Contrast media extravasation (CMEV) is a well-known complication of contrast-enhanced CT scanning1. Can also occur in MRI studies, but the complications are rare given the low volume used on it.
CT contrast extravasation occurs relatively infrequently (0.13 - 0.68%), but can have severe side effects associated with skin changes and possible skin necrosis.
Nonionic low-osmolar contrast media is known to reduce the risk of severe soft tissue injury but risk of soft tissue injury is often related to the volume of CMEV1.
Possible causes related to leakage
- The introduction of automated power injection has increased the incidence because power injection may result in extravasation of large volumes in a short period of time2, unlike what occurred with manual injection which has direct supervision of the nurse who administers the contrast.
- patient-related factors, such as:
- elderly patients;
- emaciated patients;
- edematous patients;
- confused patients.
- site of venous access: higher percentage of leakage in the venous access in the back of the hand, wrist, foot and ankle. It is believed that are related to a smaller amount of subcutaneous tissue and the fact that veins are more fragile on these regions.
- Gauge venous access: only if are tempted a smaller caliber accesses (over 22G). Study showed that risk of leakage is the same into sizes of 18 and 20G1.
- High-osmolar contrast medium2.
Most extravasations result in minimal swelling or erythema and have no long-term sequelae2. A large study found that more than 97% of patients with contrast extravasation had minimal or no injury, and reported that 79% of patients had localized swelling after extravasation, 24% had pain, and 8% were asymptomatic3.
Large volumes (> 50 mL) of high-osmolar contrast media are known to induce significant tissue damage, such as:
- skin ulceration;
- soft-tissue necrosis;
- compartment syndrome.
The conduct after an episode of CMEV will vary according to the protocol of each radiology department, and usually includes:
- discontinue the contrast infusion and notify the radiologist immediately;
- complete the acquisition of images of the CT series;
- if the canula is still in place, could be possible to aspirate any residual drug, after remove the IV canula;
- apply ice pack to affected area and elevate the affected extremity to reduce swelling.
- keep the patient under observation for at least 2 hours;
- although our policy requires plastic surgery consultation for all patients whose extravasations involve 100 mL or more of contrast medium;
- make contact with the doctor requesting the examination;
- it is suggested to follow up the patient by the next few days until the resolution of local edema. Can be accomplished with a phone call to evaluate the regression of the signs and symptoms.
- instruct the patient to notify staff if there is:
- increasing swelling or pain over time;
- blistering, ulceration, induration or other skin changes;
- altered tissue perfusion and changes in sensation;
- 1- Sinan T, Al-khawari H, Chishti FA et-al. Contrast media extravasation: manual versus power injector. Med Princ Pract. 14 (2): 107-10. doi:10.1159/000083921 - Pubmed citation
- 2- Bellin MF, Jakobsen JA, Tomassin I et-al. Contrast medium extravasation injury: guidelines for prevention and management. Eur Radiol. 2002;12 (11): 2807-12. doi:10.1007/s00330-002-1630-9 - Pubmed citation
- 3- Wang CL, Cohan RH, Ellis JH et-al. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology. 2007;243 (1): 80-7. doi:10.1148/radiol.2431060554 - Pubmed citation
- 4- Wang CL, Cohan RH, Ellis JH et-al. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology. 2007;243 (1): 80-7. doi:10.1148/radiol.2431060554 - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Extravasation of iodinated contrast||✗|
|Contrast media extravasation||✓|