Abstract
To audit the radiology department of a health facility, focusing on contrast extravasations management pre- and post-implementation of a standard protocol. The audit was conducted at the Radiology Department of Shifa International Hospital, Islamabad, Pakistan and comprised reported computed tomography contrast extravasation incidents from January 2017 to December 2019 in the retrospective phase before the implementation of a standard protocol. Post-implementation, re-audit was done prospectively to assess compliance from January 2020 to May 2021. Overall score of >80% was chosen arbitrarily as a qualifying standard for adequate documentation. Of the 49 total cases, 26(53%) related to the first phase and 23(47%) to the second. In the first phase, 2(20%) of the 10 parameters cleared the cut-off mark; 'study performed' 25(96%) and 'limb assessment by technician' 26(100%). In the second phase, 2(20%) parameters failed to clear the cut-off mark; site of cannula/extravasation' 18(78.3%) and 'volume of contrast' 15(65%). Lack of early identification and appropriate management, especially in cases of large-volume extravasation, may result in significant morbidity.
Highlights
Contrast extravasation is a not an uncommon complication resulting from contrastenhanced conmputed tomography (CT) imaging, especially on using an automated power injector to deliver the contrast[1]
A large number of contrast extravasations result in mild swelling over the cannula site with induration[1]
The audit was conducted at the Radiology Department of Shifa International Hospital, Islamabad, Pakistan, and comprised reported CT contrast extravasation incidents from
Summary
Contrast extravasation is a not an uncommon complication resulting from contrastenhanced conmputed tomography (CT) imaging, especially on using an automated power injector to deliver the contrast[1]. Paediatric and geriatric groups with debilitating conditions are at a greater risk[2]. Female gender has been reported to have greater predilection as well, especially those with morbid obesity. A large number of contrast extravasations result in mild swelling over the cannula site with induration[1]. It can lead to a potentially limb-threatening event, and ensuring adequate patient assessment and management following this adverse clinical event is essential to prevent lethal limb damage[2,3]. Identification of moderate to severe extravasation and appropriate referral within 4 hours can reduce the risk of debilitating complications[3,4]
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