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extravasation_policy
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extravasation_policy [2010/07/02 00:45] hyomul created |
extravasation_policy [2012/04/03 01:54] (current) |
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| 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. | 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. | ||
| ===== 2) The Technologist involved with the case ===== | ===== 2) The Technologist involved with the case ===== | ||
| - | 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. | + | 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. |
| ===== 3) When a contrast extravasation of ≥ 10cc occurs in adults, or any extravasation in children < 16 years ===== | ===== 3) When a contrast extravasation of ≥ 10cc occurs in adults, or any extravasation in children < 16 years ===== | ||
| - | the Technologist will immediately notify the radiologist. The technologist can notify the radiologist in cases of < 10mLs if they have concerns. | + | The Technologist will immediately notify the radiologist. The technologist can notify the radiologist in cases of < 10mLs if they have concerns. |
| ===== 4) For all extravasations of ≥ 10cc ===== | ===== 4) For all extravasations of ≥ 10cc ===== | ||
| - | 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]. | + | 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]. |
| ===== 5) The radiologist or their physician delegate ===== | ===== 5) The radiologist or their physician delegate ===== | ||
| - | will examine the patient and document the physical findings in the electronic medical record. | + | Will examine the patient and document the physical findings in the electronic medical record. |
| ==== a) Notify the ordering physician or the patient’s nurse of the complication. ==== | ==== a) Notify the ordering physician or the patient’s nurse of the complication. ==== | ||
| This contact information will be recorded on the QA form, page 2. | This contact information will be recorded on the QA form, page 2. | ||
| Line 21: | Line 21: | ||
| * Increasing pain | * Increasing pain | ||
| * Change in sensation at or distal to the site of extravasation. | * Change in sensation at or distal to the site of extravasation. | ||
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| ===== 6) The affected extremity ===== | ===== 6) The affected extremity ===== | ||
| - | 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. | + | 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. |
| - | ===== 7) Technologists ===== | + | ===== 7) Technologists completing the QA forms are responsible for turning them into the Leads on their shifts. ===== |
| - | completing the QA forms are responsible for turning them into the Leads on their shifts. | + | |
| - 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 | - 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 | ||
| - 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. | - 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. | ||
| Line 31: | Line 29: | ||
| - The referring physician should be notified. | - The referring physician should be notified. | ||
| - In the event the exam has to be rescheduled due to patient characteristics, the radiologist will make note of the reasons in the report. | - In the event the exam has to be rescheduled due to patient characteristics, the radiologist will make note of the reasons in the report. | ||
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| ===== 8) Before departing the Department of Radiology ===== | ===== 8) Before departing the Department of Radiology ===== | ||
| - | , 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. | + | 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. |
| - In the event the exam has to be rescheduled due to patient characteristics, the Radiologist will make note of the reasons in the report. | - 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 exam will be ended using a ‘reduced services’ modifier. | - The exam will be ended using a ‘reduced services’ modifier. | ||
| Line 41: | Line 38: | ||
| - 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. | - 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. | ||
| - 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. | - 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. | ||
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| ===== 10) In the event the exam has to be rescheduled ===== | ===== 10) 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 Radiologist will make note of the reasons in the report. |
| * a) The exam will be ended using a ‘reduced services’ modifier | * a) The exam will be ended using a ‘reduced services’ modifier | ||
| - | |||
extravasation_policy.1278056746.txt.gz · Last modified: 2012/04/03 01:52 (external edit)
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