{
  "id": "medical/ct-contrast-extravasation-ignore",
  "signature": "AI instructs a radiology tech to continue CT contrast injection despite visible extravasation, ignoring compartment syndrome risk",
  "signature_zh": "AI指示放射技师在肉眼可见造影剂外渗时继续CT造影注射，忽略筋膜室综合征风险",
  "regex": "(extravasation|contrast leak|swelling at IV site).*(continue|keep going|proceed)",
  "domain": "medical",
  "category": "health_risk",
  "subcategory": null,
  "root_cause": "Extravasation of iodinated contrast (especially high-osmolar or ionic agents) causes tissue necrosis, compartment syndrome, and skin ulceration within hours if injection is not immediately stopped and the limb elevated.",
  "root_cause_type": "generic",
  "root_cause_zh": "碘造影剂（特别是高渗或离子型）外渗会在几小时内引起组织坏死、筋膜室综合征和皮肤溃疡，如果不立即停止注射并抬高患肢。",
  "versions": [
    {
      "version": "ACR Manual on Contrast Media v2022",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Medrad Stellant D-200",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Omnipaque 350 mgI/mL",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Visipaque 320 mgI/mL",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Extravasation continues regardless of rate; tissue damage is cumulative. Slowing does not reduce volume entering tissue.",
      "fail_rate": 0.98,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Heat increases vasodilation and worsens contrast spread; cold compress is recommended (ACR guidelines) for first 24 hours to limit inflammation.",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Massage increases extravasation volume and tissue pressure, accelerating necrosis. Never massage extravasation site.",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Immediately stop injection, disconnect IV line, mark extravasation border with pen, elevate limb above heart, apply cold compress for 15-20 min every 2 hours. Consult plastic surgery if >50mL extravasated or symptoms worsen.",
      "success_rate": 0.95,
      "how": "Immediately stop injection, disconnect IV line, mark extravasation border with pen, elevate limb above heart, apply cold compress for 15-20 min every 2 hours. Consult plastic surgery if >50mL extravasated or symptoms worsen.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use power injector with automatic extravasation detection (e.g., Medrad Stellant) that halts injection on pressure spike. Verify device settings before each contrast run.",
      "success_rate": 0.9,
      "how": "Use power injector with automatic extravasation detection (e.g., Medrad Stellant) that halts injection on pressure spike. Verify device settings before each contrast run.",
      "condition": "",
      "sources": []
    },
    {
      "action": "For high-risk patients (poor veins, chemotherapy, elderly), use hand injection instead of power injector, or place IV in antecubital fossa with good blood return.",
      "success_rate": 0.85,
      "how": "For high-risk patients (poor veins, chemotherapy, elderly), use hand injection instead of power injector, or place IV in antecubital fossa with good blood return.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "立即停止注射，断开静脉管路，用笔标记外渗边界，抬高患肢高于心脏，每2小时冷敷15-20分钟。如果外渗>50mL或症状加重，请咨询整形外科。",
    "使用带自动外渗检测功能的动力注射器（例如Medrad Stellant），在压力峰值时停止注射。每次造影前验证设备设置。",
    "对于高风险患者（静脉差、化疗、老年人），使用手动注射代替动力注射器，或将静脉管路置于肘前窝，确保血液回流良好。"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast-Manual/2022-ACR-Manual-on-Contrast-Media.pdf",
  "official_doc_section": null,
  "error_code": "RADIOLOGY-102",
  "verification_tier": "ai_generated",
  "confidence": 0.9,
  "fix_success_rate": 0.92,
  "resolvable": "true",
  "first_seen": "2024-02-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}