Management of Contrast Extravasation

Immediate Actions

The American College of Radiology recommends stopping the infusion immediately upon recognition of extravasation without removing the cannula, aspirating extravasated contrast by gently withdrawing as much solution as possible through the existing cannula, and avoiding manual pressure over the extravasated area to prevent worsening tissue damage 1, 2, 4
The European Society of Radiology suggests aspirating extravasated contrast and documenting the volume removed in the patient record to reduce the amount of contrast remaining in tissues and decrease potential tissue damage 1, 2, 4

The American College of Radiology recommends applying dry cold compresses for 15-20 minutes, four times daily for 24-48 hours to promote vasoconstriction and limit drug dispersion, and elevating the affected limb to reduce edema and improve venous drainage 1, 5, 4
The European Society of Radiology suggests administering analgesia as necessary for patient comfort 5, 4

The American College of Radiology advises against using subcutaneous corticosteroids, as retrospective data demonstrates that intralesional corticoids increased the need for surgical debridement 1, 2, 5, 4
The European Society of Radiology recommends not removing the cannula immediately before attempting aspiration of extravasated solution, and not applying manual pressure to the extravasation site 1, 2, 4

The American College of Radiology suggests documenting the patient name and identification number, signs and symptoms, description of IV access site and location, estimated extravasation area and volume, management steps taken with times, and photographic documentation 1, 2, 3, 6, 7

The American College of Surgeons recommends surgical debridement for unresolved tissue necrosis or pain lasting more than 10 days, consisting of wide three-dimensional excision of all involved tissue, temporary coverage with biologic dressing, and delayed graft application at 2-3 days once the wound is clean 6, 7