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Discussion

Hot pack or Cold pack for CT contrast infiltration?

I'm guessing cold pack as contrast is an irritant to tissue...am I wrong?

Which one do you use? For how long? And how do you follow up?

Thanks

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  • Admin

There is no standard that I can find . . we always applied warm compresses (the patients reported it felt good, and we noted decrease in swelling of the extravasation area after compress application). Other facilities applied cold/ice.

Depends on the amt of extravasation as to what the Radiologist would recommend for f/u; he may have had the pt return the next day so he could assess the area. Large extravasations may require Plastic Surgery consult.

Below are three links that might be helpful to you. Review the literature (what does the American College of Radiologists recommend?), then write your policy. BTW, I did the Google search with the words "contrast extravasation treatment."

http://radiology.rsnajnls.org/cgi/reprint/176/1/65

http://www.extravasation.org.uk/Cut.htm

http://www.amershamhealth-us.com/medpro/clinref/extravasation.html

Good luck! --- D

  • Author

thanks for the advice... 1st link has good info..but based on the references it seems outdated..... 2nd link shows a quick study from the UK with no detailed data....3rd link didnt work.... any nurses have first hand experience with this?

  • Admin

Hmmmm, you might try another search . .

I tried to give links to literature, to support evidence-based practice.

My first-hand experience was using warm compresses (preceded by confirmation of a good IV and CAREFUL observation of the site during infusion, so you can halt the injection if you see swelling), thinking the warmth would dilate capillaries = increasing blood flow to the affected area, to aid in absorption of the contrast.

Others I've spoken with advocated cold compresses/ice packs, to decrease inflammation at the site.

I preferred the warm compresses because the pts reported the site felt better and the swelling diminished after 20-30 min of application.

I'm interested to hear any other opinions/experiences, or see any pertinent links. :)

Not that long ago I was a Radiology Nurse for a while. Our policy was warm compress to site.

You could contact ARNA (American Radiological Nurses Assoc.) and see what their official recommendation is.

www.arna.net

We had a pt this week that had two extravasations back to back. Great 18g in the AC, flushed great. Infiltrated about 10ml. Started a new IV on the other side in the forearm, flushed great. Intiltrated about 5-10m. I had the radioligist come out and have a look. He said her veins just couldn't take it and go ahead and do the study w/o contrast. He said our protocol was heat for 30 minutes then ice and told the patient to keep alternating at home. She came back the next day and no signs of extravasation were present.

  • Author

Dutchgirl... whats the logic behind alternating hot and cold?

Dutchgirl... whats the logic behind alternating hot and cold?

I have no idea, just following doctors orders. I'll ask the radiologist and let eveyone know.

  • Admin

Prolly to dilate with the warm, then constrict and decrease inflammation w/the cold ("flush," if you will: increase blood flow, decrease blood flow, w/the alternating hot/colds).

Prolly to dilate with the warm, then constrict and decrease inflammation w/the cold ("flush," if you will: increase blood flow, decrease blood flow, w/the alternating hot/colds).

I think you've got it. Thanks dianah.

At our hospital we advise pt's to use Cold Compresses q4hrs x 20 mins. for 24hrs. then warm compresses q4 for 24hrs. : of course this is while awake. We also advise the pt. to elevate their arm when possible. If 100cc or greater of IV contrast infiltrates, then our protocol requires a Plastics consult. I hope this helps. We also do a follow-up phone call in 24hrs to check on the pt's condiion.

I'm guessing cold pack as contrast is an irritant to tissue...am I wrong?

Which one do you use? For how long? And how do you follow up?

Thanks

The ACR (American College of Radiology) acknowledges that there is no medical evidence to support cold or warm compresses for infiltrations. On their website they have a "Manual on Contrast Administration" which is downloadable and a great reference tool.

Our facility applies warm compresses initially, has the pt keep their arm elevated for the first 12-24 hours. The patient is then instructed that they should apply compresses for comfort (their choice, heat or cold) 15 minutes on and 15 minutes off.

We track all infiltrates with physician follow-up with those infiltrates that are less than 100cc's. If any infiltrate results in blistering, is 100cc's or greater, or patient has any s/s of compromised profusion with potential for tissue sloughing they are referred to a plastic surgeon for evaluation and follow up.

Hope this information is helpful.

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