Ding Sandrine, Meystre Nicole Richli, Campeanu Cosmin, Gullo Giuseppe
Department of Technical Medical Radiology, Haute École de Santé Vaud (HESAV), University of Applied Sciences Western Switzerland (HES-SO), Lausanne, Switzerland.
Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence, Lausanne, Switzerland.
JBI Database System Rev Implement Rep. 2018 Jan;16(1):87-116. doi: 10.11124/JBISRIR-2017-003348.
To identify risk factors and interventions preventing or reducing contrast medium extravasation.
Computed tomography (CT) is a radiological examination essential for the diagnosis and monitoring of many diseases. It is often performed with the intravenous (IV) injection of contrast agents. Use of these products can result in a significant complication, extravasation, which is the accidental leakage of IV material into the surrounding tissue. Patients may feel a sharp pain and skin ulceration or necrosis may develop.
This review considered studies that included patients (adults and children) undergoing a CT with IV administration of contrast media. The risk factors considered were patient demographics, comorbidities and medication history. This review also investigated any strategies related to: contrast agent, injection per se, material used for injection, apparatus used, healthcare professionals involved, and patient risk assessment performed by the radiology personnel. The comparators were other interventions or usual care. This review investigated randomized controlled trials and non-randomized controlled trials. When neither of these were available, other study designs, such as prospective and retrospective cohort studies, case-control studies and case series, were considered for inclusion. Primary outcomes considered were: extravasation frequency, volume, severity and complications.
The databases PubMed, CINAHL, Embase, the Cochrane Register of Controlled Trials, Web of Science PsycINFO, ProQuest Dissertations and Theses A&I, TRIP Database and ClinicalTrials.gov were searched to find both published and unpublished studies from 1980 to September 2016. Papers were assessed by two independent reviewers for methodological validity using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted using the standardized data extraction tool from JBI SUMARI. In one case, quantitative data from two cohort studies were pooled in a statistical meta-analysis. However, generally, statistical pooling was not possible due to heterogeneity of the interventions, populations of interest or outcomes. Accordingly, the findings have been presented in narrative form.
Fifteen articles were selected from a total of 2151 unique studies identified. Two were randomized controlled trials and 13 were quasi-experimental and observational studies. The quality of these studies was judged to be low to moderate. Some patient characteristics, such as female sex and inpatient status, appeared to be risk factors for extravasation. Additionally, injection rate, venous access site and catheter dwelling time could affect the volume extravasated. Preliminary studies seemed to indicate the potential of extravasation detection accessories to identify extravasation and reduce the volume extravasated. The other interventions either did not result in significant reduction in the frequency/volume of extravasation, or the results were mixed across the studies.
The majority of the studies included in this review evaluated the outcomes of extravasation frequency and volume. Given the quality of the primary studies, this systematic review identified only potential risk factors and interventions. It further highlighted the research gap in this area and the importance of conducting trials with solid methodological designs.
确定预防或减少造影剂外渗的危险因素及干预措施。
计算机断层扫描（CT）是许多疾病诊断和监测必不可少的放射学检查。它通常通过静脉注射造影剂来进行。使用这些产品可能会导致一种严重的并发症，即外渗，也就是静脉内物质意外渗漏到周围组织中。患者可能会感到剧痛，还可能出现皮肤溃疡或坏死。
本综述纳入了包括接受静脉注射造影剂的CT检查的患者（成人和儿童）的研究。所考虑的危险因素包括患者的人口统计学特征、合并症和用药史。本综述还调查了与以下方面相关的任何策略：造影剂、注射本身、注射所用材料、所用设备、相关医护人员以及放射科人员进行的患者风险评估。对照措施为其他干预措施或常规护理。本综述调查了随机对照试验和非随机对照试验。当这两种试验均不可用时，也考虑纳入其他研究设计，如前瞻性和回顾性队列研究、病例对照研究和病例系列研究。所考虑的主要结局包括：外渗频率、量、严重程度及并发症。
检索了PubMed、CINAHL、Embase、Cochrane对照试验注册库、Web of Science、PsycINFO、ProQuest学位论文与学术期刊数据库A&I、TRIP数据库和ClinicalTrials.gov，以查找1980年至2016年9月期间已发表和未发表的研究。由两名独立评审员使用乔安娜·布里格斯循证卫生保健中心统一管理、评价和评审信息系统（JBI SUMARI）对论文的方法学有效性进行评估。使用JBI SUMARI的标准化数据提取工具提取数据。在一个案例中，将两项队列研究的定量数据进行了统计荟萃分析。然而，一般来说，由于干预措施、研究对象群体或结局的异质性，无法进行统计合并。因此，研究结果以叙述形式呈现。
从总共识别出的2151项独特研究中选取了15篇文章。其中2篇为随机对照试验，13篇为准实验性和观察性研究。这些研究的质量被判定为低到中等。一些患者特征，如女性和住院状态，似乎是外渗的危险因素。此外，注射速率、静脉穿刺部位和导管留置时间可能会影响外渗量。初步研究似乎表明，外渗检测附件具有识别外渗并减少外渗量的潜力。其他干预措施要么没有显著降低外渗频率/量，要么研究结果不一。
本综述纳入的大多数研究评估了外渗频率和量的结局。鉴于原始研究的质量，本系统评价仅确定了潜在的危险因素和干预措施。它进一步凸显了该领域的研究差距以及开展具有扎实方法学设计的试验的重要性。
