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KMID : 1131320160180010031
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Journal of Korean Society of Computed Tomographic Technology
2016 Volume.18 No. 1 p.31 ~ p.39
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The study of using contrast media through central venous catheters in CT contrast examination(in the case of the patients who could not gain access to peripheral vein)
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Park Yoon-A
Lee Seong-Ju
Hong Mi-Hye
Km Yeon-Hee
Yoo Sang-Jae
Kim Dong-Seong
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Abstract
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Purpose : As the CT scan technology develops, the number of CT contrast test is also on the rise. However, the reality is that there are not sufficient guidelines about injection of contrast media in case of a patient with central venous line for whom the medical staff fail to obtain peripheral IV and the patient should do the CT contrast test. Consequently, the purpose of this article is to present guidelines for a safer and more accurate CT contrast test using central venous line.
Materials and Method : For one year, we observed the state, side effects and prognosis of patients who took the CT contrast test using central venous line. For the catheter test, we used a total of eight products including Permcatheter of Tal PALINDROME™, IJC of Sungwon Medical, Chemoport of Bard, C-line(7Fr, 5Fr) of ARROW Medical, Hickmann of Bard Medical, PICC(single, dual) of COOK Medical, and according to The Guidelines for the Use of Contrast Media Using Central Venous Line recommended by the Seoul National University Hospital(SNUH), we injected contrast media with 350mg iodine content and 400mg iodine content using two kinds of power injectors of MEDRAD(STELLANT？？) and NEMOTO injector(Nemoto Kyorindo co.,LTD) with the other conditions being equal. Then, we compared the resultant PSI values and tested if the maximum PSI values(in case of MEDRAD, the vale is 325PSI and NEMOTO, 300PSI) recommended by the injector makers were exceeded. Before the experiment, we measured and compared the pressure of the power injectors, injecting the same amount of air with the same speed. In doing this, we used the pressure gauge we made, and the syringes supplied by the injector makers. And the pressure line connected to the syringe was Check Valve Set(total length: 2m 10cm) manufactured by INSUNG MEDICAL CO.,LTD.
Result : All the patients could complete the experiment without any significant side effects, and the prognosis was normal. Though the resultant values minimally varied due to the different methods of measuring psi values of the different injector makers, 87.5% of the catheters did not exceed the recommended psi values for both kinds of contrast media containing 350mg and 400mg iodine.
Conclusion : Many hospitals do not have standards set for contrast media, such as flow rate and total volume when a patient should do the CT contrast test using the central venous line because of the difficulty of securing peripheral IV. Thus, hospitals should provide the guidelines like those of the SNUH in order for a safe and accurate test. The results of the experiment conducted according to the guidebook presented in this article showed an average 87.5% of the catheters were judged safe. There were no side effects and the prognosis of the patients was normal. It is desirable that hospitals have in place accurate guidelines considering many factors including the quality control of power injectors and side effects of patients.
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KEYWORD
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Central Venous line, PSI, Permcatheter, C-line, Chemoport, PICC, Hickmann, IJC
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