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RADIOGRAPHIC CONTRAST ADVERSE EVENT REPORT – EXTRAVASATION
Contrast Type: Omnipaque 300
Catheter Location: Antecubital
Estimated contrast volume extravasated: 70-79 mL: Surgery Consult if in distal extremity
The total amount of contrast left in the injector subtracted from the total amount of contrast that was loaded into
the injector.
Initial signs and symptoms of extravasation: (Select all that apply)
Swelling: Mild (< 2 cm)
Skin: Blanched
Decreased perfusion: No
Compartment Syndrome: No
Pain: Mild
Blistering/Ulceration: No
Altered sensation: No
Comments:
Initial Interventions (Select all that apply):
Compresses: Hot
Observation: Yes
Surgical Consultation: No
Comments:
Extremity Elevation: Yes
If Yes, Observation time: 1-2 hours
Assessment of Stage of Extravasation Injury: Stage I.
Stage I: Skin blanched, edema < 2cm, skin cool to touch, mild pain
Stage II: Skin blanched, skin cool to touch, edema > 2cm, perfusion changes, signs of tissue damage
Stage III: Skin translucent, edema > 3cm, skin cool to touch, perfusion changes, moderate pain, numbness
Stage IV: Skin translucent/tight/discolored/bruised. Pitting edema, ulceration, pulse decreased or absent.
Provider Notification: