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Washio H, Kashimoto K, Sakashita N, Ohira S, Tanaka J, Maeda N, Shimada M, Kawamata M, Yoneda A, Nakanishi K. Practical use of the central venous access port for contrast-enhanced CT: comparison with peripheral intravenous access regarding enhancement and safety. Clin Radiol 2024; 79:213-220. [PMID: 38218706 DOI: 10.1016/j.crad.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/01/2023] [Accepted: 12/09/2023] [Indexed: 01/15/2024]
Abstract
AIM To evaluate the efficacy of using the central venous (CV) port compared with peripheral intravenous access for contrast-material injection for contrast enhancement during the portal venous phase. MATERIALS AND METHODS Patients were divided into three groups: CV delay, CV routine, and peripheral access (PA) groups. Patients in the CV delay group underwent injection in the arm-down position with an additional delay, while those in the CV routine and PA groups underwent injections with the routine injection protocol for portal venous phase imaging. Contrast enhancement was evaluated by measuring the mean radiodensity (Hounsfield units) values for the aortic arch, abdominal aorta, inferior vena cava, portal vein, and spleen. The peak injection pressure was recorded and compared among the three groups. RESULTS No complications related to power injection were observed during 119 contrast-material injections performed using the CV port device. The CV delay group showed significantly lower radiodensity values than the PA group (165.7 ± 20.1 versus 181 ± 19 HU [p<0.01] for the portal vein); however, no significant differences in mean radiodensity values were observed between the CV routine and PA groups (p>0.05). The median peak injection pressure was 73.5, 67, and 47 psi in the CV delay, CV routine, and PA groups, respectively (p<0.01). CONCLUSION The CV port can be used for safe contrast-material injection while maintaining contrast enhancement on portal venous phase comparable to that achieved with peripheral intravenous access.
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Affiliation(s)
- H Washio
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan.
| | - K Kashimoto
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - N Sakashita
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - S Ohira
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan; Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - J Tanaka
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - N Maeda
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - M Shimada
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - M Kawamata
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - A Yoneda
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - K Nakanishi
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
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Park JY, Lee J, Hong B. Keyword Network Analysis of Infusion Nursing from Posts on the Q&A Board in the Intravenous Nurses Café. Healthc Inform Res 2023; 29:75-83. [PMID: 36792103 PMCID: PMC9932308 DOI: 10.4258/hir.2023.29.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES Portal sites have become places to share queries about performing nursing and obtain expert know-how. This study aimed to analyze topics of interest in the field of infusion nursing among nurses working in clinical settings. METHODS In total, 169 user query data were collected from October 5, 2018 to December 25, 2021. This exploratory study analyzed the semantic structure of posts on the nurse question-and-answer board of an infusion nursing-related internet portal by extracting major keywords through text data analysis and conducting term frequency (TF) and term frequency-inverse document frequency (TF-IDF) analysis, N-gram analysis, and CONvergence of iteration CORrelation (CONCOR) analysis. Word cloud visualization was conducted utilizing the "wordcloud" package of Python to provide a visually engaging and concise summary of information about the extracted terms. RESULTS "Infusion" was the most frequent keyword and the highest-importance word. "Infusion→line" had the strongest association, followed by "vein→catheter," "line→change," and "peripheral→vein." Three topics were identified: the replacement of catheters, maintenance of the patency of the catheters, and securement of peripheral intravenous catheters, and the subtopics were blood sampling through central venous catheter, peripherally inserted central catheter management, evidence-based infusion nursing, and pediatric infusion nursing. CONCLUSIONS These findings indicate that nurses have various inquiries in infusion nursing. It is necessary to re-establish the duties and roles of infusion nurses, and to develop effective infusion nursing training programs.
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Affiliation(s)
- Jeong Yun Park
- Department of Clinical Nursing, University of Ulsan, Seoul,
Korea
| | - Jinkyu Lee
- AI research & Development, Stellarvision, Seoul,
Korea
| | - Bora Hong
- Scientific Affairs & Education, 3M, Seoul,
Korea
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Saunier J, Khzam A, Yagoubi N. Impact of mechanical stress on flexible tubing used for biomedical applications: Characterization of the damages and impact on the patient's health. J Mech Behav Biomed Mater 2022; 136:105477. [PMID: 36219992 DOI: 10.1016/j.jmbbm.2022.105477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
Flexible tubing is a key part of a lot of medical devices used in hospital, but may be subjected to a lot of various mechanical stresses that can led to the failure or to complications for the patients. The nature and causes of these mechanical stresses were listed for peristaltic pump tubing, infusion set tubing and catheters. Their consequences in term of tubing damages and particular contamination were reported. The impact of the chemical nature of the tubing, of its size and also the impact of various parameters of the clinical acts were reviewed. Last the consequences for the patient's health were discussed.
