Extravasation During CT
A 70-year-old female with a history of diabetes and peripheral vascular disease is receiving IV contrast for a CT pulmonary angiogram. The IV is a 22-gauge catheter in the right antecubital fossa. During injection, the patient complains of severe burning at the site. The technologist notices swelling and redness around the IV site. The injection is stopped immediately. The patient's arm is cool to touch and there is blanching.
1. What are the immediate actions the technologist should take?
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Immediate actions: Stop injection, remove IV line, elevate the affected extremity, apply cold compresses (for most contrast media, except for vesicants like doxorubicin; for iodinated contrast, cold is recommended), monitor vital signs, notify the radiologist and referring physician, document the event (time, volume, symptoms), and instruct the patient to report any worsening symptoms. Do not massage the site. Assess distal pulses and capillary refill.
2. What factors contributed to this extravasation, and how could it have been prevented?
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Contributing factors: small gauge catheter (22G) in a patient with vascular disease, high flow rate for CTA, and possibly inadequate verification of IV patency. Prevention: use a larger gauge (20G or larger) for high-flow injections, assess IV site for blood return and patency before injection, consider a central line if peripheral access is poor, and use a test injection of saline. Also, monitor the patient during injection.