title: Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT.
abstract: OBJECTIVE
  The purpose of this article is to prospectively assess the frequency and type of IV injection site complications associated with high-flow power injection of nonionic contrast medium in MDCT.
  
  
  METHODS
  Contrast-enhanced (300-370 mg iodine/mL) MDCT examinations with high flow rates (up to 8 mL/s) using automatic CT injectors were performed according to standardized MDCT protocols. The location, type, and size (16-24 gauge) of IV catheters and volumes, iodine concentration, and flow rates of contrast medium were documented. Patients were questioned about associated discomfort, IV catheter sites were checked, and adverse effects were recorded.
  
  
  RESULTS
  Prospectively, 4,457 patients were studied. The injection rate ranged from 1-2.9 mL/s (group 1; n = 1,140) to 3-4.9 mL/s (group 2; n = 2,536) to 5-8 mL/s (group 3; n = 781); 1.2% of the patients experienced extravasations (n = 52). Contrast medium iodine concentration, flow rates, and volumes were not related to the frequency of extravasation. 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 (≥ 50 vs < 50 years, 0.6% vs 1.4%; p = 0.019). Different iodine concentrations did not trigger significant differences in contrast material reactions (p = 0.782).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Radiology, University of Muenster, Muenster D-48149, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Wienbeck
authors.forename: Roman
authors.initials: R
authors.lastname: Fischbach
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Kloska
authors.forename: Peter
authors.initials: P
authors.lastname: Seidensticker
authors.forename: Noriaki
authors.initials: N
authors.lastname: Osada
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: Kai U
authors.initials: KU
authors.lastname: Juergens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D003287:Contrast Media / Q000008:administration & dosage*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media