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Extravasation Risk Using Ultrasound‐guided Peripheral Intravenous Catheters for Computed Tomography Contrast Administration
Author(s) -
Rupp Jordan D.,
Ferre Robinson M.,
Boyd Jeremy S.,
Dearing Elizabeth,
McNaughton Candace D.,
Liu Dandan,
Jarrell Kelli L.,
McWade Conor M.,
Self Wesley H.
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13000
Subject(s) - medicine , extravasation , confidence interval , odds ratio , radiology , confounding , retrospective cohort study , contrast (vision) , logistic regression , surgery , pathology , artificial intelligence , computer science
Objective Ultrasound‐guided intravenous catheter ( USGIV ) insertion is increasingly being used for administration of intravenous ( IV ) contrast for computed tomography ( CT ) scans. The goal of this investigation was to evaluate the risk of contrast extravasation among patients receiving contrast through USGIV catheters. Methods A retrospective observational study of adult patients who underwent a contrast‐enhanced CT scan at a tertiary care emergency department during a recent 64‐month period was conducted. The unadjusted prevalence of contrast extravasation was compared between patients with an USGIV and those with a standard peripheral IV inserted without ultrasound. Then, a two‐stage sampling design was used to select a subset of the population for a multivariable logistic regression model evaluating USGIV s as a risk factor for extravasation while adjusting for potential confounders. Results In total, 40,143 patients underwent a contrasted CT scan, including 364 (0.9%) who had contrast administered through an USGIV . Unadjusted prevalence of extravasation was 3.6% for contrast administration through USGIV s and 0.3% for standard IV s (relative risk = 13.9, 95% confidence interval [ CI ] = 7.9 to 24.6). After potential confounders were adjusted for, CT contrast administered through USGIV s was associated with extravasation (adjusted odds ratio = 8.6, 95% CI = 4.6 to 16.2). No patients required surgical management for contrast extravasation; one patient in the standard IV group was admitted for observation due to extravasation. Conclusions Patients who received contrast for a CT scan through an USGIV had a higher risk of extravasation than those who received contrast through a standard peripheral IV . Clinicians should consider this extravasation risk when weighing the risks and benefits of a contrast‐enhanced CT scan in a patient with USGIV vascular access.