Risk factors and strategies to limit contrast media extravasation during computed tomography: A scoping review

INTRODUCTION: The extravasation of iodinated contrast media is a well-recognised complication of computed tomography (CT) examinations, potentially resulting in patient discomfort, tissue damage, and long-term consequences. The purpose of this study was to synthesise the current understanding of patient-related risk factors and strategies to prevent contrast media (CM) extravasation in patients undergoing CT scans. METHODS: This scoping review was conducted following the JBI methodology. Studies were considered for inclusion if they involved patients undergoing contrast-enhanced CT and evaluated the effect of risk factors and/or strategies for preventing extravasation. A comprehensive search was conducted in PubMed, Embase, and CINAHL to find articles in English and French. Two reviewers independently screened the titles, abstracts, and full-text articles, then extracted the data. Disagreements were resolved through consensus. RESULTS: Of the 882 studies identified, 29 met the inclusion criteria. The most examined risk factors were age (n = 9), sex (n = 8), and body mass index. Regarding strategies, injection rate (n = 10), injection site (n = 8), and CM concentration and type were the most frequently reported. The outcomes, in descending order of use in the articles, were extravasation frequency, extravasated volume, and injury severity. The articles focused primarily on adults, and used conventional and angiography CT. CONCLUSION: The preventive measures identified are based primarily on a rigorous pre-injection patient risk assessment and concern access and injection parameters. Many of the risk factors and strategies synthetised in this study are new compared to previous reviews, such as the saline venous line testing and the injection pressure/injection flow ratio. IMPLICATIONS FOR PRACTICE: Integrating newly identified risk factors and strategies can help medical imaging professionals reduce the incidence and severity of CM extravasation and enhance patient outcomes.