Rose Hall, RT(R)(CT), Lisa Griffin, RT(R)(CT), and Dr. Ryan Lee
Einstein Medical Center Philadelphia
Extravasation of intravenous contrast during a computed tomography (CT) scan is a common event that can harm patients, with rare instances of severe complications. Besides the possible complications of contrast extravasation and causing inconvenience to the patient, these events also require additional patient assessment and observation that may disrupt the workflow of the healthcare team.
During monthly quality improvement meetings, Rose Hall, Lisa Griffin, and Dr. Ryan Lee identified a trend of increased contrast extravasation and decided to design a process to reduce these events. They observed that the rates of contrast extravasation were lower when using a dual-head power injector—used for CT coronary angiograms—rather than the routine precontrast test bolus administered via hand injection. So they implemented a new protocol in May 2016 which requires a power injected 30cc saline bolus through the patient's IV, prior to administering the iodinated contrast. The power injected test bolus is actively observed by the CT technologist at the scanner gantry to look for signs of extravasation; if the saline extravasates, a new IV site of access is attempted. If contrast still extravasates despite a successful saline test bolus, the event is reported by the performing CT technologist, and postcontrast extravasation protocols are followed.
Comparing the rate of contrast extravasation before and after the power injected saline bolus intervention protocol was implemented reveals a 53% reduction in the extravasation rate as compared to the baseline period. The process has provided a safe and effective method to reduce IV contrast extravasation, increase patient safety, improve healthcare staff efficiency, and contribute to better outcomes when performing contrast-enhanced CT scans.