.3%). Mean volume of extravasated contrast material was statistically significantly less for catheters newly placed in the radiology department, for higher flow rates, for smaller gauge catheters, and for catheters placed in the hand. Mean volume of extravasated contrast material did not vary significantly based on patient age or sex. CONCLUSIONS The volume of extravasate was likely to be smaller for smaller-gauge catheters in the hand with higher flow rates and for catheters newly placed in the radiology department.
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Hawi N, Citak M, Liodakis E, Petri M, Haasper C, Krettek C, Meller R. Kompartmentsyndrom nach paravasaler Applikation von Röntgenkontrastmittel. Unfallchirurg 2013; 117:374-9. [DOI: 10.1007/s00113-013-2393-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[Interest and feasibility of local anesthesia in the management of massive extravasation of contrast medium]. CHIRURGIE DE LA MAIN 2013; 32:108-12. [PMID: 23538101 DOI: 10.1016/j.main.2013.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 11/25/2012] [Accepted: 02/10/2013] [Indexed: 11/21/2022]
Abstract
Radiographic contrast medium extravasation in the upper extremity is not rare. It can be responsible for functional (compartment syndrome) and cosmetic sequelae. It is very difficult to predict the degree of final tissue injury in emergency. Currently, there is no consensus of emergency treatment. However, liposuction and saline washout as described by Gault is the usual treatment. We report the case of 42 year-old woman with radiographic contrast medium extravasation in the arm (120 cm(3)) with neurologic complications involving median nerve and medial cutaneous nerves of arm and forearm. Emergency conservative surgical washout with saline solution was performed under local anaesthesia. Drainage was realised by lipoaspiration cannula and arm massages. Clinical and radiological results were estimated. Ultimately, the patient has retained no sequela. Contrast medium extravasation in the arm with tissue complications is exceptional. We think that saline washout and lipoaspiration cannula drainage are an emergency useful treatment for radiographic contrast medium extravasation with tissue complications. Tolerance of the management was quite good. Postoperative X-rays are useful to assess treatment efficacy.
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Saade C, Brennan P. Clinical Implementation of the New MEDRAD XDS Contrast Extravasation Detector for Multidetector Computed Tomography. J Med Imaging Radiat Sci 2011; 42:179-182. [PMID: 31051812 DOI: 10.1016/j.jmir.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 05/05/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increased speeds of computed tomography (CT) acquisition and concomitant increased intravenous (IV) bolus injection rates have placed patients at greater risk of contrast extravasation. PURPOSE To assess the efficacy of the MEDRAD XDS extravasation detector by recording the incidence of contrast extravasation in high-risk patients during CT angiography. MATERIAL AND METHODS We prospectively collected data on 25 adults ages 45 to 85 years (mean=65 years), all of whom were considered to be at high risk of having a contrast extravasation. All patients underwent CT angiography with power-injected IV contrast injection introduced via an antecubital venous line. Details recorded included patient age and weight, contrast volume, flow rate, maximum injector pressure, image quality, and extravasation incidence and volume. The size of the most commonly used cannula was 20 gauge and the flow rates ranged from 4.0 to 6 mL/second. RESULTS The XDS device alerted the clinicians to five episodes of extravasation. These were identified at an early stage of the injection with no more than 8 mL of contrast material having been introduced. CONCLUSION The utility of this device has been demonstrated and its employment should reduce extravasated contrast volumes with minimum discomfort to high-risk patients.
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Affiliation(s)
- Charbel Saade
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales Australia, University of Sydney, Australia
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Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. AJR Am J Roentgenol 2010; 195:825-9. [PMID: 20858804 DOI: 10.2214/ajr.09.3739] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to prospectively assess the frequency and type of IV injection site complications associated with high-flow power injection of nonionic contrast medium in MDCT. SUBJECTS AND METHODS Contrast-enhanced (300-370 mg iodine/mL) MDCT examinations with high flow rates (up to 8 mL/s) using automatic CT injectors were performed according to standardized MDCT protocols. The location, type, and size (16-24 gauge) of IV catheters and volumes, iodine concentration, and flow rates of contrast medium were documented. Patients were questioned about associated discomfort, IV catheter sites were checked, and adverse effects were recorded. RESULTS Prospectively, 4,457 patients were studied. The injection rate ranged from 1-2.9 mL/s (group 1; n = 1,140) to 3-4.9 mL/s (group 2; n = 2,536) to 5-8 mL/s (group 3; n = 781); 1.2% of the patients experienced extravasations (n = 52). Contrast medium iodine concentration, flow rates, and volumes were not related to the frequency of extravasation. The extravasation rate was highest with 22-gauge IV catheters (2.2%; p < 0.05) independently of the anatomic location. For 20-gauge IV catheters, extravasation rates were significantly higher in the dorsum of the hand than in the antecubital fossa (1.8% vs 0.8%; p = 0.018). Extravasation rates were higher in older patients (≥ 50 vs < 50 years, 0.6% vs 1.4%; p = 0.019). Different iodine concentrations did not trigger significant differences in contrast material reactions (p = 0.782). CONCLUSION Automated IV contrast injection applying high flow rates (i.e., up to 8 mL/s) is performed without increased risk of extravasation. The overall extravasation rate was 1.2% and showed no correlation with iodine concentration, flow rates, or contrast material reactions. Performing high flow rates with low-diameter IV catheters (e.g., 22-gauge catheters) and a location of IV catheter in the hand is associated with a higher extravasation rate.
