Frequency, Management, and Outcome of Extravasation of Nonionic Iodinated Contrast Medium in 69 657 Intravenous Injections

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.

© RSNA, 2007

References

  • 1 Cohan RH, Dunnick NR, Leder RA, Baker ME. Extravasation of nonionic radiologic contrast media: efficacy of conservative treatment. Radiology 1990; 176: 65–67. LinkGoogle Scholar
  • 2 Miles SG, Rasmussen JF, Litwiller T, Osik A. Safe use of an intravenous power injector for CT: experience and protocol. Radiology 1990;176:69–70. LinkGoogle Scholar
  • 3 Sistrom CL, Gay SB, Peffley L. Extravasation of iopamidol and iohexol during contrast-enhanced CT: report of 28 cases. Radiology 1991;180:707–710. LinkGoogle Scholar
  • 4 Bullard MA, Cohan RH, Ellis JH, Jan SH, Francis IR, Dunnick NR. Extravasation of intravenous contrast material: incidence, management, outcome. Acad Radiol 1997;4:711–718. Crossref, MedlineGoogle Scholar
  • 5 Federle MP, Chang PJ, Confer S, Ozgun B. Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection. Radiology 1998;206:637–640. LinkGoogle Scholar
  • 6 Jacobs JE, Birnbaum BA, Langlotz CP. Contrast media reactions and extravasation: relationship to intravenous injection rates. Radiology 1998;209:411–416. LinkGoogle Scholar
  • 7 Cohan RH, Ellis JH, Garner WM. Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology 1996;200:593–604. LinkGoogle Scholar
  • 8 Upton J, Mulliken JB, Murray JE. Major intravenous extravasation injuries. Am J Surg 1979;137:497–506. Crossref, MedlineGoogle Scholar
  • 9 Leung PC, Cheng CY. Extensive local necrosis following the intravenous use of x-ray contrast medium in the upper extremity. Br J Radiol 1980;53:361–364. Crossref, MedlineGoogle Scholar
  • 10 Ayre-Smith G. Tissue necrosis following extravasation of contrast material. J Can Assoc Radiol 1982;33:104. MedlineGoogle Scholar
  • 11 Burd DA, Santis G, Milward TM. Severe extravasation injury: an avoidable iatrogenic disaster? Br Med J (Clin Res Ed) 1985;290:1579–1580. Crossref, MedlineGoogle Scholar
  • 12 Loth TS, Eversman WM. Extravasation injuries in the upper extremity. Clin Orthop Relat Res 1991;272:248–254. MedlineGoogle Scholar
  • 13 Pond GD, Dorr RT, McAleese KA. Skin ulceration from extravasation of low-osmolality contrast medium: a complication of automation. AJR Am J Roentgenol 1992;158:915–916. Crossref, MedlineGoogle Scholar
  • 14 Memolo M, Dyer R, Zagoria RJ. Extravasation injury with nonionic contrast material. AJR Am J Roentgenol 1993;160:203–204. Crossref, MedlineGoogle Scholar
  • 15 Young RA. Injury due to extravasation of nonionic contrast material [letter]. AJR Am J Roentgenol 1994;162:1499. Google Scholar
  • 16 Benson LS, Sathy MJ, Port RB. Forearm compartment syndrome: forearm compartment syndrome due to automated injection of computed tomography contrast material. J Orthop Trauma 1996;10:433–436. Crossref, MedlineGoogle Scholar
  • 17 Sinan T, Al-Khawari H, Chishti RA, Al Saeed OM, Sheikh M. Contrast media extravasation: manual versus power injector. Med Princ Pract 2005;14:107–110. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2007