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Risk Factors for Contrast Media Extravasation in Intravenous Contrast-Enhanced Computed Tomography: An Observational Cohort Study

医学 外渗 优势比 置信区间 放射科 入射(几何) 血管造影 血栓形成 造影剂 单变量分析 计算机断层血管造影 外科 内科学 多元分析 病理 物理 光学
作者
Wanli Liu,Pinghu Wang,Hui Zhu,Hui Tang,Xiaoying Wang,Hongmei Guan,Chengxiang Wang,Yao Qiu,An Peng,Lianxiang He
出处
期刊:Academic Radiology [Elsevier BV]
卷期号:31 (5): 1792-1798 被引量:7
标识
DOI:10.1016/j.acra.2023.09.027
摘要

•This study identified the risk factors for contrast media (CM) extravasation. •Venous thrombosis, multi-site angiography, injection rate ≥ 3 mL/s are risk factors. •Patients with malignant tumors have a low incidence of CM extravasation. •Support the selection of high-pressure-resistant PICCs for patients. Rationale and Objectives To identify the risk factors for contrast media (CM) extravasation and provide effective guidance for reducing its incidence. Materials and Methods We observed adult inpatients (n = 38 281) who underwent intravenous contrast-enhanced computed tomography between January 1, 2018, and December 31, 2022. Risk factors for CM extravasation were evaluated using univariate and multivariate logistic regression. Results Among the 38 281 inpatients who underwent enhanced computed tomography angiography, 3885 received peripherally inserted central venous catheters (PICCs) and 34 396 received peripheral short catheters. In 3885 cases of PICCs, no CM extravasation occurred, but in five cases, ordinary PICCs that are unable to withstand high pressure were mistakenly used; three of those patients experienced catheter rupture, and eventually, all five patients underwent unplanned extubation. Among 34 396 cases of peripheral short catheters, 224 (0.65%) had CM extravasation. Female sex (odds ratio [OR]=1.541, 95% confidence interval [CI]: 1.111–2.137), diabetes (OR=2.265, 95% CI: 1.549–3.314), venous thrombosis (OR=2.157, 95% CI: 1.039–4.478), multi-site angiography (OR=9.757, CI: 6.803–13.994), and injection rate ≥ 3 mL/s (OR=6.073, 95% CI: 4.349–8.481) were independent risk factors for CM extravasation. Due to peripheral vascular protection measures in patients with malignant tumor, there was a low incidence of CM extravasation (OR=0.394, 95% CI: 0.272–0.570). Conclusion Main risk factors for CM extravasation are female, diabetes, venous thrombosis, multi-site angiography, and injection rate ≥ 3 mL/s. However, patients with malignant tumor have a low incidence of CM extravasation. Clinical Impact Analysis of these risk factors can help reduce the incidence of CM extravasation. To identify the risk factors for contrast media (CM) extravasation and provide effective guidance for reducing its incidence. We observed adult inpatients (n = 38 281) who underwent intravenous contrast-enhanced computed tomography between January 1, 2018, and December 31, 2022. Risk factors for CM extravasation were evaluated using univariate and multivariate logistic regression. Among the 38 281 inpatients who underwent enhanced computed tomography angiography, 3885 received peripherally inserted central venous catheters (PICCs) and 34 396 received peripheral short catheters. In 3885 cases of PICCs, no CM extravasation occurred, but in five cases, ordinary PICCs that are unable to withstand high pressure were mistakenly used; three of those patients experienced catheter rupture, and eventually, all five patients underwent unplanned extubation. Among 34 396 cases of peripheral short catheters, 224 (0.65%) had CM extravasation. Female sex (odds ratio [OR]=1.541, 95% confidence interval [CI]: 1.111–2.137), diabetes (OR=2.265, 95% CI: 1.549–3.314), venous thrombosis (OR=2.157, 95% CI: 1.039–4.478), multi-site angiography (OR=9.757, CI: 6.803–13.994), and injection rate ≥ 3 mL/s (OR=6.073, 95% CI: 4.349–8.481) were independent risk factors for CM extravasation. Due to peripheral vascular protection measures in patients with malignant tumor, there was a low incidence of CM extravasation (OR=0.394, 95% CI: 0.272–0.570). Main risk factors for CM extravasation are female, diabetes, venous thrombosis, multi-site angiography, and injection rate ≥ 3 mL/s. However, patients with malignant tumor have a low incidence of CM extravasation.
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