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Contrast Material Administration Protocols for 64-MDCT Angiography: Altering Volume and Rate and Use of a Saline Chaser to Better Match the Imaging Window—Physiologic Phantom Study. AJR Am J Roentgenol 2009; 193:1568-75. [DOI: 10.2214/ajr.09.2670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Callahan MJ, Poznauskis L, Zurakowski D, Taylor GA. Nonionic iodinated intravenous contrast material-related reactions: incidence in large urban children's hospital--retrospective analysis of data in 12,494 patients. Radiology 2009; 250:674-81. [PMID: 19244041 DOI: 10.1148/radiol.2503071577] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To examine the incidence and severity of nonionic intravenous contrast material reactions in a large pediatric patient population. MATERIALS AND METHODS Electronic records on all consecutive patients at a tertiary care pediatric hospital who received ioversol contrast material over a 7-year period for computed tomographic or excretory urographic studies were reviewed, yielding individual contrast material injection events in 12,494 patients up to 21 years of age. There were 6600 male patients and 5894 female patients. Contrast material reactions were categorized as mild, moderate, or severe according to American College of Radiology guidelines. Logistic regression analysis was performed to evaluate effects of age, sex, season, and study year on the presence of an intravenous contrast material reaction. RESULTS There were 57 adverse events related to nonionic iodinated intravenous contrast material in 12,494 consecutive pediatric and young adult patients. Incidence of a contrast material reaction was 0.46% (57 of 12,494), or one in 200 patients. Incidence of a type I (mild) contrast material reaction was 0.38% (47 of 12,494), or one in 250 patients. Incidence of a type II (moderate) reaction was 0.08% (10 of 12,494), or one in 1000 patients. There were no severe (type III) reactions. The average age of patients with a contrast material reaction (12.9 years +/- 4.3 [standard deviation]) was 3.4 years older (P < .001) than the average age of all patients in the study (9.5 years +/- 5.9). There was a significant relationship between patient age and incidence of contrast material reaction per 1000 studies (P = .003), independent of sex, season, and year of study. CONCLUSION Adverse reactions to intravenous administration of a nonionic contrast material (ioversol) are rare in children and increase in frequency with advancing age. The great majority of reactions in children are mild.
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Affiliation(s)
- Michael J Callahan
- Department of Radiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
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28
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Weinreb JC. Which Study When? Is Gadolinium-enhanced MR Imaging Safer than Iodine-enhanced CT?1. Radiology 2008. [DOI: 10.1148/radiol.2491080075] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schaverien MV, Evison D, McCulley SJ. Management of large volume CT contrast medium extravasation injury: technical refinement and literature review. J Plast Reconstr Aesthet Surg 2008; 61:562-5; discussion 565. [PMID: 17459795 DOI: 10.1016/j.bjps.2007.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 10/18/2006] [Accepted: 02/27/2007] [Indexed: 11/15/2022]
Abstract
The incidence of radiographic contrast medium extravasation is on the rise due to the rapid increase in availability of contrast enhanced imaging. There is no consensus, however, regarding its management. There is a wide spectrum of clinical presentations, ranging from localised erythema and oedema to skin necrosis, which is related to the osmolarity and volume of the extravasated contrast medium. It is not possible to predict the degree of final tissue injury at initial examination. The increase in use of automated bolus injection has led to an increase in incidence of large volume extravasation injuries. Here we present a review of the literature regarding clinical presentation, risk factors, and management of contrast extravasation injuries. We also report the management of a large volume computed tomography contrast extravasation injury following mechanical bolus injection using a combination of liposuction and saline washout as described by Gault, and the use of compression by a Rhys-Davies exsanguinator as a technical refinement to achieve immediate resolution of the soft tissue oedema.
