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.
Computed tomography (CT) is widely used in patients with intravenous devices. With the advent of CT angiography (CTA), there is a requirement for the rapid infusion of contrast media (CM) using a power injector at injection rates of 4 ml/sec and higher through intravenous (IV) access achieved ideally by an 18-gauge IV line in the antecubital fossa. Patients with limited IV options can have IV access achieved by several methods, including indwelling ports (Hickman, Broviac catheters, etc), peripherally inserted central catheters (PICC lines), and central venous catheters (CVCs). CVCs, typically triple-lumen catheters, are commonly placed in acutely ill patients in emergency departments and intensive and critical care units.
To our knowledge, there are no guidelines from the manufacturers of CVCs regarding maximal injection rate thresholds. Data regarding the feasibility and safety of power injection of CM through CVCs are limited. As a consequence, CVCs are not used for examinations requiring high injection rates due to several possible concerns. Potential complications are possible rupture under high injection flow rates causing catheter fragmentation and/or vessel injury and extravasation of CM, ultimately leading to patient morbidity.
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Materials and methods
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Results
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Table 1
Catheter Lengths and Injection Rates
Catheter Length (cm) Injection Rate (ml/sec) No. Mean Pressure (psi) SD_P_ Value 16 5 5 120 2.2 0.0002 20 5 5 129 2.3 16 10 5 310 5.7 0.0075 20 10 5 324 6.9 16 15 5 528 12 0.0007 20 15 5 565 8.2 16 20 5 753 14.3 0.26 20 20 5 768 22.6 16 25 5 916 17.7 0.06 20 25 5 886 23.7 16 30 5 920 25.7 0.0161 20 30 5 872 24.2
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Discussion
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Acknowledgments
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