Contrast enhanced CT is performed by the intravenous injection of a large volume of contrast at a high rate by an electric power injector. Extravasation of contrast media is a recognized complication of intravenous administration of contrast. While not common, extravasation of contrast can be serious. It is an adverse outcome for patients. In mild cases, extravasation results in pain and swelling of the surrounding tissues. In severe cases, tissue necrosis and compartment syndrome may occur. Surgical procedures may be required to treat these complications....

Our department has 3 Multislice CT scanners. We scan approximately100 patients per day (26,000 to 30,000 patients per annum). Extravasation injury results from a combination of factors, which include infusion pressure, duration of an indwelling venula and patient factors. By analysing the processes using a flow chart, we were able to identify the most likely causes for extravasation. Fig 3 (Flow Chart)and 4 (Cause and Effect Diagram). One cause of extravasation is the administration of a large volume of contrast medium at a high flow...

The rate of extravasation of contrast ranges from 0.03% to 1.3% in the literature. We were able to progressively reduce the rate of extravasation of contrast from 0.16 % in 2007 to 0.07 % in 2014. In the last two years, the rate has stabilised to 0.07 to 0.08 %. Fig 8 and 9.

Extravasation of contrast has potentially serious consequences. It is important to reduce the rate of extravasation. Reducing its rate can be achieved by changing processes and adopting new technology. Staff education and regular audits are important to sustain the achievements. Leadership and motivation at every level is necessary.

1. ACR Manual on Contrast Media – Version 9, 2013. American College of Radiology. 2. Wang CL, Cohan RH, Ellis JH, Caoili EM, Wang G, Francis IR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology 2007;243:80-7. 3. Sistrom CL, Gay SB, Peffley L. Extravasation of iopamidol and iohexol during contrast-enhanced CT: report of 28 cases. Radiology 1991;180:707-10. 4. Miles SG, Rasmussen JF, Litwiller T, Osik A. Safe use of an intravenous power injector for CT: experience and...