Background:
Extravasated iodinated contrast media is hyperosmolar and toxic to the surrounding tissues. Most patients recover without sequelae but severe adverse events may occur. Extravasation produces an acute local inflammatory response that peaks at 24-48 hrs although ulceration and tissue necrosis may occur as early as 6 hours after the extravasation. Extravasation of a large volume of contrast material can produce a compartment syndrome.
Evaluation and Treatment:
- All patients in which an extravasation has occurred should be evaluated by a radiologist from the service that would be reading the exam.
- All outpatients should be monitored in the department for a minimum of 1 hour even if the patient is asymptomatic.
- Elevation of the extremity and cold compresses should be applied to the site up to four times/day for 1-3 days.
- If the symptoms improve or the patient remains asymptomatic, they may be sent home but told to go immediately to an ER if symptoms deteriorate or if there are skin/neurologic changes (ulceration, blistering, change in sensation).
- If symptoms have not improved after 2 hours or skin/neurologic changes develop, the patient should be referred to the emergency room.
- For inpatients, the extremity should be elevated and a cold compress should be applied (as above). Inpatients may be sent back to the floor but the house staff must be notified of the incident.
- A plastic surgical consult is frequently not necessary and a reliance of a volume threshold for surgical consultation is unreliable. In general, the need for surgical consultation should be made on the basis of the patients signs and symptoms.
- An immediate plastic surgical consultation is indicated with the following:
- Increasing swelling/pain after 2-4 hours.
- Altered tissue perfusion as evidenced by decreased capillary refill
- Change in sensation of the affected limb
- Skin ulceration or blistering.
- All extravasation events should be documented in the radiology report and the referring physician should be notified.