Extravasation

We are writing to reach out to individuals who may have experienced an extravasation during their medical treatment. Many patients are unaware of this patient-safety issue, and we are hoping to bring it to light.

Patient Safety Issue/Risk – Extravasations of Radiopharmaceuticals (commonly used in PET and SPECT scans)

Extravasation of Radiopharmaceuticals refers to the unintended leakage or escape of a radiopharmaceutical substance from a vein or blood vessel into the surrounding tissues during a medical procedure, such as nuclear medicine imaging or therapy. Radiopharmaceuticals are compounds containing a radioactive isotope that are administered intravenously or through other routes for various diagnostic or therapeutic purposes. When extravasation occurs, it can have significant implications for patient safety and the quality of the diagnostic or therapeutic procedure.

Consequences of Radiopharmaceutical Extravasation may include:
• Local tissue damage – Radioactive material can cause irritation and damage to the tissues surrounding the injection site. This can lead to pain, inflammation, and, in severe cases, tissue necrosis (cell death).
• Impaired image quality – In diagnostic nuclear medicine imaging, extravasation can result in accurate or less reliable scans because the radiopharmaceutical may not accumulate in the intended target area. This may lead to diagnostic inaccuracy, missed abnormalities, repeat procedures and radiation exposure, increased cost, patient anxiety, and extended hospital stays.
• Radiation exposure – Extravasated radioactive material can expose healthcare workers and patients to unnecessary radiation, which poses health risks.

Signs/Symptoms of an Extravasation – Note that these symptoms can appear after several days, weeks, months, or even years.
• Skin Around/Near Injection Site – swelling; turning red, purple, or black; intense itchiness; intense burning; necrosis; or loss of arm-hair
• Underlying Tissue Under/Near Injection Site: swelling; intense pain; intense burning; or ulceration growth
• Loss of muscle strength and/or range motion in the hand/arm (the side the injection occurred)
• If your injection site was included in your scan (it often is not), there would be a black spot on the arm in which the injection occurred.

Will You Know if You Have Been Extravasated? Maybe. An extravasation may or may not be immediately noticeable to the patient. The extent to which you will know if you have been extravasated depends on several factors, including the severity of the extravasation and your individual sensitivity to pain and discomfort. Symptoms of an extravasation may not show up for months even years in some cases.

Is Your Doctor Required to Notify You If You Have Been Extravasated? No. Doctors are not required and often do not confirm that an extravasation has not occurred, and that the radiopharmaceutical was injected properly.

How often do Extravasations Occur? – One in six radiopharmaceutical administrations result in an extravasation with some individual facilities having rates as high as fifty plus (50+%) percent. As extravasations are not required to be tracked and reported, many facilities do not actually know their extravasation rate.

Why does the Nuclear Medicine community not want to track and report on extravasations? The Nuclear Medicine community believes the reporting of extravasations would cost doctors and hospitals too much time and money. This is not true. With proper training and utilization of free or inexpensive tools available on the market today, the tracking and reporting of extravasations could easily be done.

The Patients for Safer Nuclear Medicine are working to raise awareness on this issue to help patients better understand the issue so that they may be better prepared to ask the appropriate questions.

Thank you and be well.