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Bae, Kang, Ryu, Cho, Oh, Kim, Choi, Lee, and Kang: Clinical Manifestations of Contrast Media Extravasation in the Emergency Department and the Ward
Original Article

J Korean Soc Radiol 2019;80(2):294-305.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.2.294

Clinical Manifestations of Contrast Media Extravasation in the Emergency Department and the Ward

Jeong Gwuang Bae, MD1, Tae Kyung Kang, MD1, ∗, Seokyoung Ryu, MD1, Suk Jin Cho, MD1, Sung Chan Oh, MD1, Hye Jin Kim, MD1, Seung Woon Choi, MD1, Sun Hwa Lee, MD1, Mi-Jin Kang, MD2

1Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea

2Department of Radiology, Inje University Sanggye Paik Hospital, Seoul, Korea

∗Corresponding author Tae Kyung Kang, MD Department of Emergency Medicine, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea. Tel 82-2-950-1119 Fax 82-2-938-4940 E-mail emmania2011@paik.ac.kr

Received 18 May 2018       Revised 2 July 2018       Accepted 26 July 2018

Copyright © 2019 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Contrast media extravasation (CME) is an adverse reaction after administration of contrast media during CT examinations. The purpose of this study was to evaluate the frequen-cy, management, and outcomes of extravasations and to assess the risk factors for CME in the emergency department (ED) and the ward.

Materials and Methods

This retrospective study was conducted at a single academic urban hospital from January 2013 to December 2015. We analyzed the medical records of all patients who experienced CME after undergoing a CT scan. We compared the patients' age, sex, underlying disease, injection site, injection flow rate, time of CT examination, type of CT examination, and severity of injury between those in the ED and the ward.

Results

CME occurred in 41 (0.36%) of 114767 patients, which included 16 (0.34%) in the ED and 25 (0.37%) in the ward. Both groups were more frequent in those aged older than 60 years and in female. Additionally, the abdominopelvic CT type and 2–3 mL/s as the injection rate were more common in both groups. However, CME was more frequent during the nighttime (10, 62.5%) in the ER, while it was more common in the daytime (14, 56.0%) in the ward. Severe complications were more frequent in the ER (9, 56.3%) compared with the ward (8, 32.8%). There were no significant differences in CME between the ED and the ward. When comparing the clinical manifestations in the mild and severe groups, the antecubital fossa (33.3% and 0%, respectively; p = 0.013) for the injection site and abdominopelvic CT (41.7% and 82.4%, respectively; p = 0.012) and CT angiography (41.7% and 5.87%, respectively; p = 0.014) for the CT examination showed significant differences between the mild and severe groups.

Conclusion

In this study, there were no significant clinical differences in CME between the ED and ward. Thus, prevention is more important than the place of admission. Radiologists and emergency physicians should pay attention to CME in the ED because it frequently occurs at night and results in more severe complications.
night and results in more severe complications.

References

1. Bae K, Lee SM, Ha JY, Jeon KN, Moon JI, Choi BH, et al. Adverse drug reactions to CT contrast media in South Korea: incidence and risk factors. J Korean Soc Radiol. 2016; 75:41–48.
crossref
2. ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. 10th ed. Reston (VA): American College of Radiology. 2006. 20–23.
3. The Korean Society of Radiology, The Korean Academy of Asthma, Allergy and Clinical Immunology, Korea Institute of Drug Safety & Risk Management. Available at. http://www.allergy.or.kr/file/allergic2016.pdf. Published 2016. Accessed Dec 24,. 2017.
4. Bellin MF, Jakobsen JA, Tomassin I, Thomsen HS, Morcos SK, Thomsen HS, et al. Contrast medium extravasation injury: guidelines for prevention and management. Eur Radiol. 2002; 12:2807–2812.
crossref
5. 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
6. Memolo M, Dyer R, Zagoria RJ. Extravasation injury with nonionic contrast material. AJR Am J Roentgenol. 1993; 160:203–204.
crossref
7. Young RA. Injury due to extravasation of nonionic contrast material. AJR Am J Roentgenol. 1994; 162:1499.
crossref
8. Benson LS, Sathy MJ, Port RB. Forearm compartment syndrome due to automated injection of computed tomography contrast material. J Orthop Trauma. 1996; 10:433–436.
9. Heshmatzadeh Behzadi A, Farooq Z, Newhouse JH, Prince MR. MRI and CT contrast media extravasation: a systematic review. Medicine (Baltimore). 2018; 97:e0055.
10. Wang CL, Cohan RH, Ellis JH, Adusumilli S, Dunnick NR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology. 2007; 243:80–87.
crossref
11. Nicola R, Shaqdan KW, Aran S, Prabhakar AM, Singh AK, Abujudeh HH. Contrast media extravasation of computed tomography and magnetic resonance imaging: management guidelines for the radiologist. Curr Probl Diagn Radiol. 2016; 45:161–164.
crossref
12. Department of Radiology and Biomedical Imaging, University of Callifornia, San Francisco. CT and X-ray Contrast Guidelines. Available at.https://radiology.ucsf.edu/patient-care/patient-safety/contrast/iodinat-ed/. Accessed Mar 8,. 2013.
13. Jacobs JE, Birnbaum BA, Langlotz CP. Contrast media reactions and extravasation: relationship to intravenous injection rates. Radiology. 1998; 209:411–416.
crossref
14. Kingston RJ, Young N, Sindhusake DP, Truong M. Study of patients with intravenous contrast extravasation on CT studies, with radiology staff and ward staff cannulations.J Med Imaging Radiat Oncol. 2012; 56:163–167.
15. Cohan RH, Ellis JH, Garner WL. Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology. 1996; 200:593–604.
crossref
16. Alami Z, Nasri S, Ahid S, Kacem HH. Extravasation of contrast medium during CT examination: an observational case-control study. Pan Afr Med J. 2015; 20:89.
crossref
17. Sistrom CL, Gay SB, Peffley L. Extravasation of iopamidol and iohexol during contrast-enhanced CT: report of 28 cases.Radiology. 1991; 180:707–710.
18. Hadaway L. Infiltration and extravasation. Am J Nurs. 2007; 107:64–72.
crossref