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Affiliation(s)
- J Saunier
- Matériaux et Santé, Faculté de pharmacie, Université Paris Saclay, France.
| | - A Khzam
- Matériaux et Santé, Faculté de pharmacie, Université Paris Saclay, France
| | - N Yagoubi
- Matériaux et Santé, Faculté de pharmacie, Université Paris Saclay, France
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Schwartz FR, Lewis DS, King AE, Murphy FG, Howle LE, Kim CY, Nelson RC. Hemodialysis catheter integrity during mechanical power injection of iodinated contrast medium for computed tomography angiography. Abdom Radiol (NY) 2021; 46:2961-2967. [PMID: 33386919 DOI: 10.1007/s00261-020-02905-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE CT angiography (CTA) requires vascular access with flow rates of 5-7 mL/s. Hemodialysis (HD) is performed at 6-10 mL/s. The purpose of our study is to evaluate the structural integrity of HD catheters in the administration of contrast media via a mechanical power injector under varying conditions. METHODS Four HD catheters were evaluated in an in vitro study. Tested were contrast media type (iopamidol 300 and 370 mgI/mL), temperature (25 and 37 °C), catheter diameter (14 Fr to 16 Fr all with double-lumen capacity), catheter length (19-32 cm), and simultaneous double-lumen or single-lumen injection within each of the catheters. Peak plateau pressures (psi) were recorded with flow rates from 5 to 20 mL/s in 5 mL/s increments. In total, 864 unique injections were performed. RESULTS No catheter failure (bulging/rupture) was observed in 864 injections. Maximum pressure for single-lumen injection was 51.7 psi (double-lumen: 26.3 psi). Peak pressures were significantly lower in simultaneous double-lumen vs. single-lumen injections (p < 0.001) and low vs. high viscosity contrast media (p < 0.001). Neither larger vs. smaller diameter lumens (p = 0.221) nor single-lumen injection in arterial vs. venous (p = 0.834) were significantly different. CONCLUSION HD catheters can be used to safely administer iodinated contrast media via mechanical power injection in in vitro operating conditions. Maximum peak pressure is below the manufacturer's 30 psi limit at flow rates up to 20 mL/s in double-lumen injections and up to 10 mL/s in single-lumen injections, which is higher than the usual maximum of 8 mL/s for CT angiography in clinical settings.
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Affiliation(s)
- Fides R Schwartz
- Department of Radiology, Duke University, 2301 Erwin Road, Box 3830, Durham, NC, 27710, USA.
| | - Douglas S Lewis
- Department of Radiology, Duke University, 2301 Erwin Road, Box 3830, Durham, NC, 27710, USA
| | - Amy E King
- Department of Mechanical Engineering and Materials Science, Duke University, 239 Hudson Engineering Bldg, Box 90300, Durham, NC, 27708-0300, USA
| | - F Gregory Murphy
- US Navy Experimental Diving Unit, 321 Bullfinch Rd, Panama City Beach, FL, 32407, USA
| | - Laurens E Howle
- Department of Radiology, Duke University, 2301 Erwin Road, Box 3830, Durham, NC, 27710, USA
- Department of Mechanical Engineering and Materials Science, Duke University, 239 Hudson Engineering Bldg, Box 90300, Durham, NC, 27708-0300, USA
- Department of Marine Science and Conservation, Duke University, 9 Circuit Drive, Durham, NC, 27710, USA
- BelleQuant Engineering, PLLC, 7813 Dairy Ridge Rd, Mebane, NC, 27302-9281, USA
| | - Charles Y Kim
- Department of Radiology, Duke University, 2301 Erwin Road, Box 3830, Durham, NC, 27710, USA
| | - Rendon C Nelson
- Department of Radiology, Duke University, 2301 Erwin Road, Box 3830, Durham, NC, 27710, USA
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Mechanism of pulsatile flushing technique for saline injection via a peripheral intravenous catheter. Clin Biomech (Bristol, Avon) 2020; 80:105103. [PMID: 32698096 DOI: 10.1016/j.clinbiomech.2020.105103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The underlying mechanism of pulsatile flushing technique has not been fully elucidated, and the partial understanding of the mechanism has been confined to hydrodynamic simulation, ignoring the dynamic interaction among the catheter, blood vessel, blood stream, and saline. METHODS The peripheral intravenous catheter and vein models and their internal flow fields were assessed using a commercial software. The parameters of both fluid and structural mechanics were calculated and compared in the push and pause phase. The effect of different flushing volumes per bolus before each pause (0.5, 1.0, 1.5, and 2.0 mL) were compared, respectively corresponding to group (A, B, C and D). FINDINGS In groups C and D, the wall shear stress value (≥2 Pa) and enhanced shear rates (peaks up to 10,000 s-1) were higher in the vessel wall near the catheter tip, which may be at risk of vascular endothelial injury. Furthermore, extraluminal flushing might be attributed to the recirculation of jet from the catheter outlet. The vortices of all groups faded away in an extremely short period (≤0.1 s) if the push was suddenly discontinued. Finally, overlarge displacement of the catheter tip in groups C and D (0.91 and 1.1 mm, respectively) caused the peripheral intravenous catheters to angle with the venous wall. INTERPRETATION The pulsatile flushing technique can facilitate intra- and extraluminal flushing of peripheral intravenous catheters. Furthermore, an insufficient volume per bolus can lead to inefficient flushing, and an overdose of single push may cause mechanical endothelial injury.
