title: Power Injection Through Ultrasound-Guided Intravenous Lines: Safety and Efficacy Under an Institutional Protocol.
abstract: BACKGROUND
  After an index case of contrast-associated compartment syndrome, an urban hospital instituted a protocol limiting high-speed injection to intravenous (IV) lines started proximal to the forearm and testing those lines before contrast injection.
  
  
  OBJECTIVE
  In this article, we estimate the safety and efficacy of high-speed injection using this protocol in patients with IV lines inserted under ultrasound guidance.
  
  
  METHODS
  In an ambispective study, we enrolled prospective cohorts of ED patients requiring high-speed radiographic contrast media injection (≥3.5 mL/sec) into two groups: those with IV lines placed under ultrasound guidance and those with IV lines placed using traditional inspection and palpation. We also performed a retrospective review involving those groups. In addition, we reviewed hospital records for all patients with compartment syndrome between January 2010 and December 2011. We calculated 95% confidence intervals using normal approximation or exact calculation.
  
  
  RESULTS
  Between November 2013 and August 2014, the ED referred 32 patients to the Department of Radiology for computed tomography angiography involving high-speed contrast injection through ultrasound-guided IV lines. Of these, 25 of 32 (78%) had successful injection (7 failed in the Department of Radiology) vs. 26 of 27 (96%) with catheters inserted using traditional methods (risk difference 0.18 [95% confidence interval -0.01 to 0.38]). Based on retrospective records, we estimated 79 additional cases. We found no cases of compartment syndrome during either period, for an incidence estimate of 0 per 100 cases (95% confidence interval 0-3).
  
  
  CONCLUSIONS
  A hospital policy for high-speed contrast injection through ultrasound-guided IV lines has a safe record. However, 22% of patients with ultrasound-guided IV lines were refused for CT.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Witting
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Siamak
authors.initials: S
authors.lastname: Moayedi
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Kathy
authors.initials: K
authors.lastname: Dunning
authors.affiliation: MidMichigan Medical Center, Midland, Michigan.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Babin
authors.affiliation: Department of Radiology, Mercy Medical Center, Baltimore, Maryland.
authors.forename: Brad M
authors.initials: BM
authors.lastname: Cogan
mesh_terms: D057785:Catheters / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D003161:Compartment Syndromes / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications / Q000209:etiology; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous / Q000379:methods* / Q000706:statistics & numerical data; D016134:Organizational Policy; D061214:Patient Safety / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D003287:Contrast Media
keywords: angiography; catheterization; compartment syndromes; contrast media; emergency service; hospital