Keywords:
Contrast agents, Professional issues, CT, MR, Safety, Audit and standards, Quality assurance
Authors:
V. Tang, P. Eastgate, M. Prior, J. Clouston; QLD/AU
DOI:
10.1594/ranzcr2017/R-0063
Conclusion
The rate of CME in our series is comparable to prior data,
with our finding of 0.27% for CT being within the range of 0.14%-0.9% cited across the literature.4 The incidence rate of 0.06% for MRI reported by Shaqdan et al.
is similar to the 0.08% in this study.4 It is hypothesized that the higher risk of CME occurs with CT due to the larger volumes and injections rates involved with CTs.5 Observations from both this present study and prior studies reveal that CMEs are most likely to occur within the 10-49ml range.4,6
The lack of major complications is reassuring,
and suggests our current management is satisfactory.
Our result is consistent with the literature,
with major complications being rare.6 CMEs were more likely to occur with inpatients,
elderly,
and females,
all of which have been previously been identified as risk factors for CMEs.4 The paucity of major complications in CMEs over 100mls supports the current view that surgical consultations should be based on the patient’s signs and symptoms rather than being automatically required once reaching a certain volume threshold.8 Instead,
emphasis should be on immediate conservative management and appropriate patient education.
Documentation regarding injection location,
why the extravasation was noticed,
and cannula size can be improved upon.
As previously noted,
the PRIME CI system aims to reduce preventable incidents.
However,
only one incident was identified as potentially avoidable.
Indeed,
reducing CMEs from current rates have proven difficult.7 This study suggests that whilst institutional documentation of CMEs is an important quality assurance indicator,
the current guidelines of requiring a PRIME CI for all CMEs,
and its associated impact on productivity should be reviewed.