The following keywords were used in different combinations: “GBCA,” “iodine contrast agent,” “risk factor,” “ extravasation,” and “gadolinium.” 2.2 Data extraction and quality assessmentĮach of the 17 papers was reviewed by 2 radiology research fellows (AHB and ZF) who extracted the type of contrast media used, the total number of injections and extravasations for each contrast medium type, use of hand versus power injection, injection rate, catheter insertion by radiology staff versus using an existing IV catheter, catheter location and catheter size, inpatients versus outpatients and contrast agent temperature. Inclusion criteria included original articles on human subjects (letters, review articles, and comments were excluded) reporting extravasation rates during IV contrast media injection, including the total number of injections and types of contrast media and the total number of extravasations observed. No industry support was provided for this systematic review, which was conducted according to the Preferred Reporting Items for Systematic Reviews guidelines. The purpose of this systematic review is to combine data from multiple papers on contrast media extravasation using similar methodology in order to identify the factors contributing to increased extravasation risk. Given these widely disparate rates of contrast media extravasation, it is likely that a systematic review could identify risk factors which can help with prevention and risk minimization. Gadolinium-based contrast agents (GBCA) extravasation has also been reported, albeit less frequently. Later reports with larger numbers of patients, published after automated mechanical injectors and higher injection rates began to be routinely used for contrast material injection, extravasation rates increased, ranging from 0.25% to 0.9%. In early series, the rate of extravasation during CT ranged from 0.03% to 0.17%. Less serious consequences include exposure to ionizing radiation without the benefit of diagnostic images, swelling, tightness, stinging, burning pain, edema, erythema, or tenderness at the injection site. Ĭontrast medium extravasation is another well-recognized event, which is rarely serious but can include serious complications like compartment syndrome, severe skin ulceration, and tissue necrosis. Although the currently available contrast agents are considered to be safe, their use is not completely without risk and considerable attention has been focused on allergic reactions, physiologic reactions, nephrotoxicity, nephrogenic systemic fibrosis, and gadolinium deposition in tissues. Ideally, contrast agents should be injected and eliminated from the body without any adverse effects. In 2015, an estimated 38 million computed tomography (CT) and 17 million magnetic resonance imaging (MRI) examinations were performed in the United States using intravenous (IV) contrast agents reflecting their essential role in the detection, characterization, and staging of disease.
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