A patient comes in outpatient for a CT with contrast. The contrast is power injected through the PIV but results in extravasation. currently at my facility the CT dept. contacts the IV team and they come and administer the antidote per the okay from the radiologist. then the pt. leaves for home. What follow up should we be instructing the pt? notify your doctor? or if they have signs of pain, blistering, sensory loss etc go to ER? I have looked in our discharge instructions but I see we have nothing on infiltration or extravasations for the pt to take with them.
First there is only 1 published case study where the use of hyaluronidase was effective as an antidote for contrast extravasation. Others have not shown any benefit. There are numerous steps that can and should be taken to prevent this potentiall serious complication. I have been the expert in at least a dozen cases of contrast extravasation. There is a manual on contrast from the American College of Radiology that should be followed. You should be estimating the amount of contrast that extravasated. All contrast as vesicants! The patient should not be discharged until there is total absence of all signs and symptoms - edema, neurocirculatory compromise, pain, redness, leakage, etc. If there are any s&s unresolved, the patient should go to the ER. Blisters can develop within 6 hours and the complete inflammatory process can take 24 to 48 hours, which is totally different from other vesicants which take weeks to develop blisters, etc. Compartment syrndrome is the greatest risk and may require a plastics consult. If this develops, you have 6 hours to get the patient to surgery to prevent the need for arm amputation. You should be provided a written document with specific instructions to the patient if and when they are discharged. And do not use heat but apply cold instead! Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861