Risk of contrast extravasation with vascular access in computed tomography
Diagnostic computed tomography (CT) imaging, utilizing intravenous (IV) contrast administration, has become increasingly common. Potential IV contrast-associated complications include local skin and soft tissue reactions due to extravasation. The goal of this study is to describe the risk of contrast extravasation based on IV catheter anatomic location in patients receiving contrast-enhanced CT imaging.
The study was conducted as a retrospective cohort study of patients receiving contrast-enhanced CT imaging performed over a 26-month period at a single institution. The rate of contrast extravasation was calculated by IV catheter vessel anatomic location and compared by relative risk (RR) and absolute risk reduction (ARR).
Of 17,767 contrast administrations for CT imaging studies performed, 14,558 met study inclusion criteria. Forty-nine (0.34%) extravasation events were identified. Forty-one (0.28%, 95% CI 0.21–0.39%) extravasation events were observed in 14,275 peripheral IV catheters placed in a non-upper arm location. Eight (2.8%, 95% CI 1.3–5.3%) extravasation events were observed in 283 IV catheters placed, most commonly with point-of-care ultrasound (POCUS) guidance, in upper arm vessels (RR 10.1, 95% CI 4.69–21.8). Non-upper arm located IV catheters were associated with an ARR of 2.54% (95% CI 0.61–4.47%) when compared to upper arm catheters.
IV catheter placement in upper arm vessels is associated with a relatively minimal increase in extravasation risk when compared to catheters placed in a non-upper arm location. In patients without alternative available peripheral vascular access, POCUS-guided upper arm IV cannulation may be an appropriate approach.
KeywordsPhlebotomy Emergency services Organizational efficiency Delivery of health care Health care quality Ultrasound
The study authors would like to acknowledge WenShan Lin, Chris Gignac, and Lara Johnston for assistance with data collection.
JRS, RC, MC, and CM conceived and designed the study. JRS, DR, RC, and CM supervised and assisted in data collection. JRS, DR, RC, MA, and CM contributed to the data review and analysis. JRS and DR drafted the manuscript, and all authors contributed substantially to its revision. JRS takes responsibility for the paper as a whole.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 8.ACR. ACR manual on contrast media, v10.3. Reston, VA. https://www.acr.org/Quality-Safety/Resources/Contrast-Manual; 2017, Accessed date: 29 December, 2018
- 17.Rupp JD, Ferre RM, Boyd JS, Dearing E, McNaughton C, Liu D, Jarrell KL, McWade C, Self WH (2016) Extravasation risk using ultrasound-guided peripheral intravenous catheters for computed tomography contrast administration. Acad Emerg Med 23(8):918–921. https://doi.org/10.1111/acem.13000 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Benkhadra M, Collignon M, Fournel I et al (2012) Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Paediatr Anaesth 22(5):449–454. https://doi.org/10.1111/j.1460-9592.2012.03830.x CrossRefPubMedGoogle Scholar
- 22.Doniger SJ, Ishimine P, Fox JC, Kanegaye JT (2009) Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care 25(3):154–159. https://doi.org/10.1097/PEC.0b013e31819a8946 CrossRefPubMedGoogle Scholar
- 32.Smit JM, Raadsen R, Blans MJ, Petjak M, van de Ven P, Tuinman PR (2018) Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Crit Care 22(1):65. https://doi.org/10.1186/s13054-018-1989-x CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Struck MF, Fakler JKM, Bernhard M, Busch T, Stumpp P, Hempel G, Beilicke A, Stehr SN, Josten C, Wrigge H (2018) Mechanical complications and outcomes following invasive emergency procedures in severely injured trauma patients. Sci Rep 8(1):3976. https://doi.org/10.1038/s41598-018-22457-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, Karavergou A, Rapti A, Trakada G, Katsikogiannis N, Tsakiridis K, Karapantzos I, Karapantzou C, Barbetakis N, Zissimopoulos A, Kuhajda I, Andjelkovic D, Zarogoulidis K, Zarogoulidis P (2015) Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med 3(3):40. https://doi.org/10.3978/j.issn.2305-5839.2015.02.11 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Hwang B-Y, Kim E, Kim W-S et al (2014) Hemorrhagic shock occurring due to a concealed hematoma after insertion of a subclavian venous catheter in a patient undergoing anticoagulation therapy: a case report. Korean J Anesthesiol 67(5):358. https://doi.org/10.4097/kjae.2014.67.5.358 CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Panebianco NL, Fredette JM, Szyld D, Sagalyn EB, Pines JM, Dean AJ (2009) What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med 16(12):1298–1303. https://doi.org/10.1111/j.1553-2712.2009.00520.x CrossRefPubMedGoogle Scholar