Contrast Extravasation
(For CT / MRI Contrast Administration – Radiology Practice)
Contrast extravasation is the unintentional leakage of contrast media from a vein into surrounding soft tissue during injection.
It is most commonly associated with iodinated contrast in CT, but may also occur with gadolinium contrast in MRI.
✅ Prevention of Contrast Extravasation
1️⃣ Patient Assessment (Before Injection)
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Assess vein quality
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Avoid:
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Fragile veins (elderly, oncology patients)
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Post-mastectomy side
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Lymphedema limb
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Dialysis fistula arm
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Review patient history:
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Diabetes
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Chemotherapy
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Steroid use
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Peripheral vascular disease
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2️⃣ Proper IV Cannulation
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Use appropriate cannula size:
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CT power injection → 18–22G (depending on protocol)
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Choose:
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Large, straight vein in antecubital fossa
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Avoid:
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Hand veins (for high flow injection)
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Small or tortuous veins
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Secure cannula properly
3️⃣ Before Starting Injection
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Check:
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Blood return
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Flush with normal saline
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No swelling or resistance
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Confirm patient comfort
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Educate patient:
“Tell us immediately if you feel pain, burning, or swelling.”
4️⃣ During Injection
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Monitor injection site visually (if possible)
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Communicate with patient
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Watch for:
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Swelling
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Pain
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Tightness
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Injection pump high-pressure alarm
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5️⃣ High-Risk Patients
Extra caution for:
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Pediatric patients
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Elderly
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Unconscious / sedated patients
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Patients with poor sensation
🚨 Signs of Contrast Extravasation
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Swelling at injection site
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Pain or burning sensation
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Skin tightness
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Redness
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High injection pressure alarm
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Severe cases: blistering or skin discoloration
🏥 Immediate Management (Treatment)
1️⃣ STOP Injection Immediately
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Stop power injector
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Disconnect tubing
2️⃣ Leave Cannula in Place (Initially)
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Attempt gentle aspiration of contrast (if possible)
3️⃣ Elevate the Limb
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Elevate affected extremity above heart level
4️⃣ Apply Cold Compress
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Apply for 15–20 minutes
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Repeat every few hours for 24 hours
Cold helps reduce inflammation and pain.
(Some institutions may use warm compress after 24 hours depending on protocol.)
5️⃣ Assess Severity
Mild (Most Common)
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< 50 mL
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Mild swelling
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No skin compromise
👉 Conservative treatment
Moderate
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Increasing swelling
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Pain
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Limited movement
👉 Observe closely, document, inform radiologist
Severe (Rare but Emergency)
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Severe pain
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Skin blistering
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Compartment syndrome signs:
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Increasing pain
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Numbness
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Decreased pulse
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Pale skin
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👉 URGENT surgical referral
📋 Documentation (JCI / MOH Compliance)
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Amount of contrast extravasated
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Type of contrast
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Injection rate
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Site
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Patient symptoms
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Actions taken
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Radiologist notification
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Follow-up instructions
Incident report required.
⚠️ When to Refer to Surgery
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Extravasation > 100 mL (relative criteria)
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Severe pain
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Skin necrosis
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Neurovascular compromise
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Compartment syndrome suspicion
👩⚕️ Patient Instructions Before Discharge
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Elevate limb
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Apply cold compress
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Return immediately if:
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Increasing pain
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Numbness
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Blistering
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Skin color change
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Provide written instruction sheet.
🔬 Complications (Rare)
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Skin necrosis
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Compartment syndrome
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Infection
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Chronic pain
🎯 Key Message for Radiology Technologists
Early detection + Immediate action = Prevent serious complication.
Most extravasations are mild and resolve without long-term effects if managed properly.
