![]() ![]() The British Committee for Standards in Haematology Guidelines for the management of CVCs in adults does cover this issue. There are no published UK recommendations for the use of CVCs for this indication. A survey of 12 randomly selected radiology departments in North West England has shown that there is a considerable variability in practice ( Table 1). It is unclear how widespread the practice of CM injection via CVCs is. Most power injectors allow specification of a maximum injection pressure as well as a flow rate, theoretically reducing the risk of catheter damage. However, until these newer, highly resilient catheters become routinely inserted, non-power injector-rated CVCs are likely to be encountered in the majority of cases, and the temptation to use them for CM injection will remain. Many manufacturers now recognise that CT power injection is an increasingly common requirement for CVCs and power injector-capable catheters and ports from the major manufacturers are appearing on the market. Implanted ports are also used in this situation and are frequently seen in paediatric practice for intermittent use, such as antibiotic administration in cystic fibrosis. Units with a large haematology or oncology practice are likely to encounter large numbers of patients with tunnelled lines, primarily for chemotherapy. The most common use, in a general acute hospital setting, is intensive care unit patients with a non-tunnelled CVC for the delivery of drugs and fluids, central venous pressure monitoring and venous sampling. A vast range of different catheters are available in single- and multi-lumen combinations, each with their own flow and resistance characteristics. The aim is to help quantify the risks so that a reasoned decision about whether to proceed with the lines can be made by the radiologist in conjunction with the clinicians caring for the patient.Ĭentral catheters can be divided into non-tunnelled, tunnelled, dialysis/apheresis lines (which themselves may be tunnelled or non-tunnelled), implanted ports and peripherally inserted central catheters (PICC). This review summarises the current literature regarding the safety and potential complications of using the central venous route for CM injections. They are also more likely to be familiar with the power-injector delivery devices in use in their department. ![]() The radiologist is best placed to weigh up the relative risks and benefits of using a CVC for power injection of CM, as they will have a clearer knowledge of the relative importance of contrast enhancement for accurate interpretation. The use of existing central venous catheters (CVC) for CM injection is therefore a tempting alternative to potentially fruitless, or even damaging, attempts at peripheral access (such as with extensive burns, lymphoedema or to preserve potential sites for future arteriovenous fistula formation). Many emergency and critical care patients require CT examinations which would best be conducted after iv contrast. However, in certain patient groups, peripheral iv access is difficult and central access may be the only available route for contrast enhancement. Generally, peripheral iv access can be secured easily and safely for injection of CM via high-powered automated injectors. CT angiography) or to improve soft-tissue contrast. ![]() CT examinations are commonly performed with the intravenous (iv) use of iodinated contrast media (CM), either as a fundamental part of the examination ( e.g. ![]()
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