Safety and feasibility of using a central venous catheter for rapid contrast injection rates.
OBJECTIVE
Our aim was to determine the safety and feasibility of using a central venous catheter for rapid contrast injections during CT.


METHODS
An in vitro experiment was performed using a 7-French Arrow-Howes multilumen central venous catheter. Each catheter port was tested by varying contrast agent flow rates delivered by a power injector. Contrast media specifications were kept similar to routine clinical practice. The in vivo experiment included 104 cases in which rapid contrast injections, 3.0-5.0 mL/sec, were delivered through a central venous catheter for dynamic CT examinations. Patient monitoring for early complications of contrast extravasation, cardiac arrhythmia, and allergic reactions was performed. Contrast injections were monitored for pressure limitation, automatic flow-rate adjustment, and catheter injury. Chart review was performed for delayed complications of mediastinal hematoma, infection, or catheter malfunction.


RESULTS
During the in vitro experiment, all desired flow rates, 3.0-9.9 mL/sec, could be delivered through the central venous catheter with no catheter injury. No immediate or early patient or catheter complications were observed during the in vivo experiment. Follow-up evaluation revealed that 18 blood cultures and one catheter culture were positive for bacterial growth. In a subgroup of 43 patients, five contrast injections were pressure-limited by the power injector, and only one had the flow rate automatically adjusted to 3.6 mL/sec from 4.0 mL/sec.


CONCLUSIONS
Rapid contrast injection rates, at 3.0-5.0 mL/sec, through the Arrow-Howes multilumen central venous catheter are feasible and safe in the clinical setting. However, a strict protocol should be followed to avoid possible serious complications.
Sanelli
Pina C
PC
Department of Radiology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 520 E 70th St., Starr Pavilion-630, New York, NY 10021, USA. pcs9001@med.cornell.edu
Deshmukh
Monica
M
Ougorets
Igor
I
Caiati
Rachael
R
Heier
Linda A
LA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D003287:Contrast Media / Q000008:administration & dosage*; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007275:Injections, Intravenous / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D003287:Contrast Media