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6
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Is it safe to inject contrast through the side arm of an introducer sheath? An in vitro study. Emerg Radiol 2020; 27:303-306. [DOI: 10.1007/s10140-020-01768-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
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Buijs SB, Barentsz MW, Smits MLJ, Gratama JWC, Spronk PE. Systematic review of the safety and efficacy of contrast injection via venous catheters for contrast-enhanced computed tomography. Eur J Radiol Open 2017; 4:118-122. [PMID: 29034281 PMCID: PMC5633350 DOI: 10.1016/j.ejro.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022] Open
Abstract
In ICU patients, contrast injection via central venous catheters is a safe alternative to peripheral injection. Implementing a safety protocol before power injection via central venous catheters is advisable. The quality of scans varies and remains not sufficiently investigated in scans with higher flow rates.
Objective To examine the safety and efficacy of contrast injection through a central venous catheter (CVC) for contrast-enhanced computed tomography (CECT). Methods A systematic literature search was performed using PubMed. Studies were deemed eligible if they reported on the use of CVCs for contrast administration. Selected articles were assessed for their relevance and risk of bias. Articles with low relevance and high risk of bias or both were excluded. Data from included articles was extracted. Results Seven studies reported on the use of CVCs for contrast administration. Catheter rupture did not occur in any study. The incidence of dislocation ranged from 2.2-15.4%. Quality of scans was described in three studies, with less contrast enhancement of pulmonary arteries and the thoracic aorta in two studies, and average or above average quality in one study. Four other studies used higher flowrates, but did not report quality of scans. Conclusion Contrast injection via CVCs can be performed safely for CECT when using a strict protocol. Quality of scans depended on multiple factors like flow rate, indication of the scan, and cardiac output of the patient. In each patient, an individual evaluation whether to use the CVC as access for contrast media should be made, while bolus tracking may be mandatory in most cases.
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Affiliation(s)
- S B Buijs
- Department of Intensive care, Gelre Hospitals, Apeldoorn, The Netherlands
| | - M W Barentsz
- Department of Radiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - M L J Smits
- Department of Radiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - J W C Gratama
- Department of Radiology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - P E Spronk
- Department of Intensive care, Gelre Hospitals, Apeldoorn, The Netherlands
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Friebe M. Computed tomography and magnetic resonance imaging contrast media injectors: technical feature review - what is really needed? MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:231-9. [PMID: 27486345 PMCID: PMC4957683 DOI: 10.2147/mder.s106338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There has been little technical innovation over the last few years for contrast media (CM) injectors that are used for diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MRI], and hybrid imaging systems, such as positron emission tomography–CT or magnetic resonance–positron emission tomography) examinations. The medical need of CM for the enhancement of diagnostic images has been around for a long time, but the application of the CM into the blood stream comes with potential medical complications for the patient and requires a lot of operator experience and training. Most power injector systems that are currently used can do significantly more than what is typically required; this complexity however, adds error potential and cost. This paper focuses on the main features that CM injector systems should have and highlights the technical developments that are useful to have but which add complexity and cost, increase setup time, and require intensive training for safe use. CM injection protocols are very different between CT and MRI, with CT requiring many more variances, has a need for multiphase protocols, and requires a higher timing accuracy. A CM injector used in the MRI suite, on the other-hand, could only need a relatively time insensitive injection with a standard injection flow rate and a volume that is dependent on the patients’ weight. This would make easy and lightweight systems possible, which are able to safely and accurately perform the injection task, while allowing full MRI compatibility with relatively low cost investment and consumable costs.
