title: The role of saline flush injection rate in displacement of CT-injectable peripherally inserted central catheter tip during power injection of contrast material.
abstract: OBJECTIVE
  The purpose of this article is to determine the rate and the cause of displacement of CT power-injectable peripherally inserted central catheters (CT-PICCs) during contrast material and saline flush injection and to modify CT-scanning protocols to decrease the frequency of displacement.
  
  
  METHODS
  In the laboratory setting, in vitro modeling of CTPICC displacement during power injection was examined while varying the initial rate of injection of the saline flush. In the clinical setting, the CT images of all patients at a large academic hospital for one calendar year who underwent power injection of CT contrast media were reviewed for CT-PICC displacement. A retrospective comparison of the rate of displacement during the 8 months before implementing a protocol with a lower initial rate of saline flush and the rate of displacement for the 4 months after the protocol change was performed.
  
  
  RESULTS
  Laboratory modeling showed dramatic movement of the CT-PICC at higher rates of saline flush. This movement was attributed to differences in viscosity between contrast media and saline. The clinical arm of the study found that 8.2% of the 243 examinations performed before implementing the new protocol resulted in displacement, in comparison with 2.2% of the 138 examinations performed afterward. This difference was considered statistically significant (p = 0.023).
  
  
  CONCLUSIONS
  Initiation of saline flush at high injection rates correlates with a higher rate of CT-PICC displacement. The use of a slower initial rate of saline flush injection significantly reduces the rate of displacement.
authors.affiliation: 1 Department of Radiology, Beaumont Health System, Oakland University, William Beaumont School of Medicine, 3601 W 13 Mile Rd, Royal Oak, MI 48073.
authors.forename: Peter
authors.initials: P
authors.lastname: Morden
authors.forename: Farnoosh
authors.initials: F
authors.lastname: Sokhandon
authors.forename: Laura
authors.initials: L
authors.lastname: Miller
authors.forename: Michael
authors.initials: M
authors.lastname: Savin
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Michael
authors.initials: M
authors.lastname: Farah
authors.forename: Richard
authors.initials: R
authors.lastname: Silbergleit
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation*; D003287:Contrast Media / Q000008:administration & dosage*; D004868:Equipment Failure; D006801:Humans; D007275:Injections, Intravenous; D012189:Retrospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride