Forum topic

 I am now giving frequent videoconferences sponsored by BD on contrast extravaation in CT. My literature searches indicates there is a growing body of studies on this complication in radiology. Your policy should a compresensive one written for all depts. I have had about 15 legal cases involving contrast extravasation. Problems with promthazine (Phenergan) continue, so you should have a separate policy about anti-emetic drugs, preferabaly one that prohbiits giving Phenergan by the IV route. Checking for a blood return should be regarded as a component of a complete assessment of all VADs, including PIVs, before giving any medication. Many people think that its presence or absence does not tell anything about a PIV but I strongly disagree. The American College of Radiology Manual on Contrast states that a blood return is necessary before giving contrast and it is equally as importnat for other drugs. Technique could be an issue for this assessment on a PIV, with larger syringes causing negative pressure that could occlude the catheter lumen. Slow gentle withdrawal, smaller syringe, and even application of a tourniquet above the PIV site to assess the blood return. Of course the other drugs like calcium and the vesicant chemo agents are still a problem. Our online course will be updated by the end of the year. Lynn