Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection

PURPOSE: To determine the frequency and clinical effects of extravasation related to rapid bolus infusion of ionic and nonionic contrast media. MATERIALS AND METHODS: Records of 5,106 computed tomographic studies in adult patients who underwent mechanical bolus injection of contrast medium through a plastic cannula in an upper extremity were retrospectively reviewed. RESULTS: Mean infusion rate was 2.8 mL/sec (range, 1-5 mL/sec). Extravasation occurred in 48 (0.9%) patients, including in four of 928 patients who received the median injection rate (2.5 mL/sec). Injection rate was not correlated with frequency or amount of extravasation. Average age and use of ionic versus nonionic contrast medium were identical in patients with and in those without extravasation. There was no sex difference. Thirty-one patients had extravasation of ionic contrast medium; nine of these had extravasation of at least 50 mL. Seventeen patients had extravasation of nonionic contrast medium; seven of these had extravasation of at least 50 mL. Hyaluronidase infiltration was often used as treatment for larger extravasations (in 10 patients each with extravasation of ionic or nonionic medium). No patient required surgical intervention, and none had severe or permanent long-term effects. CONCLUSION: The frequency of extravasation of contrast medium after mechanical bolus injection is higher than that reported for hand-injection or drip-infusion techniques, but there is no correlation between injection rate and extravasation frequency.