Power injection of contrast media via peripherally inserted central catheters for CT

PURPOSE: To evaluate patient safety, catheter rupture rates, and computed tomography (CT) image quality when using peripherally inserted central catheters (PICCs) in vivo for the power injection of CT contrast media at standard injection rates. MATERIALS AND METHODS: A prospective study to evaluate the safety and effectiveness of power injection of contrast media via indwelling PICCs was performed. Single-lumen and double-lumen polyurethane PICCs (5 F) were injected in vivo with contrast media for clinical CT examinations at injection rates ranging from 1 mL/sec to 4 mL/sec. Data collected included PICC rupture rate, patient complications, injection rate, peak injection pressure, PICC length, PICC age, and quality of contrast enhancement on the CT images. RESULTS: One hundred ten power injections of PICCs for CT examinations were performed. There were 12 injections of single-lumen PICCs and 98 injections of double-lumen PICCs. The most common injection rate was 2 mL/sec, accounting for 89 of the 110 injections (81%). Two PICCs ruptured during power injection, both as a result of operator error. One of the PICCs that ruptured was clamped at the time of injection and the other one was kinked at its venous entry site. One additional PICC showed evidence of dysfunction; it ballooned without actually rupturing. No significant patient complications occurred. Contrast enhancement of the CT images was subjectively rated as average or above average in 95% of cases. CONCLUSIONS: Contrast media can be power-injected via PICCs for routine CT examinations at a rate of 2 mL/sec, yielding satisfactory image quality without exposing patients to significant additional risk. Power injection rates greater than 2 mL/sec, as are typically used in CT angiography applications, were not fully evaluated by this study.