Rationale and Objectives
Modern computed tomographic scanners and examination protocols often require high injection rates of iodinated contrast media (CM). The purpose of this study was to investigate the maximum injection pressures (MIPs) with different CM at different temperatures in the most common intravenous cannula (IVC) sizes.
Materials and methods
Three IVC sizes, 22, 20, and 18 gauge, were evaluated. All examinations were performed with a pressure-limited (300 psi) power injector. The MIPs of three different CM (Solutrast 300, Imeron 350, and Imeron 400) were measured at room temperature (20°C) and at 37°C using increasing flow rates (1–9 mL/s). The intactness of the IVCs was checked after injection.
Results
Heating the CM led to reductions in injection pressures ( P < .001). Using constant flow rates, the difference in MIP between 20-gauge and 22-gauge IVCs was higher than that between 20-gauge and 18-gauge IVCs. By heating the CM, the manufacturer’s suggested operating pressure limit was exceeded at higher flow rates, such as with an 18-gauge cannula at 8 mL/s instead of 6 mL/s using warmed iomeprol 400. Even with pressures of up to 159.7 psi, none of the IVCs ruptured.
Conclusions
Heating of CM effectively reduces MIPs using power injection in common IVCs. Although the manufacturer’s suggested MIP was exceeded at higher flow rates, safe CM injection seems to be possible even in small cannulas using power injection. The compilation of the obtained data is meant to serve as guidance for future decisions on parameters of the power injection of iodinated CM.
Modern computed tomographic scanners and examination protocols often require high intravenous iodine delivery rates. Arterial contrast enhancement is directly proportional to the injection flow rate and to the iodine concentration . Higher injection rates of contrast media (CM) result in higher injection pressures in both the dedicated material and patients’ veins. Although the majority of manufacturers offer peripheral intravenous catheters (IVCs) in calibers of 16 gauge and higher, the most commonly used cannula sizes used for CM application in daily clinical routine are 22, 20, and 18 gauge. The preference for these calibers is also reflected by the majority of publications reporting examinations that rely on high-flow injection protocols (eg, coronary computed tomographic angiography or brain perfusion imaging with computed tomography) .
Previous studies have reported on the pressures occurring in IVCs during power injection of unheated CM . Nowadays, virtually every power injector has a CM-heating device. Although it is known that heating CM has a major influence on injection physics , only limited data exist about the effects of heating CM for peripheral intravenous power injection of iodinated CM compared to CM at room temperature.
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Materials and methods
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Table 1
Contrast Media Used for Testing
Brand Name Iodine Agent Concentration of Iodine (mg/mL) Viscosity (mPa · s) 37°C 20 °C Solutrast 300 ∗ Iopamidol 300 4.5 8.1 Imeron 350 ∗ Iomeprol 350 7.5 ± 0.6 14.5 ± 1.1 Imeron 400 ∗ Iomeprol 400 12.6 ± 1.1 27.5
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Table 2
Intravenous Catheters Used for Testing
Name Color Caliber (Gauge) Catheter Length (mm) Outer Diameter (mm) Inner Diameter (mm) MIP (bar/psi) Vasofix Safety ∗ Green 18 45 1.3 0.96 3/43.5 Vasofix Safety ∗ Pink 20 33 1.1 0.76 3/43.5 Vasofix Safety ∗ Blue 22 25 0.9 0.61 3/43.5
MIP, manufacturer’s suggested maximum injection pressure.
