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Contrast Media Extravasation Injury

  • Chapter
Contrast Media

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Extravasation of contrast medium during injection, especially when doing contrast-enhanced CT, is now a common problem. The risk factors include patient factors, the class of contrast medium used, and the injection technique. The mechanisms discussed are effects of osmolality, cytotoxicity, volume, and compression. The clinical picture varies from no subjective complaints to pain, ulcers, and compartment syndrome. However, nearly all cases can be effectively handled by simple conservative treatment with a cold pack and elevation of the arm. The treatment and follow-up of the patient must be documented.

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References

  • ACR Manual on contrast media—version 8, 2012. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/FullManual.pdf. Accessed 20 Jan 2012

  • Ayre-Smith G (1982) Tissue necrosis following extravasation of contrast media. J Can Assoc Radiol 33:104

    CAS  PubMed  Google Scholar 

  • Bellin MF, Jakobsen JA, Tomassin I et al (2002) Contrast media safety committee of the European society of urogenital radiology. Contrast medium extravasation injury: guidelines for prevention and management. Eur Radiol 12:2807–2812

    Article  PubMed  Google Scholar 

  • Benson LS, Sathy MJ, Port RB (1996) Forearm compartment syndrome due to automated injection of computed tomography contrast material. J Orthop Trauma 10:433–436

    Article  CAS  PubMed  Google Scholar 

  • Birnbaum BA, Nelson RC, Chezmar JL, Glick SN (1999) Extravasation detection accessory: clinical evaluation in 500 patients. Radiology 212:431–438

    Article  CAS  PubMed  Google Scholar 

  • Carrier DA, Ford JJ, Hayman LA (1993) MR appearance of extravasated gadolinium contrast medium. AJNR 14:363–364

    CAS  PubMed  Google Scholar 

  • Chew FS (2010) Extravasation of iodinated contrast medium during CT: self-assessment module. AJR 195:S80–S85

    Article  PubMed  Google Scholar 

  • Cochran ST, Bomyea K, Sayre JW (2001) Trends in adverse events after IV administration of contrast media. AJR 176:1385–1388

    Article  CAS  PubMed  Google Scholar 

  • Cohan RH, Dunnick NR, Leder RA, Baker ME (1990a) Extravasation of nonionic contrast media: efficacy of conservative treatment. Radiology 174:65–67

    Google Scholar 

  • Cohan RH, Leder RA, Bolick D et al (1990b) Extravascular extravasation of radiographic contrast media: effects of conventional and low-osmolar contrast agents in the rat thigh. Invest Radiol 25:504–510

    Article  CAS  PubMed  Google Scholar 

  • Cohan RH, Leder RA, Herzberg AJ et al (1991) Extravascular toxicity of two magnetic resonance contrast agents: preliminary experience in the rat. Invest Radiol 26:224–226

    Article  CAS  PubMed  Google Scholar 

  • Cohan RH, Ellis JH, Garner WL (1996) Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology 200:593–604

    CAS  PubMed  Google Scholar 

  • Cohan RH, Bullard MA, Ellis JH et al (1997) Local reactions after injection of iodinated contrast material: detection, management, and outcome. Acad Radiol 4:711–718

    Article  CAS  PubMed  Google Scholar 

  • Earhart A, McMahon P (2011) Vascular access and contrast media. J Infus Nurs 34:97–105

    Article  PubMed  Google Scholar 

  • Elam EA, Dorr RT, Lagel KE, Pond GD (1991) Cutaneous ulceration due to contrast extravasation: experimental assessment of injury and potential antidotes. Invest Radiol 26:13–16

    Article  CAS  PubMed  Google Scholar 

  • Federle MP, Chang PJ, Confer S, Ozgun B (1998) Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection. Radiology 206:637–640

    CAS  PubMed  Google Scholar 

  • Gault DT (1993) Extravasation injuries. Br J Plast Surg 46:91–96

    Article  CAS  PubMed  Google Scholar 

  • Gothlin J (1972) The comparative frequency of extravasal injection at phlebography with steel and plastic cannulas. Clin Radiol 23:183–184

    Article  CAS  PubMed  Google Scholar 

  • Hastings-Tolsma TM, Yucha CB et al (1993) Effect of warm and cold applications on the resolution of IV infiltrations. Res Nurs Health 16:171–178

    Article  CAS  PubMed  Google Scholar 

  • Heckler FR (1989) Current thoughts on extravasation injuries. Clin Plast Surg 16:557–563

    CAS  PubMed  Google Scholar 

  • Hoff L, Brabrand K, Andersen NB, Medhus S (2008) Monitoring X-ray contrast agent injections with Doppler ultrasound. In Proceedings IEEE international ultrasonics symposium. doi: 10.1109/ULTSYM.2008.0004

  • Jacobs JE, Birnbaum BA, Langlotz CP (1998) Contrast media reactions and extravasation: relationship to intravenous injection rates. Radiology 209:411–416

    CAS  PubMed  Google Scholar 

  • Kaste SC, Young CW (1996) Safe use of power injectors with central and peripheral venous access devices for pediatric CT. Pediatr Radiol 26:499–501

    Article  CAS  PubMed  Google Scholar 

  • Katayama H, Yamaguchi K, Kozuka T et al (1990) Adverse reactions to ionic and non-ionic contrast media: a report from the Japanese committee on the safety of contrast media. Radiology 175:621–628

