Extravasation Policy

Certain patients are at increased risk of extravasation: elderly, infants and children, patients with altered consciousness, severely ill, debilitated or altered circulation in the limb. Intravenous lines in the hand, wrist, ankle and foot, or lines that have been in place for more than 24 hours.

Will report extravasation of radiographic contrast material to a supervising physician who must determine appropriate management. All patients with extravasations estimated to be ≥ 60 mL, or who have significant pain or swelling at the time, should, at least, be followed up at 24 hours with a phone call.

The Technologist will immediately notify the radiologist. The technologist can notify the radiologist in cases of < 10mLs if they have concerns.

The Technologist will complete the first page of the ‘Contrast Extravasation Quality Assurance (QA) Form,’ including patient demographics (with a contact phone number), type of CT study, peripheral IV site and gauge, personnel who placed the IV, injection rate, estimated volume of contrast extravasation, and the patient’s symptoms. QA forms are available here [1].

Will examine the patient and document the physical findings in the electronic medical record.

This contact information will be recorded on the QA form, page 2.

• Skin blistering
• Evidence of altered tissue perfusion (decreased capillary refill)
• Increasing pain
• Change in sensation at or distal to the site of extravasation.

Will be elevated have ice packs applied for 10 minutes, then removed, and the extremity should be elevated for 12 hours. Ice packs can be re-applied, as desired.

1. The CT lead will distribute the QA forms to the QA folder in Angiography if the extravasation is ≥ 60 mls. and/or the LIP requests follow-up, or to the QA Coordinator if < 60 mls
2. If the patient is an outpatient and the extravasation is ≥ 60 mls,, the patient will remain in the department for 2-4 hours. The affected extremity will be elevated and ice packs applied intermittently to the site, after which time, the Resident, PA, ARNP, or attending physician will re-evaluate the patient to establish clinical stability.
3. Documentation of the event will be made in the patient’s electronic chart by the evaluating physician.
4. The referring physician should be notified.
5. In the event the exam has to be rescheduled due to patient characteristics, the radiologist will make note of the reasons in the report.

The patient will be given a ‘Contrast Material Extravasation Information’ card (completed by either the CT Technologist or the Radiologist) explaining the significance of a contrast material extravasation experience. A contact phone number will be provided to the patient so he/she can contact a nurse should concerning symptoms develop.

1. In the event the exam has to be rescheduled due to patient characteristics, the Radiologist will make note of the reasons in the report.
2. The exam will be ended using a ‘reduced services’ modifier.

will notify the Department of Radiology nursing staff of any patients who have had a contrast material extravasation of above 60 mls. All patients will receive a phone call from a radiology nurse 24-48 hours following the extravasation. During holiday weekends, the LIP should assign another person for follow-up if the Radiology nurse is unlikely to be available at 24-48 hours. The nursing staff will personally visit any affected inpatients 24-48 hours following the extravasation to clinically evaluate the patient and make recommendations on management as appropriate. Patients with extravasation injuries occurring on the weekends will be visited or called the following Monday.

1. If symptoms do not resolve, the patient will be asked to return to the Urgent Care Clinic in the morning hours for appropriate clinical evaluation of the patient.
2. Documentation of patient contacts by the Department of Radiology nursing staff members will be made as an addendum to the physician report in the patient’s electronic chart.

The Radiologist will make note of the reasons in the report.

• a) The exam will be ended using a ‘reduced services’ modifier