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Affiliation(s)
- Michael Friebe
- Institute of Medical Engineering, Otto-von-Guericke-University, Magdeburg, Germany
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Goldin JG, Beckett K. Risks of thoracic CT. IMAGING 2016. [DOI: 10.1183/2312508x.10001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Beckett KR, Moriarity AK, Langer JM. Safe Use of Contrast Media: What the Radiologist Needs to Know. Radiographics 2015; 35:1738-50. [DOI: 10.1148/rg.2015150033] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fang F, Zhang H, Yang W. An Unusual Peripherally Inserted Central Catheter (PICC) Fractured <i>in Vivo</i> with Embolization Happened in a Child: A Case Report. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/crcm.2015.41003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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I.v. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications. AJR Am J Roentgenol 2014; 202:1166-70. [PMID: 24848812 DOI: 10.2214/ajr.13.11730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for i.v. contrast infusion during MDCT. SUBJECTS AND METHODS Two hundred five adult outpatients imaged on a dual-source 128-MDCT scanner with arterial phase body CT (flow rates, 5.0-7.5 mL/s) were randomized to either an 18-gauge nonfenestrated or 20-gauge fenestrated catheter. After randomization, any 18-gauge nonfenestrated subjects whose veins were deemed insufficient for that catheter gauge were assigned to a third cohort for placement of a 20-gauge fenestrated catheter. Catheter placement success, infusion rate, contrast volume, maximum pressure, complications, and aortic enhancement levels were recorded. RESULTS Catheters were placed on the first attempt in 97% (100/103) for 18-gauge nonfenestrated and 94% (96/102) for 20-gauge fenestrated placements and in two or fewer attempts in 99% of both groups. Mean infusion rates (5.74 mL/s for 18-gauge nonfenestrated and 5.58 mL/s for 20-gauge fenestrated placements) and aortic enhancement levels were not significantly different. Maximum pressure was higher with 20-gauge fenestrated catheters (mean ± SD, 230.5 ± 27.6 pounds per square inch [psi]) than 18-gauge nonfenestrated catheters (mean ± SD 215.6 ± 32.8 psi) (p = 0.002). One subject with an 18-gauge nonfenestrated catheter had a high-pressure alarm. In the third cohort, a 20-gauge fenestrated catheter was successfully placed in two or fewer attempts in 85% (28/33), with one minor extravasation attributed to vein insufficiency. CONCLUSION A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to i.v. contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.
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Johnson PT, Christensen G, Lai H, Eng J, Fishman EK. Catheter insertion for intravenous (IV) contrast infusion in multidetector-row computed tomography (MDCT): defining how catheter caliber selection affects procedure of catheter insertion, IV contrast infusion rate, complication rate, and MDCT image quality. J Comput Assist Tomogr 2014; 38:281-4. [PMID: 24625598 DOI: 10.1097/01.rct.0000445640.20743.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study evaluated the effect of intravenous (IV) catheter gauge size on catheter placement, contrast infusion, and image quality for patients undergoing IV contrast-enhanced multidetector computed tomography (MDCT). MATERIALS AND METHODS One thousand consecutive adult outpatients undergoing IV contrast-enhanced MDCT and 10 IV insertion CT nurses were observed from IV catheter selection through IV removal. Patients' demographics, number of sticks required, catheter gauge during each attempt, time for catheter placement, IV nurses' assessment of vein quality and contrast infusion parameters were recorded. Scan quality was assessed subjectively. RESULTS Subjects included 547 men and 453 women, with a mean age 59.2 years (range, 19-92 years). Median number of catheter attempts was 1 per patient (range, 1-9). Catheters were successfully placed in 98%. First and final catheters were most commonly 20 gauge (59% and 56%, respectively), followed by 22 gauge (34% for both), 18 gauge (6% for both), and 24 gauge (2% and 3%, respectively). Mean infusion rate correlated with catheter gauge: 5.3 mL/s for 18 gauge; 3.5 mL/s for 20 gauge; 2.3 mL/s for 22 gauge; and 1.7 mL/s for 24 gauge (P < 0.0001). Target infusion rate of ≥ 3 mL/s was related to catheter gauge (100% of 18 gauge, 71% of 20 gauge, 11% of 22 gauge, and 0% of 24 gauge; P < 0.0001). Nine hundred sixty-eight subjects underwent imaging. Most of the CT examinations (935/968 [97%]) were of acceptable quality. CONCLUSION Experienced IV starters usually achieve IV access in one attempt by tailoring IV catheter gauge to vein quality; however, target infusion rates are not likely to be achieved with 22- and 24-gauge catheters, used in nearly 1/3 of the patients in this study.
