Martin Lee David Gunn MBChB, Presenter: Medical Advisor, TransformativeMed, Inc Spouse, Consultant, Wolters Kluwer nv Grant, Koninklijke Philips NV

Bruce E. Lehnert MD, Abstract Co-Author: Nothing to Disclose

The primary purpose of this study was to examine the contrast extravasation (CE) rate and complications from power-injected intravenous low-osmolality iodinated contrast media The secondary purpose was to determine the impact of real-time pressure monitoring and saline test injections on the CE rate.

Retrospective, single-center review of adult patients (18 years and older) maintained in a dedicated CE database from 2006 to 2013 inclusive, encompassing approximately 80,000 contrast injections. Demographic information, iv line location (peripheral or central), scan protocol used, flow rate, contrast type, volume of contrast extravasation, and complications were examined. Statistical analysis included chi-squared tests for contingency tables, and t-test for continuous variables.

From 2006-2013 inclusive, there were 290 CE's from 80,045 contrast injections, yielding an overall CE rate of 0.362%. All injections were non-ionic low-osmolality contrast media (iohexol 300, iohexol 350, iodixanol 320). CE occurred in older patients than those without CE (52.04 vs 46.9 years, p<0.0001). There was a significant gender difference, with males slightly less likely to have extravasations than females (relative risk 0.74; 95%CI 0.59-0.94; p=0.014).. Volume of extravasation ranged from 20 cc to 200 cc (mean 72.8cc, sd 41. 14 cc). Following implementation of a power-injected saline test flush and real-time technologist pressure monitoring in 2008, there was no reduction in the extravasation rate (pre: 0.40%, post: 0.33% to (p<=0.17), or volume (69.8 cc vs 75 cc 95CI = -6.1-16.35 cc, p=0.36) CE line type were: 238 (82%) peripheral, 22 (8%) central, and 30 unknown (10%)respectively. There were two serious complications - forearm compartment syndrome requiring a fasciotomy, and central line extravasation requiring chest tube placement.

We report a low rate of CE following iv power injection. Age is correlated with risk. 2/259 serious complications occurred, confirming the safety of LOCM CE power-injections. The implementation of saline test power-injections and real-time pressure monitoring was not associated with a lower rate or volume of extravasations.

The risk of a complication requiring intervention due to CE is extremely low, approx 2 / 80,000 in our series. Using a saline test bolus, and real-time infusion pressure monitoring do not reduce, or volume of CE.

Gunn, M, Lehnert, B, Intravenous Contrast Extravasation: Trends in Rate, Complications, and Demographics.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011456.html