Reactions and Complication
 | 1. How often do contrast reactions occur to IV contrast? Are there patients at increased risk? |
| 2. Although most iodinated contrast reactions are typically mild, what is the long term sequelae to the patient who gets a reaction? |
| 3. Are there specific patients or risk factors that make it more likely to get a contrast reaction? |
| 4. Will faster injection rates (5 cc/sec vs. 1 cc/sec) result in an increased incidence of contrast reactions? |
 | NO "The prevalence of anaphylactoid reactions is not affected by the rate of injection." Ionic Versus Nonionic Contrast Media: A Prospective Study of the Effect of Rapid bolus Injection on Nausea and Anaphylactoid Reactions Federle MP et al. J Comput Assist Tomography 22:341-345 Does faster injection rates result in higher extravasation rates?
"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." Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. Wienbeck S et al. AJR Am J Roentgenol. 2010 Oct;195(4):825-9 "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." Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. Wienbeck S et al. AJR Am J Roentgenol. 2010 Oct;195(4):825-9 "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 (³ 50 vs < 50 years, 0.6% vs 1.4%; p = 0.019)." Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. Wienbeck S et al. AJR Am J Roentgenol. 2010 Oct;195(4):825-9 |
| 5. What are the categories of contrast reactions? |
| 6. Death is one of the potential complications of IV contrast. How often does this occur? |
| 7. What are the risks of IV contrast in terms of renal failure (CIN)? How often does CIN occur? How we prevent CIN? |
| 8. Who can not get IV contrast material? |
Allergic Reactions | |
| 1. Part 1: Can a patient get a rash from IV contrast? Can it occur 24-36 hours post CT study? |
| 2. Is it possible for a patient to get a delayed reaction to IV contrast? |
| 3. What if a patient is allergic to IV contrast material? |
| 4. Part 1: What patients are allergic to IV contrast? Part 2: Can we premedicate these patients and if yes what is our premedication protocol? |
| 5. Our patient needs the study now. What else can we do? |
| 6. The patient is allergic to shellfish or crabs. Can they get a IV contrast? |
Extravasation | |
| 1. What is contrast extravasation and how often does it occur? |
| 2. How do you prevent contrast extravasation? |
| 3. Part 1: How do we treat contrast extravasation when it happens? Part 2: Is cold compresses the rule or hot compresses? |
| 4. What if extravasation does occur. How often are there severe complication? |