# AI instructs a radiology tech to continue CT contrast injection despite visible extravasation, ignoring compartment syndrome risk

- **ID:** `medical/ct-contrast-extravasation-ignore`
- **Domain:** medical
- **Category:** health_risk
- **Error Code:** `RADIOLOGY-102`
- **Verification:** ai_generated
- **Fix Rate:** 92%

## 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.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| ACR Manual on Contrast Media v2022 | active | — | — |
| Medrad Stellant D-200 | active | — | — |
| Omnipaque 350 mgI/mL | active | — | — |
| Visipaque 320 mgI/mL | active | — | — |

## Workarounds

1. **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.** (95% success)
   ```
   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.
   ```
2. **Use power injector with automatic extravasation detection (e.g., Medrad Stellant) that halts injection on pressure spike. Verify device settings before each contrast run.** (90% success)
   ```
   Use power injector with automatic extravasation detection (e.g., Medrad Stellant) that halts injection on pressure spike. Verify device settings before each contrast run.
   ```
3. **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.** (85% success)
   ```
   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.
   ```

## Dead Ends

- **** — Extravasation continues regardless of rate; tissue damage is cumulative. Slowing does not reduce volume entering tissue. (98% fail)
- **** — Heat increases vasodilation and worsens contrast spread; cold compress is recommended (ACR guidelines) for first 24 hours to limit inflammation. (85% fail)
- **** — Massage increases extravasation volume and tissue pressure, accelerating necrosis. Never massage extravasation site. (95% fail)