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Everything you need to know about Computed Tomography (CT) & CT Scanning


Reactions and Complication

question1. How often do contrast reactions occur to IV contrast? Are there patients at increased risk?
question2. Although most iodinated contrast reactions are typically mild, what is the long term sequelae to the patient who gets a reaction?
question3. Are there specific patients or risk factors that make it more likely to get a contrast reaction?
question4. Will faster injection rates (5 cc/sec vs. 1 cc/sec) result in an increased incidence of contrast reactions?
questionNO
"The prevalence of anaphylactoid reactions is not affected by the rate of injection."

Ionic Versus Nonionic Contrast Media: A Prospective Study of the Effect of Rapid bolus Injection on Nausea and Anaphylactoid Reactions
Federle MP et al.
J Comput Assist Tomography 22:341-345

Does faster injection rates result in higher extravasation rates?
  • Potential factors
  • Contrast injection rate (cc/sec)
  • Contrast volume (cc)
  • Contrast type (Omnipaque vs Visipaque)
  • Gauge of needle (18 vs 20 vs 24)
  • Type of needle (fenestrated or not)

"Automated IV contrast injection applying high flow rates (i.e., up to 8 mL/s) is performed without increased risk of extravasation. The overall extravasation rate was 1.2% and showed no correlation with iodine concentration, flow rates, or contrast material reactions. Performing high flow rates with low-diameter IV catheters (e.g., 22-gauge catheters) and a location of IV catheter in the hand is associated with a higher extravasation rate."

Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT.

Wienbeck S et al.
AJR Am J Roentgenol. 2010 Oct;195(4):825-9

"Performing high flow rates with low-diameter IV catheters (e.g., 22-gauge catheters) and a location of IV catheter in the hand is associated with a higher extravasation rate."

Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT.

Wienbeck S et al.
AJR Am J Roentgenol. 2010 Oct;195(4):825-9

"The extravasation rate was highest with 22-gauge IV catheters (2.2%; p < 0.05) independently of the anatomic location. For 20-gauge IV catheters, extravasation rates were significantly higher in the dorsum of the hand than in the antecubital fossa (1.8% vs 0.8%; p = 0.018). Extravasation rates were higher in older patients (³ 50 vs < 50 years, 0.6% vs 1.4%; p = 0.019)."

Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT.

Wienbeck S et al.
AJR Am J Roentgenol. 2010 Oct;195(4):825-9
question5. What are the categories of contrast reactions?
question6. Death is one of the potential complications of IV contrast. How often does this occur?
question7. What are the risks of IV contrast in terms of renal failure (CIN)? How often does CIN occur? How we prevent CIN?
question8. Who can not get IV contrast material?

Allergic Reactions

question

1. Part 1: Can a patient get a rash from IV contrast? Can it occur 24-36 hours post CT study?

Part 2: How do you treat the rash?

question2. Is it possible for a patient to get a delayed reaction to IV contrast?
question3. What if a patient is allergic to IV contrast material?
question

4. Part 1: What patients are allergic to IV contrast?

Part 2: Can we premedicate these patients and if yes what is our premedication protocol?

question5. Our patient needs the study now. What else can we do?
question6. The patient is allergic to shellfish or crabs. Can they get a IV contrast?

Extravasation

question1. What is contrast extravasation and how often does it occur?
question2. How do you prevent contrast extravasation?
question

3. Part 1: How do we treat contrast extravasation when it happens?

Part 2: Is cold compresses the rule or hot compresses?
question4. What if extravasation does occur. How often are there severe complication?

 

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