CT contrast media extravasation - Revision history

Rossdonaldson1: /* Evaluation */

2021-11-25T11:58:03Z

Evaluation

← Older revision		Revision as of 11:58, 25 November 2021
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	==Evaluation==		==Evaluation==
	[[File:PMC4891405 gr1.png\|thumb\|Contrast extravasation of 120 ml into the biceps compartment. A and B, External and internal rotation radiographs of the arm approximately one hour after injection show a soft tissue collection of contrast material in the expected location of the biceps compartment that is completely contained with sharp margins.]]		[[File:PMC4891405 gr1.png\|thumb\|Contrast extravasation of 120 ml into the biceps compartment. A and B, External and internal rotation radiographs of the arm approximately one hour after injection show a soft tissue collection of contrast material in the expected location of the biceps compartment that is completely contained with sharp margins.]]
			[[File:PMC5265191 13244 2016 524 Fig4 HTML.png\|thumb\|(a) Extravasation of intravenously injected contrast material. Coronal reformatted CT depicts extravasated contrast in the upper extremity soft tissues. (b) CT scout image after extravasation of intravenously administered contrast in the left upper extremity allows assessment of the extent of extravasation and permits evaluation of possible compartment syndrome.]]
	*Clinical (if no complication)		*Clinical (if no complication)
	*Consider plain films and/or CT, if concern for significant complication		*Consider plain films and/or CT, if concern for significant complication

Rossdonaldson1 at 11:24, 25 November 2021

2021-11-25T11:24:24Z

← Older revision		Revision as of 11:24, 25 November 2021
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	*Consider hyaluronidase for iodinated contrast extravasation<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>		*Consider hyaluronidase for iodinated contrast extravasation<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>
	**Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>		**Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>
			*Monitor for signs of [[compartment syndrome]]

			==Disposition==
			*May discharge after 2 hours with precautions, if no signs of complications.

	==Complications==		==Complications==
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	**79% have localized swelling after extravasation		**79% have localized swelling after extravasation
	**24% had pain		**24% had pain

	*Large volumes (> 50 mL) of high-osmolar contrast media = highest risk		*Large volumes (> 50 mL) of high-osmolar contrast media = highest risk
	**~~skin~~ ulceration		**Skin ulceration
	**~~soft~~-tissue necrosis		**Soft-tissue necrosis
	**[[~~compartment~~ syndrome]]		**[[Compartment syndrome]]

	~~==Disposition==~~
	*May discharge after 2 hours with precautions, if no signs of complications.

	==See Also==		==See Also==

Rossdonaldson1: /* Evaluation */

2021-11-25T11:23:08Z

Evaluation

← Older revision		Revision as of 11:23, 25 November 2021
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	==Evaluation==		==Evaluation==
			[[File:PMC4891405 gr1.png\|thumb\|Contrast extravasation of 120 ml into the biceps compartment. A and B, External and internal rotation radiographs of the arm approximately one hour after injection show a soft tissue collection of contrast material in the expected location of the biceps compartment that is completely contained with sharp margins.]]
	*Clinical (if no complication)		*Clinical (if no complication)
			*Consider plain films and/or CT, if concern for significant complication

	==Management==		==Management==

Rossdonaldson1: /* Management */

2021-11-25T11:15:25Z

Management

← Older revision		Revision as of 11:15, 25 November 2021
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	*Ice pack to affected area		*Ice pack to affected area
	*Elevate		*Elevate
	*Consider hyaluronidase for iodinated contrast ~~through~~ the original IV ~~to be given subcutaneously~~<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>		*Consider hyaluronidase for iodinated contrast extravasation<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>
			**Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>

	==Complications==		==Complications==

Rossdonaldson1 at 11:12, 25 November 2021

2021-11-25T11:12:09Z

← Older revision		Revision as of 11:12, 25 November 2021
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	==Background==		==Background==
	*~~complication~~ of contrast-enhanced CT scanning		*Complication of contrast-enhanced CT scanning
	**~~may~~ also occur from MRI, but rare given low volume used		**May also occur from MRI, but rare given low volume used
	*[[Ultrasound-assisted peripheral line placement\|Ultrasound-guided IVs]] are at higher risk<ref>Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001</ref>		*[[Ultrasound-assisted peripheral line placement\|Ultrasound-guided IVs]] are at higher risk<ref>Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001</ref>

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	*Ice pack to affected area		*Ice pack to affected area
	*Elevate		*Elevate
	*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> ~~for iodinated contrast through the original IV to be given subcutaneously~~		*Consider hyaluronidase for iodinated contrast through the original IV to be given subcutaneously<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>

	==Complications==		==Complications==
Line 34:		Line 34:

	==Disposition==		==Disposition==
	May discharge after 2 hours with precautions if no signs of complications		*May discharge after 2 hours with precautions, if no signs of complications.

	==See Also==		==See Also==

Andreawu: /* Management */

2021-11-23T20:25:25Z

Management

← Older revision		Revision as of 20:25, 23 November 2021
Line 21:		Line 21:
	*Ice pack to affected area		*Ice pack to affected area
	*Elevate		*Elevate
	*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> for iodinated contrast		*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> for iodinated contrast through the original IV to be given subcutaneously

	==Complications==		==Complications==

Andreawu: /* Complications */

2021-11-23T20:21:55Z

Complications

← Older revision		Revision as of 20:21, 23 November 2021
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	**79% have localized swelling after extravasation		**79% have localized swelling after extravasation
	**24% had pain		**24% had pain
	**8%
	*Large volumes (> 50 mL) of high-osmolar contrast media = highest risk		*Large volumes (> 50 mL) of high-osmolar contrast media = highest risk
	**skin ulceration		**skin ulceration

Andreawu: /* Management */

2021-11-23T20:20:48Z

Management

← Older revision		Revision as of 20:20, 23 November 2021
Line 21:		Line 21:
	*Ice pack to affected area		*Ice pack to affected area
	*Elevate		*Elevate
	*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>		*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> for iodinated contrast

	==Complications==		==Complications==

Elcatracho: /* Background */

2021-03-03T15:33:57Z

Background

← Older revision		Revision as of 15:33, 3 March 2021
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	*complication of contrast-enhanced CT scanning		*complication of contrast-enhanced CT scanning
	**may also occur from MRI, but rare given low volume used		**may also occur from MRI, but rare given low volume used
			*[[Ultrasound-assisted peripheral line placement\|Ultrasound-guided IVs]] are at higher risk<ref>Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001</ref>

	===Epidemiology===		===Epidemiology===

Rossdonaldson1: /* Management */

2021-03-02T23:46:30Z

Management

← Older revision		Revision as of 23:46, 2 March 2021
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	*Remove IV canula		*Remove IV canula
	*Ice pack to affected area		*Ice pack to affected area
	*Elevate		*Elevate
			*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref>

	==Complications==		==Complications==