Contrast extravasation in CT [QSI Ref: XR-513]

An audit of the assessment & management of patients who sustained contrast extravasation during CT examination

Contrast extravasation is a potentially limb-threatening event and is not an infrequent occurrence during CT examinations. Ensuring that patients receive timely assessment & aftercare following contrast extravasation is crucial to prevent irreversible limb damage.

This audit aims to determine:

1) Whether contrast extravasations are recorded in the radiology department & whether a local protocol for assessing & managing them exists in the department

2) To audit whether the radiology department is meeting the local protocol

The standard: 

1) Ensure there is a locally agreed protocol for contrast extravasation in CT & that there is a record/database of patients that sustained contrast extravasations.

2) A locally agreed protocol could include (for example): the need for all patients to be assessed by a healthcare professional (defined in the local protocol) following contrast extravasation with clear documentation on limb assessment, the volume of contrast injected & further management (e.g. if referral made to plastics or if not then giving advice/leaflet to patient/ward team about icing & elevation of limb & symptoms to watch out for). This information may be recorded on RIS or in a patient's hospital record or in the CT report.

Target: 

1) 100% of contrast extravasations should be reviewed by a health care professional before the patient is sent home (if outpatient CT) or (if inpatient CT) before being sent back to the ward.

2) Documentation on the extravasation should include: the volume of contrast injected (100%), assessment of the limb (100%), further management (100%).

Indicators: 

% of records containing the information set out in the standard, i.e. documentation of limb assessment, the volume of contrast injected & further management.

Data items to be collected: 

Whether health care professional reviewed (yes/no)

Volume of contrast injected (yes/no)

Assessment of limb (yes/no - diagram or written description)

Further management (referral to plastic surgery/discharge with advice)

Site or location where the extravasation occurred, including whether this happened in a CDC, in a hospital with or without A&E, in a hospital with or without plastics available, or where radiologists were available remotely

Availability of resources in the CT scanner area, including whether only green or pink cannulas were available

Contributory factors to contrast extravasation, including difficult venous access (including prior chemotherapy), cannula insertion by trainee radiographers, use of a new injector, and cannula selection and injection rate

Any complaints by the patient

Outcome of the contrast extravasation, including what happened to the limb, whether the patient required observation only or was sent to A&E, and whether amputation occurred

Suggested number: 

20 cases or all that occur within a 3-month period, depending on local event frequency.

If no local protocol & documentation exists regarding contrast extravasation, then this should be established with standards as specified in this template.

If <100% of patients being assessed by health care professional, recommend radiographers ask health care professionals that are reporting in closest proximity to CT scanner to review patients.

If <100% of records complete, pro forma can be developed to accurately record contrast extravasation & arrange meeting with radiographers & radiologists to explain information that needs to be recorded when contrast extravasation occurs (as set out in standard).

1. ACR manual on contrast media. ACR committee on drugs and contrast media Version 10.3 (https://www.acr.org/Clinical-Resources/Contrast-Manual); 2017. Accessed 22 December 2018.

Stefan Lazic