From the April 2019 issue of HealthCare Business News magazine
To test the theory, the team at Einstein changed the protocol for all CE CT exams to use power-injection of the saline test bolus, using the same flow rate as the diagnostic injection. Over the next 15 months, a 53% reduction in the department’s overall extravasation rates was observed. As a result of this finding, power-injection of the saline test bolus at the same flow rate as the diagnostic contrast injection is now routinely utilized for all CT contrast-enhanced exams, and considered a best practice within the Einstein Medical Center.
Technologists can play an important role in the reduction of extravasations. For example, keeping the patient’s arm in the same position for the pre-injection saline test bolus and the diagnostic contrast injection can be beneficial. When a patient places their arm above the head for the diagnostic scan, the IV can change in position and become kinked, increasing the risk of extravasation. Thus evaluating the IV with the saline test injection in the same position as the diagnostic injection can be an important consideration.
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Current literature demonstrates that Ultrasound-guided IVs have higher rates of extravasation than other peripheral IVs. This led to a recommendation of avoiding IVs that were placed using Ultrasound guidance for CT IV contrast administration whenever possible.
Radiologist and Technologist need to work together to continue to share information and best practices to address extravasation. The study at Einstein is evidence that the implementation of best practices can help to drive down overall rates.
Best practice recommendations for reducing contrast extravasations:
- Use of a power-injected saline test injection at the same flow rate as contrast injection*
- IV Location – antecubital fossa
- IV Gauge – 20G preferred
- Avoid ultrasound guided IV placements
- Place the patient’s arm in the same position for the pre-injection saline test bolus and the diagnostic contrast injection
- When extravasations occur, use the 5P’s (Pain, Pallor, Pulse, Paralysis and Paresthesia) to evaluate for possible surgical consultation
Dr. Ryan K. Lee
Injection of contrast media for enhanced CT exams plays an important role in diagnosis of pathology. With more than 36 million CE CT exams each year in the United States it is imperative we continually evaluate best practice approaches to help reduce contrast extravasation.
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