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Affiliation(s)
- Mark V Schaverien
- Department of Plastic, Reconstructive and Burns Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Saba L, Sanfilippo R, Pirisi R, Pascalis L, Montisci R, Mallarini G. Multidetector-row CT angiography in the study of atherosclerotic carotid arteries. Neuroradiology 2007; 49:623-37. [PMID: 17607571 DOI: 10.1007/s00234-007-0244-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/25/2007] [Indexed: 11/28/2022]
Abstract
Pathologies of the carotid arteries, and in particular atherosclerosis, are now an important medical problem. Stroke is the third leading cause of severe disability in the Western World leading to millions of deaths every year. Extracranial carotid atherosclerotic disease is the major risk factor for stroke. In years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (MDCTA), CT imaging of the carotid arteries has become increasingly effective. In addition, the volume data obtained can be further rendered to generate high-quality two-dimensional and three-dimensional images. The purpose of this study was to review the atherosclerotic carotid arteries, their complications and how MDCTA depicts them, underlining the benefits and pitfalls of this diagnostic technique.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Policlinico Universitario, s.s. 554 Monserrato, 09045 Cagliari, Italy.
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31
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Jakobsen JA. Physiological effects of contrast media for use in multidetector row computed tomography. Eur J Radiol 2007. [DOI: 10.1016/j.ejrad.2007.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wang CL, Cohan RH, Ellis JH, Adusumilli S, Dunnick NR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology 2007; 243:80-7. [PMID: 17392249 DOI: 10.1148/radiol.2431060554] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine retrospectively the frequency, management, and outcomes of extravasations of intravenously injected nonionic iodinated contrast medium. MATERIALS AND METHODS Institutional review board approval was obtained, and the requirement for informed consent was waived. The study was HIPAA compliant. For 69,657 intravenous injections of nonionic iodinated contrast medium for computed tomographic examinations between January 1, 2000, and March 31, 2005, the incident reports, radiology reports, and medical records of patients in whom contrast medium extravasations occurred were reviewed. Data collected included patient age, catheter gauge, injection site, volume extravasated, patient symptoms, severity of injury, treatment, whether or not the plastic surgery service was consulted and any additional treatment that service instituted, and patient outcome. RESULTS Extravasations occurred in 475 (0.7%) of 69 657 patients, and follow-up information was available for 442 adults (280 women, 162 men; mean age, 57 years) and 17 children (nine girls, eight boys; mean age, 6 years). Extravasated volumes ranged from 3 to 150 mL. Symptoms usually consisted of swelling and/or pain. The plastic surgery service was consulted for 38 adults and six children and provided additional treatment in eight patients (seven adults, one child). Among adults, 432 had minimal or no adverse effects, nine had moderate adverse effects, and one had a severe complication (75 mL of contrast material extravasated into the hand, causing compartment syndrome). Only one moderate or severe complication in an adult resulted from an extravasation of less than 50 mL. Fifteen children had minimal or no adverse effects, one had moderate adverse effects, and one had a severe complication (18 mL of contrast material extravasated into the arm, causing brachial plexopathy). CONCLUSION Extravasation of nonionic iodinated contrast medium results only rarely in moderate or severe adverse effects, and these usually occur only when large volumes of contrast medium are involved.
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Affiliation(s)
- Carolyn L Wang
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109-0030, USA
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Nagamoto M, Gomi T, Terada H, Terada S, Kohda E. Evaluation of the acute adverse reaction of contrast medium with high and moderate iodine concentration in patients undergoing computed tomography. ACTA ACUST UNITED AC 2006; 24:669-74. [PMID: 17186321 DOI: 10.1007/s11604-006-0087-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 08/07/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this prospective study was to evaluate and compare acute adverse reactions between contrast medium containing moderate and high concentrations of iodine in patients undergoing computed tomography (CT). MATERIALS AND METHODS A total of 945 patients undergoing enhanced CT were randomly assigned to receive one of two doses of contrast medium. We then prospectively investigated the incidence of adverse reactions. Iopamidol was used as the contrast medium, with a high concentration of 370 mg I/ml and a moderate concentration of 300 mg I/ml. The frequency of adverse reactions, such as pain at the injection site and heat sensation, were determined. RESULTS Acute adverse reactions were observed in 2.4% (11/458) of the moderate-concentration group compared to 3.11% (15/482) of the high-concentration group; there was no significant difference in incidence between the two groups. Most adverse reactions were mild, and there was no significant difference in severity. One patient in the high-concentration group was seen to have a moderate adverse reaction. No correlation existed between the incidence of adverse reactions and patient characteristics such as sex, age, weight, flow amount, and flow rate. The incidence of pain was not significantly different between the two groups. In contrast, the incidence of heat sensation was significantly higher in the high-concentration group. CONCLUSIONS The incidence and severity of acute adverse reactions were not significantly different between the two groups, and there were no severe adverse reactions in either group.