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Results
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Table 3
Calculated Maximum Injection Pressures (psi) in the Intravenous Catheters with Three Different Contrast Media
Catheter Flow Rate (mL/s) Solutrast 300 ∗ Minimum Maximum Imeron 350 ∗ Minimum Maximum Imeron 400 ∗ Minimum Maximum 37°C Vasofix Safety † (green, 18 gauge) 1 1.0 1.0 1.0 3.0 2.0 4.0 3.7 3.3 4.3 2 3.3 2.0 4.0 5.3 3.0 8.0 7.7 7.0 9.0 3 5.7 5.7 5.7 8.3 8.3 8.3 13.3 13.3 13.3 4 7.7 8.7 9.7 11.3 11.3 11.3 19.3 19.0 20.0 5 7.7 13.0 18.7 15.0 13.3 17.3 26.3 23.7 28.7 6 16.3 17.7 19.3 20.0 16.0 28.0 31.7 31.7 31.7 7 22.0 22.0 22.0 24.3 21.0 26.0 39.7 37.7 43.7 8 26.7 20.0 30.0 29.0 15.7 35.7 45.3 ‡ 34.7 50.7 9 32.7 29.7 38.7 34.3 17.0 43.0 Vasofix Safety † (pink, 20 gauge) 1 2.0 2.0 2.0 3.0 3.0 3.0 12.3 9.3 18.3 2 8.0 6.0 10.0 9.0 8.0 11.0 22.0 22.0 22.0 3 14.7 12.7 17.7 14.7 14.3 15.3 31.0 29.3 34.3 4 21.0 20.7 21.7 21.0 20.3 21.3 41.3 40.0 43.0 5 30.3 24.7 33.7 28.3 22.3 31.3 54.7 ‡ 52.7 57.7 6 36.7 34.3 40.3 33.7 30.0 37.0 66.7 ‡ 62.7 71.7 7 44.3 ‡ 43.0 47.0 41.3 40.0 43.0 83.0 ‡ 77.7 91.7 8 54.0 ‡ 53.0 56.0 51.7 ‡ 48.7 57.7 9 68.7 ‡ 66.7 71.7 62.7 ‡ 54.0 68.0 Vasofix Safety † (blue, 22 gauge) 1 10.0 9.0 12.0 9.3 9.0 10.0 21.3 20.3 23.3 2 23.3 22.0 24.0 23.0 23.0 23.0 41.0 38.0 45.0 3 42.0 40.7 43.7 38.3 38.3 38.3 62.0 ‡ 60.3 65.3 4 65.3 ‡ 64.7 65.7 55.7 ‡ 52.3 59.3 84.0 ‡ 82.0 86.0 5 87.7 ‡ 81.7 97.7 79.3 ‡ 76.3 85.3 112.3 ‡ 108.7 119.7 6 113.0 ‡ 110.3 115.3 105.3 ‡ 104.0 107.0 7 139.7 ‡ 136.0 142.0 135.7 ‡ 134.0 137.0 8 159.7 ‡ 158.0 161.0 9 20°C Vasofix Safety † (green, 18 gauge) 1 4.3 3.3 5.3 6.3 5.0 9.0 8.7 6.7 10.7 2 8.0 7.3 9.3 10.7 8.3 13.3 14.7 11.3 19.3 3 12.0 8.7 16.7 15.7 15.0 16.0 21.7 19.0 24.0 4 15.0 13.7 17.7 20.3 20.3 20.3 30.3 30.3 30.3 5 19.0 18.0 20.0 26.7 26.7 26.7 38.7 38.0 40.0 6 24.3 24.0 25.0 33.0 29.7 36.7 7 30.3 29.7 30.7 40.0 39.3 40.3 8 38.0 37.3 38.3 9 49.3 ‡ 47.0 51.0 Vasofix Safety † (pink, 20 gauge) 1 5.7 3.3 8.3 10.0 10.0 10.0 13.3 12.7 13.7 2 11.0 9.3 12.3 17.3 17.3 17.3 26.3 24.3 28.3 3 19.0 16.7 23.7 26.3 25.0 28.0 41.3 39.0 46.0 4 28.7 27.7 29.7 34.7 33.3 35.3 55.7 ‡ 54.3 58.3 5 38.7 37.0 40.0 46.7 ‡ 44.7 47.7 6 48.7 ‡ 47.0 51.0 56.7 ‡ 56.7 56.7 7 64.3 ‡ 62.7 67.7 8 77.0 ‡ 76.3 78.3 9 Vasofix Safety † (blue, 22 gauge) 1 10.7 9.3 13.3 18.0 17.0 19.0 29.3 26.7 34.7 2 26.0 24.3 29.3 40.3 39.3 41.3 56.7 ‡ 54.3 58.3 3 45.3 ‡ 44.7 45.7 64.0 ‡ 64.0 64.0 83.0 ‡ 83.0 83.0 4 66.7 ‡ 65.7 68.7 87.0 ‡ 84.3 88.3 5 97.3 ‡ 93.0 102.0 112.3 ‡ 111.7 112.7 6 124.7 ‡ 123.0 127.0 7 8 9
Empty cells indicate an excess of the power injector’s pressure limitation (300 psi).
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Discussion
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Conclusion
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Acknowledgment
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