Cleary N, McNulty J P, Foley S J, Kelly E
Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland.
Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland; Radiology Department, University Hospital Galway, Newcastle Road, Galway, Ireland.
Radiography (Lond). 2017 Nov;23(4):e87-e92. doi: 10.1016/j.radi.2017.05.009. Epub 2017 Jun 9.
Iodinated contrast extravasation is a serious complication associated with intravenous administration in radiology. Departmental protocols and the radiographer's approach on both prevention techniques and treatment will affect the prevalence of extravasation, and the eventual outcome for the patient when it does occur.
To examine contrast extravasation protocols in place in Irish CT departments for alignment with European Society of Urogenital Radiology (ESUR) Guidelines (2014); to establish radiographer's opinions on contrast extravasation; and to examine radiographer adherence to protocols.
Contrast extravasation protocols from a purposively selected sample of CT departments across Ireland (n = 6) were compared to ESUR guidelines, followed by an online survey of CT radiographers practicing in the participating centres.
All participating CT departments (n = 5) had written protocols in place. High risk patients, such as elderly or unconscious, were identified in most protocols, however, children were mentioned in just one protocol and obese patients were not specified in any. The response rate of CT radiographers was 23% (n = 24). 58% (n = 14) of respondents indicated that contrast extravasation was more likely during CTA examinations. While high levels of confidence in managing extravasation were reported, suggested treatment approaches, and confidence in same, was more variable. Clinical workload in CT departments was also identified as a factor impacting on patient care and management.
While contrast extravasation protocols were generally in line with ESUR Guidelines, high risk patients may not be getting sufficient attention. More radiographer awareness of patient monitoring needs, particularly in busy departments with a heavy workload may also reduce extravasation risk, and improve management of same.
碘化造影剂外渗是放射学中静脉给药相关的一种严重并发症。科室协议以及放射技师在预防技术和治疗方面的方法会影响外渗的发生率，以及外渗发生时患者的最终结局。
检查爱尔兰CT科室现行的造影剂外渗协议是否符合欧洲泌尿生殖放射学会（ESUR）指南（2014年）；了解放射技师对造影剂外渗的看法；并检查放射技师对协议的遵守情况。
将从爱尔兰各地有目的地选取的CT科室样本（n = 6）的造影剂外渗协议与ESUR指南进行比较，随后对参与中心的CT放射技师进行在线调查。
所有参与的CT科室（n = 5）都有书面协议。大多数协议中都识别出了高风险患者，如老年人或无意识患者，然而，只有一份协议提到了儿童，没有任何协议明确指出肥胖患者。CT放射技师 的回复率为23%（n = 24）。58%（n = 14）的受访者表示在CT血管造影（CTA）检查期间造影剂外渗的可能性更大。虽然报告了对处理外渗有较高的信心，但建议的治疗方法以及对此的信心则更具变化性。CT科室的临床工作量也被确定为影响患者护理和管理的一个因素。
虽然造影剂外渗协议总体上符合ESUR指南，但高风险患者可能没有得到足够的关注。放射技师更多地意识到患者监测需求，特别是在工作量大的繁忙科室，也可能降低外渗风险，并改善对外渗的管理。