Table 1.
General Characteristics of Patients
  ED (n =16) Ward (n = 25) Total (n = 41) p-Value
Age (years),n (%) 67.7 ± 13.5 70 ± 16.8 69.3 ± 15.5 0.435
< 18 0 1 (4.0) 1 (2.4) 1.000
18–59 4 (25.0) 2 (8.0) 6 (14.6) 0.187
> 60 12 (75.0) 22 (88.0) 34 (82.9) 0.401
Sex,n (%)
Male 5 (31.3) 11 (44.0) 16 (39.0) 0.519
Female 11 (68.7) 14 (56.0) 25 (61.0)  
Underlying disease, n (%)
HTN 8 (50.0) 13 (52.0) 21 (51.2) 1.000
DM 4 (25.0) 9 (36.0) 13 (31.7) 0.513
Malignancy 0 4 (16.0) 4 (9.76) 0.143
CVD 5 (31.3) 5 (20.0) 10 (24.4) 0.472

CVD = cardiovascular disease, DM = diabetes mellitus, ED = emergency department, HTN = hypertension

Table 2.
Comparison of CT Study Type between ED and Ward
  ED (n =16) Ward (n = 25) p-Value
Study, n (%)
Abdominopelvis 10 (62.5) 14 (56.0) 0.753
Chest 1 (6.3) 1 (4.0) 1.000
Neck 0 1 (4.0) 1.000
Brain 0 1 (4.0) 1.000
Chest/Neck 0 1 (4.0) 1.000
Chest/Abdomen 1 (6.3) 0 0.390
CTA 4 (25.0) 7 (28.0) 1.000

CTA = computed tomography angiography, ED = emergency department

Table 3.
Comparison of Contrast Media Extravasation between ED and Ward
  ED (n =16) Ward (n = 25) p-Value
Shift, n (%)
Day 6 (37.5) 14 (56.0) 0.341
Day Night 6 (37.5) 10 (62.5) 14 (56.0) 11 (44.0) 0.341
Cannula site, n (%)
Arm 4 (25.0) 10 (40.0) 0.501
AC 5 (31.3) 3 (12.0) 0.225
Forearm 1 (6.3) 6 (24.0) 0.215
Dorsum 5 (31.3) 5 (20.0) 0.472
Foot 1 (6.3) 0 0.390
Central 0 1 (4.0) 1.000
Flow rate (mL/s),n (%)
2 < 0 1 (4.0) 1.000
2–3 10 (62.5) 14 (56.0) 0.753
3 > 6 (37.5) 10 (40.0) 1.000
Severity, n (%)
Mild 7 (43.8) 17 (68.0) 0.124
Severe 9 (56.3) 8 (32.8)  
AC = antecubital fossa, ED = emergency department
Table 4.
Comparison of Patients according to Severity of Contrast Media Extravasation
  Mild (n =24) Severe (n = 17) p-Value
Sex,n (%)
Male 9 (37.5) 7 (41.2) 1.000
Female 15 (62.5) 10 (58.8)  
Age (years),n (%)
< 18 1 (4.2) 0 1.000
18–59 1 (4.2) 5 (29.4) 0.066
> 60 22 (91.6) 12 (70.6) 0.105
Shift,n (%)
Day 14 (58.3) 6(35.3) 0.208
Night 10 (41.7) 11(64.7)  
Site,n (%)
Arm 7 (29.2) 7 (41.2) 0.512
AC 8 (33.3) 0 0.013
Forearm 4 (16.7) 3 (17.6) 1.000
Dorsum 4 (16.7) 6 (35.2) 0.270
Foot 0 1 (6.0) 0.415
Central 1 (4.1) 0 1.000
CT study,n (%)
Abdominopelvis 10 (41.7) 14 (82.4) 0.012
Chest 1 (4.17) 1 (5.87) 1.000
Neck 1 (4.17) 0 1.000
Brain 1 (4.17) 0 1.000
Chest/Neck 1 (4.17) 0 1.000
Chest/Abdomen 0 1 (5.87) 0.415
CTA 10 (41.7) 1 (5.87) 0.014
Flow rate (mL/s), n (%)
< 2 1 (4.17) 0 1.000
2–3 11 (45.8) 13 (76.5) 0.062
> 3 12 (50.0) 4 (23.5) 0.113
Underlying disease,n (%)
HTN 12 (50) 9 (52.9) 1.000
DM 7 (29.2) 6 (35.3) 0.742
Malignancy 3 (12.5) 1 (5.9) 0.629
CVD 7 (29.2) 3 (17.7) 0.480

AC = antecubital fossa, CTA = computed tomography angiography, CVD = cardiovascular disease, DM = diabetes mellitus, HTN = hypertension

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