I.v. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications.
OBJECTIVE
The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for i.v. contrast infusion during MDCT.


METHODS
Two hundred five adult outpatients imaged on a dual-source 128-MDCT scanner with arterial phase body CT (flow rates, 5.0-7.5 mL/s) were randomized to either an 18-gauge nonfenestrated or 20-gauge fenestrated catheter. After randomization, any 18-gauge nonfenestrated subjects whose veins were deemed insufficient for that catheter gauge were assigned to a third cohort for placement of a 20-gauge fenestrated catheter. Catheter placement success, infusion rate, contrast volume, maximum pressure, complications, and aortic enhancement levels were recorded.


RESULTS
Catheters were placed on the first attempt in 97% (100/103) for 18-gauge nonfenestrated and 94% (96/102) for 20-gauge fenestrated placements and in two or fewer attempts in 99% of both groups. Mean infusion rates (5.74 mL/s for 18-gauge nonfenestrated and 5.58 mL/s for 20-gauge fenestrated placements) and aortic enhancement levels were not significantly different. Maximum pressure was higher with 20-gauge fenestrated catheters (mean ± SD, 230.5 ± 27.6 pounds per square inch [psi]) than 18-gauge nonfenestrated catheters (mean ± SD 215.6 ± 32.8 psi) (p = 0.002). One subject with an 18-gauge nonfenestrated catheter had a high-pressure alarm. In the third cohort, a 20-gauge fenestrated catheter was successfully placed in two or fewer attempts in 85% (28/33), with one minor extravasation attributed to vein insufficiency.


CONCLUSIONS
A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to i.v. contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.
1 All authors: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline St, Rm 3140D, Baltimore, MD 21287.
Pamela T
PT
Johnson
Gale M
GM
Christensen
Elliot K
EK
Fishman
D001027:Aortography / Q000009:adverse effects / Q000379:methods; D062905:Central Venous Catheters / Q000145:classification*; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000009:adverse effects / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media