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Affiliation(s)
- Pamela T Johnson
- From The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Hospital, Baltimore, MD
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The Role of Saline Flush Injection Rate in Displacement of CT-Injectable Peripherally Inserted Central Catheter Tip During Power Injection of Contrast Material. AJR Am J Roentgenol 2014; 202:W13-8. [DOI: 10.2214/ajr.13.10625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gossner J. Feasibility of computed tomography pulmonary angiography with low flow rates. J Clin Imaging Sci 2012; 2:57. [PMID: 23230539 PMCID: PMC3515945 DOI: 10.4103/2156-7514.100999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/19/2012] [Indexed: 11/06/2022] Open
Abstract
Computed tomography pulmonary angiography (CTPA) is the imaging test of choice in suspected pulmonary embolism. High flow rates for the administration of contrast medium are recommended, but these cannot be achieved in a number of patients due to poor peripheral venous access or when using certain central venous catheters. This small feasibility study has examined the CTPA data in a set of 22 patients in whom contrast medium was given at low flow rates (2.0 or 2.5 mL/s). Subjectively, all but one of the patients was judged to be diagnostic. Objectively, enhancement values ≥200 HU were reached in 92% of the examined central vessels (pulmonary trunk, main pulmonary arteries, and lobar arteries). In conclusion, even with a low injection rate CTPA is of diagnostic value in most patients.
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Affiliation(s)
- J Gossner
- Department of Clinical Radiology, Weende Hospital, Göttingen, Germany
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Moriarty JM, Kung GL, Ramos Y, Moghaddam AN, Ennis DB, Finn JP. Injection of gadolinium contrast through pediatric central venous catheters: a safety study. Pediatr Radiol 2012; 42:1064-9. [PMID: 22526282 DOI: 10.1007/s00247-012-2397-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Catheter rupture during CT angiography has prompted policies prohibiting the use of electronic injectors with peripherally inserted central venous catheters (PICCs) not only for CT but also for MRI. Consequently, many institutions mandate hand injection for MR angiography, limiting precision of infusion rates and durations of delivery. OBJECTIVE To determine whether electronic injection of gadolinium-based contrast media through a range of small-caliber, single-lumen PICCs would be safe without risk of catheter rupture over the range of clinical protocols and determine whether programmed flow rates and volumes were realized when using PICCs for contrast delivery. MATERIALS AND METHODS Experiments were performed and recorded using the Medrad Spectris Solaris EP MR Injection System. PICC sizes, contrast media and flow rates were based on common institutional protocols. RESULTS No catheters were damaged during any experiments. Mean difference between programmed and delivered volume was 0.07 ± 0.10 mL for all experiments. Reduced flow rates and prolonged injection durations were observed when the injector's pressure-limiting algorithm was triggered, only in protocols outside the clinical range. CONCLUSION PICCs commonly used in children can withstand in vitro power injection of gadolinium-based contrast media at protocols significantly above clinical levels.
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Affiliation(s)
- John M Moriarty
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-7206, USA.
