Korean J Radiol.  2018 Jun;19(3):489-497. 10.3348/kjr.2018.19.3.489.

Two Small Intravenous Catheters for High-Rate Contrast Medium Injection for Computed Tomography in Patients Lacking Superficial Veins to Accommodate a Large Catheter

Affiliations
  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea. parksh.radiology@gmail.com

Abstract


OBJECTIVE
To prospectively investigate the feasibility of using 2 small intravenous catheters for high-rate computed tomography (CT) contrast injection in patients lacking superficial veins capable of accommodating ≤ 20-gauge catheters.
MATERIALS AND METHODS
Sixty-eight consecutive eligible adults referred for dynamic liver CT were enrolled; 58 had previously undergone liver CT, including 8 that experienced extravasation. Two 22- or 24-gauge catheters were placed in all patients after 2-5 venipunctures, and 2 mL/kg of contrast agent (370 mg I/mL) was split-administered through both catheters to achieve total flow rate of 4 mL/s. Patients' experience and examination success rate, defined as uneventful scans completed at 4 mL/s or at < 4 mL/s achieving standard image quality in all phases, were analyzed. Quantitative hepatic signal-to-noise and hepatic vascular contrast-to-noise ratios (CNRs) were compared with 30 control examinations scanned at 4 mL/s using an 18-gauge catheter.
RESULTS
One case each of extravasation and severe injection pain caused the examination to be aborted. Success rate was 88.2% (60/68; 54 patients scanned at 4 mL/s, 6 at 3.5-3.9 mL/s). Fifty-five of 58 patients (94.8%) that had past CT regarded the venipuncture as more tolerable than (n = 36) or similar to (n = 19) past experiences; 45 of 58 patients (77.6%) found contrast injection less painful than (n = 35) or similar to (n = 10) past experiences. When compared with control examinations, signal-to-noise ratio was similar in all phases (p ≥ 0.502), but the hepatic arterial CNR in arterial phase was slightly inferior (p ≤ 0.047).
CONCLUSION
Using 2 small intravenous catheters can effectively achieve high-rate CT contrast injection in patients lacking adequate superficial veins.

Keyword

Multidetector computed tomography; Contrast media; Adverse effects; Safety; Quality assurance, Health care; Patient satisfaction
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