Contrast Extravasation using Power Injectors for Contrast-Enhanced Computed Tomography in Children: Frequency and Injury Severity

Purpose: To evaluate the safety of power injectors for contrast-enhanced computed tomography (CT) in children, namely: the prevalence and injury severity of contrast extravasations related to power injectors and the factors associated with these events. Methods: The need to obtain informed consent was waived for this HIPAA-compliant and IRB approved retrospective study. Around 2429 contrast-enhanced CT performed with a power injector were identified during a 3-year period. Data collected included patient demographic, power injector, and contrast agent information. The patients' symptoms, severity of injury and treatment with contrast extravasation were recorded. Around 1496 cases (823 boys, 673 girls) were included in the analysis. Independentsample t test and Chi-square were used. For a sub-analysis using the extravasation cases, nonparametric tests were used. Results: The mean age was 9.5 +/- 6.1 years. The most common access site, catheter site, and contrast agent used were the antecubital fossa, 22 gauge and lohexol. The mean peak pressure was 68.9 +/- 62.3 psi and the flow rate was 1.7 +/- 0.9 mUs. Eighteen cases of contrast extravasation were identified with a mean age of 11.2 +/- 6.2 years. There were seven mild, six moderate, and five severe. Cases with extravasation had significantly higher peak pressure (p < 0.001) and flow rate (p < 0.001) compared to those without extravasation. Patients who received lohexol-350 had significantly more contrast extravasation compared to those who used lohexol-300 (p = 0.03). However, after post-hoc correction, only peak pressure (p < 0.01) and flow rate (p = 0.01) remained significant. Conclusion: The use of power injectors in children undergoing contrast-enhanced CT is associated with a low rate of extravasation and of long-term injury.