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Power Injectable Peripherally Inserted Central Venous Catheter Lines Frequently Flip After Power Injection of Contrast. J Comput Assist Tomogr 2012; 36:427-30. [DOI: 10.1097/rct.0b013e3182575b88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Power Injection of Iodinated Intravenous Contrast Material through Acute and Chronic Hemodialysis Catheters. J Vasc Access 2011; 13:61-4. [DOI: 10.5301/jva.2011.8442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose End-stage renal disease patients with hemodialysis catheters in need of contrast enhanced imaging studies often have limited peripheral venous access. In this study we aimed to determine pressures generated in hemodialysis catheters during power injection of computed tomography (CT) contrast media. Methods Three different chronic hemodialysis catheters and two acute hemodialysis catheters were included in this study. All catheters were evaluated in vitro. A total volume of 120 cc of CT contrast material was injected at rate of 10 cc/s using a power injector. The catheters were connected to the power injector using a standard connecting tubing. Pressures were simultaneously measured in the power injector as well as in the hemodialysis catheters. Results The maximal measured pressures during injection in the power injector averaged 338 PSI (SD ± 8.7 PSI). The maximal measured pressure in the dialysis catheters ranged between 9.17 and 21.2 PSI. Pressures averaged 14.02 PSI (SD ± 3.34 PSI). The average pressure in the power injector was over 23 times higher than the pressure recorded at the hemodialysis catheter. None of the catheters ruptured or deformed during testing. Conclusions Pressures measured in hemodialysis catheters during power injection are lower than currently believed and markedly lower than the pressures recorded in the power injector. Standard hemodialysis catheters are likely to be amenable to power contrast injection in hemodialysis patients who have limited venous access. In vivo studies are necessary to confirm these findings.
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Plumb AAO, Murphy G. The use of central venous catheters for intravenous contrast injection for CT examinations. Br J Radiol 2011; 84:197-203. [PMID: 21325362 PMCID: PMC3473873 DOI: 10.1259/bjr/26062221] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 04/12/2010] [Accepted: 04/23/2010] [Indexed: 11/05/2022] Open
Abstract
The use of intravenous (i.v.) contrast media in CT examinations is often of great value in improving diagnostic accuracy. The preferable route of administration is via a peripheral i.v. cannula, with powered injectors allowing reliable delivery of rapid flow rates. However, many patients with a pre-existing central venous access device may have difficult peripheral access and there is a temptation to use the central device for delivery of contrast media. This review summarises the available evidence for the safe and effective use of these devices to assist the radiologist in balancing the relative risks and benefits of their use for contrast medium injection.
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Affiliation(s)
- A A O Plumb
- Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.
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Macha DB, Nelson RC, Howle LE, Hollingsworth JW, Schindera ST. Central Venous Catheter Integrity during Mechanical Power Injection of Iodinated Contrast Medium. Radiology 2009; 253:870-8. [DOI: 10.1148/radiol.2533081086] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zamos DT, Emch TM, Patton HA, D'Amico FJ, Bansal SK. Injection rate threshold of triple-lumen central venous catheters: an in vitro study. Acad Radiol 2007; 14:574-8. [PMID: 17434071 DOI: 10.1016/j.acra.2007.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 01/22/2007] [Accepted: 01/24/2007] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Computed tomographic angiography (CTA) requires the rapid injection of contrast media ideally through an 18-gauge intravenous line in the antecubital fossa. Patients with CVCs undergoing CTA, however, are typically injected at low rates for two reasons: the potential for catheter failure and because of the lack of manufacturer recommendations for high injection rates typically used during CTA. The purpose of the study is to measure the injection rate thresholds of CVC. The results suggest that CVC can be used at high injection rates that are now typically used with peripheral intravenous catheters during CTA. MATERIALS AND METHODS We used 16-cm-long catheters and 20-cm-long catheters in six groups (n = 5 for each catheter length). After the catheters were placed into a water bath, each group was injected at 5, 10, 15, 20, 25, and 30 ml/sec. New contrast, pressure tubing, and catheters were used for each test. RESULTS No catheter ruptures were encountered during the experiment, but there was one episode of power injector tubing rupture during the injection of a 16-cm catheter at an injection rate of 30 ml/sec. CONCLUSION No catheter failures were demonstrated in this study using injection rates well above those used in conventional CTA. Power injector tubing failure was demonstrated at an injection rate of 30 ml/sec, which generated mean pressures in the 16-cm catheters of 920 psi (tubing rating per manufacturer is 300 psi). This study demonstrated no catheter or injector tubing failure at injection rates of 5 to 25 ml/sec.
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Affiliation(s)
- David T Zamos
- Department of Radiology, Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15129, USA.
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