Current Clinical Concerns in CT: Results : IV Contrast Administration
Power injectors and central lines
1. Is it OK to use the power injector to administer contrast through an indwelling central venous portocatheter if there is no other IV access. If so, are there any rate restrictions that would prevent performing a CT chest for PE exam? [This question was posed by 4 individuals]
| Answer: Our policy is to hand inject the central lines; although, the literature would surely suggest that a rate of 2 ml/sec should be fine with a central line that flushes well. We hand inject as fast as possible, which is 1.5 to 2.3 cc/sec to the best of my calculations. We do not power inject central lines or PICC lines. Bard is developing a PICC line that is specifically designed for power injectors. |
2. Is there any evidence that CT injectors can damage central lines?
| Answer: Although we do not power inject central lines or PICC lines, a number of articles have suggested that as long as one is careful with the pressure settings, that it may be safe. |
3. I am looking for any information in regards to acceptable rate and pressure limits for central lines, double lumens, mediports, etc.
| Answer: With each line, the manufacturer publishes acceptable limits in the product insert. To be safe, I would use 20-30% lower than these limits. |
References
Salis AI. Eclavea A. Johnson MS. Patel NH. Wong DG. Tennery G.
Maximal flow rates possible during power injection through currently available PICCs: an in vitro study. Journal of Vascular & Interventional Radiology 2004; 15(3):275-81
- Summary: This study evaluated 232 4-F single-lumen and 5-F dual lumen silicone and polyurethane peripherally inserted central catheters (PICCs). Catheters were evaluated at full length and trimmed. Using an injector, catheters were infused with IV contrast at progressively increasing rates. The pressure at which catheters ruptured and the site were recorded. Silicone catheters ruptured at lower flow rates (0.5 to 3.5 mL/sec) compared to polyurethane catheters (4 to 15.4 mL/sec). The authors concluded that the silicone catheters would not withstand infusion rates used for CT angiography.
Herts BR. Cohen MA. McInroy B. Davros WJ. Zepp RC. Einstein DM. Power injection of intravenous contrast material through central venous catheters for CT: in vitro evaluation. Radiology. 1996; 200(3):731-5.
- Summary: This was an in vitro study of 9.6-F Hickman catheters and 10-F Leonard catheters. Contrast was infused at 1.0 to 2.5 mL/second, and peak pressure recorded. Using these infusion rates, the authors reported that "the upper limits of the prediction interval for the peak pressure at the connection between the coiled tubing and the catheter were below the manufacturer's specified peak pressure." They concluded that these results should be followed by in-vivo testing of the safety and efficacy for power injecting central lines.