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Affiliation(s)
- Masashi Nagamoto
- Department of Radiology, School of Medicine, Toho University, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-1251, Japan.
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CT demonstration of intravenous contrast medium extravasation and subsequent resorption in the mediastinum: a complication of a central venous catheter injection. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cradex.2004.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Affiliation(s)
- Sachiko T Cochran
- Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA 90095-1721, USA
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Cochran ST, Bomyea K, Sayre JW. Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 2001; 176:1385-8. [PMID: 11373197 DOI: 10.2214/ajr.176.6.1761385] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Data collected from 1985 to 1999 on adverse events after the IV administration of contrast media were evaluated to identify trends. MATERIALS AND METHODS Data collected on 391 adverse events after 90,473 administrations of iodinated contrast media and 19 events after 28,340 administrations of gadolinium were evaluated. Reactions were graded as mild, moderate, or severe. Data were also collected regarding contrast extravasation. RESULTS When only ionic iodinated contrast material was used, the adverse reaction rate was 6-8%. With the selective use of contrast material, the adverse reaction rate was 0.6% and 0.7%, respectively, for ionic and nonionic agents. The rate decreased to 0.2% with the universal use of nonionic agents. More than 90% of adverse reactions were allergic-like. Seven severe reactions (0.05%) and no deaths occurred in the ionic group. During the selective use period, one death occurred in the nonionic group. No severe reactions or deaths occurred during the first 5 years of universal nonionic use. Since then, 10 severe reactions (0.02%) and one death have occurred. Seven reactions occurred in patients after helical CT angiography. The extravasation rate for iodinated contrast material has remained constant at 0.3-0.4% annually. The adverse reaction rate to gadolinium contrast material was 0.06%. CONCLUSION Mild and moderate adverse events are more common with ionic contrast material than with nonionic. Most reactions are allergic-like. Severe reactions are seen equally with ionic and nonionic contrast material but differ in type. The reactions were allergic-like in the ionic group but were predominantly attributable to cardiopulmonary decompensation in the nonionic group. Helical CT angiography may play a role in reactions.
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Affiliation(s)
- S T Cochran
- Department of Radiological Sciences, UCLA School of Medicine, 10833 Le Conte Ave., Los Angeles, CA 90095-1721, USA
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Birnbaum BA, Nelson RC, Chezmar JL, Glick SN. Extravasation detection accessory: clinical evaluation in 500 patients. Radiology 1999; 212:431-8. [PMID: 10429700 DOI: 10.1148/radiology.212.2.r99au14431] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the ability of an extravasation detection accessory (EDA) to detect clinically important (> or = 10 mL) extravascular injection of iodinated contrast material delivered with an automated power injector. MATERIALS AND METHODS Five hundred patients referred for contrast material-enhanced body computed tomography (CT) participated in a prospective, multi-institutional, observational study in which the EDA was used to identify and interrupt any injection associated with clinically important extravasation. The presence or absence of extravasation was definitively established with helical CT at the injection site (injection rate, from 1.0 to 5.0 mL/sec; mean, 2.9 mL/sec; median, 3.0 mL/sec). RESULTS There were four true-positive (extravasation volumes, 13-18 mL), 484 true-negative, 12 false-positive, and no false-negative cases. The prevalence of overall and clinically important (> or = 10 mL) extravasation was 3.6% (18 of 500 cases) and 0.8% (four of 500 cases), respectively. The EDA had a sensitivity of 100% (four of four cases; 95% CI: 51%, 100%) and a specificity of 98% (484 of 496 cases; 95% CI: 96%, 99%) in the detection of clinically important extravasation. CONCLUSION The EDA is easy to use, safe, and accurate in the monitoring of intravenous injections for extravasation, which could prove especially useful in high-flow-rate CT applications.
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Affiliation(s)
- B A Birnbaum
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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