CTs with contrast through central lines

[GardenDove]

The head of our radiology informed me that they cannot do CTs with contrast for PEs or of the Aorta through central lines because they have to push 150cc of contrast in 4 seconds, and it apparently causes the tail of the catheter to have a whipping action that can damage the vessel. She called me the other day after we had had a discussion with her at the nurses station regarding the CTs scheduled on a couple of our pts who had central lines. She finally found out the policy as dictated by our radiologist, she actually wasn't even sure of it herself until the discussion came up.

Anyone know anything about this? Obviously, many people with central lines have them because of lack of access. She said that they would need an intrajugular or a special PICC line that had a name that eludes me. I passed the info on to my manager.

[NewEastCoastRN]

yes, we have the same policy. every patient has to have a peripheral line. unfortunately, this can mean the test is delayed for those with poor access.

[Altra, BSN, RN]

Same policy here ... no CT contrast through central line or through an EJ line.

The special PICC you're referring to ... I've heard it called a Power PICC ... I've not seen one, but it is supposed to be designed to accomodate a power injection.

[GardenDove]

Yes, that's the name for it. But they were able to do the CT of my pt's throat by hand injecting the contrast because you don't need the quick bolus that you need with the PE or Aorta CT.

[all4schwa]

they do it where i work through piccs, everyone gets a power picc. the rn must go and do the injecting though.

[burn out]

nope, no contrast through centrall ines for ct or nuc med. I had to start nine IV's on a patient the other for all the test and the contrast was injected so fast that the lines kept blowing..it was a day from h---.

[k3immigrant]

it's always a pain when CT chest is ordered to a pt who has a central line. i work with PICCs so we informed out fellow nurses to request for a Power PICC everytime as much a s possible.you would know that it is a power PICC becuase it's purple & it has three ports & one of the port will have a label for CT.if a pt has a PICC & a peripheral is unobtainable, we request for PICC exchange.

[rnin02]

I thought that they could use a central line, but to do so they would have to do the contrast slower and change some of the settings on the machine to get accurate results...so they don't like to do it. but it is possible. but i could be wrong and thinking of something else.

[caroladybelle, BSN, RN]

The purple Bard Power PICC accomodates power CT injectors.

[cardiacRN2006, ADN, RN]

Same here. Central line can't be used unless it's a Purple Power PICC.

Otherwise, we have to get a 20g or larger placed higher than the wrist for the CT.

[CritterLover, BSN, RN]

i thought that they could use a central line, but to do so they would have to do the contrast slower and change some of the settings on the machine to get accurate results...so they don't like to do it. but it is possible. but i could be wrong and thinking of something else.

iv contrast for non-vascular studies usually can be done this way.

however, if they are trying to visualize arteries (ct angio of head -- or anything else -- ct chest r/o pe), then the contrast has to go at a certain speed, otherwise the test will be non-diagnostic. usually, we referr to these kinds of cts as needing a "power injector." iv contrast for ct abdomen, ct chest non-vascular, etc can be done with hand-injected contrast, or machine-injected with settings adjusted; and can be given through any picc or central line, as long as your facility allows it.

the problems with using a traditional central line and using piccs for tests requiring a power injector are different.

traditional central lines are fairly stiff, but strong. when the contrast is injected through them, it can cause the tip to whip around, possibly damaging the (major) vessels. traditional piccs are soft, but not very strong. the problem here is the very real possibility that the power injector will cause the picc to fracture. (think about it -- if you can't use anything smaller than a 5 or 10 cc syringe [depending on your facility policy] because it may cause the thing to break, what do you think thick contrast injected under high pressure would do?)

bard solved that problem by creating a power picc: strong enough to withstand the power injector, yet still soft enough to not damage vessels. better yet, they actually studied how the power picc reacted to a pressure injector, and found it safe.

i could be very wrong about this, but my understanding isn't that it is unsafe to use a (non-picc) central line for power-injected constrast, but that nobody has proven that it is safe. i believe that the concern that the tip of a tlc could cause damage to the vessel walls is a concern, a theory, more than fact.

that being said, i know that you will find that some facilities use subclavians/ijs with the power injector -- i've worked in one of them.:uhoh21:

i'm not sure, though, why one poster stated that they can't use piccs/central lines for nuc med studies. that is hand-injected, not power injected, and i've never worked anywhere that had that limitation.

[GardenDove]

Thanks, critter, for the added info. According to our imaging lady who spoke to me, the whip that you get on the central line is dependent on how much of it is in the body. Ours are 20cm, and because of that length, physics causes it to thrash, much like a garden hose, with the force of the power injecter. She said an IJ is allowed because it has a shorter catheter inside the body.