Management of Extravasated Contrast
The management of extravasated contrast should focus on immediate assessment, conservative treatment, and appropriate follow-up, with special interventions reserved for severe cases.
Initial Assessment and Documentation
- Document the incident thoroughly, including patient information, date and time of extravasation, type and amount of contrast media extravasated, signs and symptoms, description of IV access, affected area and approximate volume, and management steps 1
- Consider photographic documentation for follow-up purposes 1
- Assess for signs of tissue damage, pain, swelling, erythema, and potential compartment syndrome 2
Immediate Management
- Stop the infusion immediately when extravasation is detected 1
- For central line extravasation, attempt gentle aspiration through the catheter 1
- Elevate the affected extremity to reduce swelling 3
- Apply cold compresses to the affected area to reduce inflammation 3
Conservative Treatment Approach
- Provide appropriate analgesia for pain control 1
- Implement conservative management including elevation of the extremity, frequent pulse and sensation exams, local massage, and temporary splinting 3
- Monitor for signs of compartment syndrome including increasing pain, tension, decreased sensation, or compromised circulation 4
Special Interventions
- For large volume extravasations, consider hyaluronidase (HYLENEX) injection to enhance dispersion and absorption of extravasated contrast 5
- Typical dose is 150 U injected subcutaneously into the affected area 5
- In severe cases with signs of compartment syndrome, immediate surgical consultation is required for potential fasciotomy 4
- For significant extravasation injuries, plastic surgery consultation may be warranted, though most cases of non-ionic contrast extravasation can be managed conservatively 3
Follow-up Recommendations
- Regular monitoring of the extravasation site for the first week, with daily or every 2 days follow-up 1
- Weekly follow-up until complete resolution of symptoms 1
- Instruct patients about potential signs of complications requiring immediate attention (increasing pain, swelling, skin discoloration, or decreased sensation) 1
Risk Factors and Prevention
- High-risk patients include infants, young children, unconscious and debilitated patients 6
- Higher risk with automated power injection which may result in extravasation of large volumes 6
- Use appropriate IV access and careful evaluation of the intravenous administration site before contrast injection 4
- Close monitoring during contrast material injection 4
Special Considerations
- Non-ionic contrast media extravasation is generally less harmful than ionic contrast media 3
- Most extravasations (90%) involve less than 100cc of contrast and can be managed conservatively 3
- Compartment syndrome is a rare but serious complication that requires immediate surgical intervention 4
- Central line extravasation is rare (0.24% of cases) but potentially serious, with contrast accumulating in the mediastinum, pleura, or subcutaneous chest/neck tissue 1
Remember that most extravasations result in minimal swelling or erythema with no long-term sequelae, but vigilant monitoring is essential to identify the rare cases requiring more aggressive intervention 6.