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Emerg Radiol. 2020 Jan 9. doi: 10.1007/s10140-020-01752-x. [Epub ahead of print]

Risk of contrast extravasation with vascular access in computed tomography.

Author information

1
Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA. Jeffrey_Stowell@DMGAZ.org.
2
Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA. Jeffrey_Stowell@DMGAZ.org.
3
Department of Emergency Medicine, Creighton University School of Medicine, 7500 Mercy Rd, Omaha, NE, 68124, USA. Jeffrey_Stowell@DMGAZ.org.
4
Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA.
5
Department of Radiology, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ, 85008, USA.
6
Department of Emergency Medicine, University of Arizona College of Medicine- Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA.
7
Department of Emergency Medicine, Creighton University School of Medicine, 7500 Mercy Rd, Omaha, NE, 68124, USA.

Abstract

PURPOSE:

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.

METHODS:

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).

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Delivery of health care; Emergency services; Health care quality; Organizational efficiency; Phlebotomy; Ultrasound

PMID:
31919617
DOI:
10.1007/s10140-020-01752-x

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