infiltration of IV contrast

[PICC chic]

Yesterday a pt had a massive infiltration of ct contrast, which required her to go to the OR immediately. Though is not an event that occurs often, we are now looking to take steps to see if there is something that we are not doing that we should be doing. Like where the IV is located, size and how long has it been in place. I was wondering if any has any suggestions to help safegaurding the pt from having this happen.

Thanks in advance:)

[UM Review RN, ASN, RN]

Our policy requires a #20 guage or bigger to the AC.

[dianah, ASN]

We had no policy, as Angie has. Sometimes all I could get in a pt was a 22g, if out-pt post-chemo, and pt had no other access. We'd always start the contrast while one of us was in the room, fingers over the IV site, feeling and monitoring for extravasation, then run out of the room at the last minute, still observing thru the control room window. One downside to the new non-ionic agents is they don't burn and hurt if they infiltrate, like the old high-osmolar agents did, so there's no pain warning. Watch and feel.

Re: in-pts with existing IV: test, test, test. And watch and feel, same as the out-pts.

I wonder if the Manual of Contrast Administration, put out by the American College of Radiology, has any advice or guidelines? Hmmmmm, I'll have to check tomorrow.

[Beachbum]

We had no policy, as Angie has. Sometimes all I could get in a pt was a 22g, if out-pt post-chemo, and pt had no other access. We'd always start the contrast while one of us was in the room, fingers over the IV site, feeling and monitoring for extravasation, then run out of the room at the last minute, still observing thru the control room window. One downside to the new non-ionic agents is they don't burn and hurt if they infiltrate, like the old high-osmolar agents did, so there's no pain warning. Watch and feel.

Re: in-pts with existing IV: test, test, test. And watch and feel, same as the out-pts.

I wonder if the Manual of Contrast Administration, put out by the American College of Radiology, has any advice or guidelines? Hmmmmm, I'll have to check tomorrow.

We do the same. We try to get a 20ga in the ac if possible, but like you said with the older population and we have so many cancer patients we are happy to get a 22ga. We also decrease the ml/sec if we use a smaller ga catheter.

[dianah, ASN]

"We also decrease the ml/sec if we use a smaller ga catheter. " Yes, Beachbum, we'd do that too. You just can't "slam it in" for every pt!

PICCchic, I'm not sure you'll find a totally failsafe method or protocol to follow, considering all the factors involved in whether an injection infiltrates or not . . . We can check so many things, and there may be other unknowns in the equation. Let us know what you're doing, I'd be interested to know what your group comes up with. (yes, I forgot to check the ACR manual but I will :) )

[kiwilinda59]

We try to put a 20g needle in the elbow and to test it give a really fast flush of saline 10-15mls. I also try and keep the elbow straight as the contrast goes thru,either by stretching the arm out behind them or elevating the arm so it rests on the ct machine. And like you say, stay in the room until the bitter end then run out. If its a smaller needle we put the flow rate down also.