title: Peripheral intravenous power injection of iodinated contrast media through 22G and 20G cannulas: can high flow rates be achieved safely? A clinical feasibility study.
abstract: OBJECTIVE
  Modern examination protocols for computed tomography (CT) often require high injection rates of iodinated contrast media (CM). The purpose of this study was to evaluate the maximum achievable flow rates and stability of different peripheral intravenous catheters (IVC) in vitro and to assess the feasibility of higher injection rates through small IVC in vivo.
  
  
  METHODS
  For in vitro experiments flow measurements followed by high pressure testing of different types of IVC (22, 20, and 18 gauge [G]) were performed. For the in vitro study 91 patients with already inserted 22 or 20G IVC who had been referred for CT received Iopamidol (300 mg iodine/ml) at flow rates between 2 and 5 ml/sec. Complications were documented.
  
  
  RESULTS
  The maximal achievable flow rate of the tested IVC in vitro ranged from 5 to 8 ml/sec. No damage was observed during in vitro testing. The initially targeted in vivo flow rate was dropped in 33 of 91 (36 %) patients because the IVC could not be flushed adequately with saline before CM injection. Extravasation of CM occurred in 2 cases. In the remaining 58 patients the standard CT protocol was performed with flow rates of 3 ml/sec through 22G IVC and 5 ml/sec through 20G IVC, respectively. In this group, the extravasation of CM was observed twice (p > 0.05).
  
  
  CONCLUSIONS
  Even with highly viscous CM, high flow rates can be applied in vitro in 22, 20, and 18G IVC without risking material damage. In vivo power injection of iodinated CM through 22G and 20G IVC seems to be safely achievable in the majority of patients with flow rates of up to 3 ml/sec and 5 ml/sec. Extravasation rates do not differ significantly between patients with high-flow or low-flow injections.
authors.affiliation: Radiologisches Institut, Universitätsklinikum Erlangen.
authors.forename: S A
authors.initials: SA
authors.lastname: Schwab
authors.forename: M
authors.initials: M
authors.lastname: Uder
authors.forename: K
authors.initials: K
authors.lastname: Anders
authors.forename: M C
authors.initials: MC
authors.lastname: Heinrich
authors.forename: M A
authors.initials: MA
authors.lastname: Kuefner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis* / Q000209:etiology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D007455:Iodine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D007455:Iodine