    CAS  PubMed  Google Scholar 

  • Kim SH, Park JH, Kim YI et al (1990) Experimental tissue damage after subcutaneous injection of water-soluble contrast media. Invest Radiol 25:678–685

    Article  CAS  PubMed  Google Scholar 

  • Laurie WS, Wilson L, Kernahan A et al (1984) Intravenous extravasation injuries: the effectiveness of hyaluronidase in their treatment. Ann Plast Surg 13:191–194

    Article  CAS  PubMed  Google Scholar 

  • Loth TS, Jones DEC (1988) Extravasations of radiographic contrast material in the upper extremity. J Hand Surg 13:395–398

    Article  CAS  Google Scholar 

  • McAlister WH, Palmer K (1971) The histologic effects of four commonly used contrast media for excretory urography and an attempt to modify the responses. Radiology 99:511–516

    CAS  PubMed  Google Scholar 

  • McCullough M, Davies P, Richardson R (1989) A large trial of intravenous Conray 325 and Niopam 300 to assess immediate and delayed reactions. Br J Radiol 62:260–265

    Article  CAS  PubMed  Google Scholar 

  • Memolo M, Dyer R, Zagoria RJ (1993) Extravasation injury with nonionic contrast material. AJR 160:203

    Article  CAS  PubMed  Google Scholar 

  • Miles SG, Rasmussen JF, Litwiller T (1990) Safe use of an intravenous power injector for CT: experience and protocol. Radiology 176:69–70

    CAS  PubMed  Google Scholar 

  • Panto PN, Davies P (1986) Delayed reactions to urographic contrast media. Br J Radiol 59:41–44

    Article  CAS  PubMed  Google Scholar 

  • Park KS, Kim SH, Park JH et al (1993) Methods for mitigating soft-tissue injury after subcutaneous injection of water-soluble contrast media. Invest Radiol 28:332–334

    Article  CAS  PubMed  Google Scholar 

  • Pond GD, Dorr RT (1993) Extravasation injury with nonionic contrast material. AJR 160:203–204

    Article  Google Scholar 

  • Pond GD, Dorr RT, McAleese KA (1992) Skin ulceration from extravasation of low-osmolar contrast medium: a complication of automation. AJR 158:915–916

    Article  CAS  PubMed  Google Scholar 

  • Runge VM, Dickey KM, Williams NM, Peng X (2002) Local tissue toxicity in response to extravascular extravasation of magnetic resonance contrast media. Invest Radiol 37:393–398

    Article  CAS  PubMed  Google Scholar 

  • Schummer C, Sakr Y, Steenbeck J et al (2010) Risk of Extravasation after Power Injection of Contrast Media via the Proximal Port of Multilumen Central Venous Catheters: Case Report and Review of the Literature. Rofo 182:14–19

    Article  CAS  PubMed  Google Scholar 

  • Shehadi WH (1975) Adverse reactions to intra-vascularly administered contrast media: a comprehensive study based on a prospective survey. Radiology 124:145–152

    CAS  Google Scholar 

  • Sistrom CL, Gay SB, Peffley L (1991) Extravasation of iopamidol and iohexol during contrast-enhanced CT: report of 28 cases. Radiology 176:65–67

    Google Scholar 

  • Upton J, Mulliken JB, Murray JE (1979) Major intravenous extravasation injuries. Am J Surg 137:497–506

    Article  CAS  PubMed  Google Scholar 

  • Vandeweyer E, Heymans O, Deraemaecker R (2000) Extra-vasation injuries and emergency suction as treatment. Plast Reconstr Surg 105:109–110

    Article  CAS  PubMed  Google Scholar 

  • Wang C, Cohan RH, Ellis JH et al (2007) Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69 657 intravenous injections. Radiology 243:80–87

    Article  PubMed  Google Scholar 

  • Wienbeck S, Fishbach R, Kloska SP et al (2010) Prospective study of access site complications of automated contrast injection with peripheral venous access in MDT. AJR 195:825–829

    Article  PubMed  Google Scholar 

  • Young RA (1994) Injury due to extravasation of nonionic contrast material (letter). AJR 162:1499

    Article  CAS  PubMed  Google Scholar 

  • Yucha CB, Hastings-Tolsma TM, Szeverenyi N (1994) Effect of elevation on intravenous extravasations. J Intraven Nurs 17:231–234

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital Rikshospitalet, 4950 Nydalen, 0027 Oslo, Norway

    Jarl Å. Jakobsen

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  1. Jarl Å. Jakobsen
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Correspondence to Jarl Å. Jakobsen .

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Editors and Affiliations

  1. Copenhagen University Hospital, Herlev, Denmark

    Henrik S. Thomsen

  2. Diagnostic Radiology Dept., St. Bartholomews Hospital, London, United Kingdom

    Judith A. W. Webb

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© 2014 Springer-Verlag Berlin Heidelberg

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Jakobsen, J.Å. (2014). Contrast Media Extravasation Injury. In: Thomsen, H., Webb, J. (eds) Contrast Media. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2013_888

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  • DOI: https://doi.org/10.1007/174_2013_888

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36723-6

  • Online ISBN: 978-3-642-36724-3

  • eBook Packages: MedicineMedicine (R0)

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