title: Extravasation Risk Using Ultrasound-guided Peripheral Intravenous Catheters for Computed Tomography Contrast Administration.
abstract: Ultrasound-guided intravenous catheter (USGIV) insertion is increasingly being used for administration of intravenous (IV) contrast for computed tomography (CT) scans. The goal of this investigation was to evaluate the risk of contrast extravasation among patients receiving contrast through USGIV catheters.
  
  
  
  A retrospective observational study of adult patients who underwent a contrast-enhanced CT scan at a tertiary care emergency department during a recent 64-month period was conducted. The unadjusted prevalence of contrast extravasation was compared between patients with an USGIV and those with a standard peripheral IV inserted without ultrasound. Then, a two-stage sampling design was used to select a subset of the population for a multivariable logistic regression model evaluating USGIVs as a risk factor for extravasation while adjusting for potential confounders.
  
  
  
  In total, 40,143 patients underwent a contrasted CT scan, including 364 (0.9%) who had contrast administered through an USGIV. Unadjusted prevalence of extravasation was 3.6% for contrast administration through USGIVs and 0.3% for standard IVs (relative risk = 13.9, 95% confidence interval [CI] = 7.9 to 24.6). After potential confounders were adjusted for, CT contrast administered through USGIVs was associated with extravasation (adjusted odds ratio = 8.6, 95% CI = 4.6 to 16.2). No patients required surgical management for contrast extravasation; one patient in the standard IV group was admitted for observation due to extravasation.
  
  
  
  Patients who received contrast for a CT scan through an USGIV had a higher risk of extravasation than those who received contrast through a standard peripheral IV. Clinicians should consider this extravasation risk when weighing the risks and benefits of a contrast-enhanced CT scan in a patient with USGIV vascular access.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Rupp
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Robinson M
authors.initials: RM
authors.lastname: Ferre
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Boyd
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dearing
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Dandan
authors.initials: D
authors.lastname: Liu
authors.affiliation: School of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Kelli L
authors.initials: KL
authors.lastname: Jarrell
authors.affiliation: School of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Conor M
authors.initials: CM
authors.lastname: McWade
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D004636:Emergency Service, Hospital; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography; D062666:Vascular Access Devices
chemical_list: D003287:Contrast Media