iv expertise!

[Adina]

what is iv expertise for contrast administration?I am not familiar with this.Thank you,Aly

[limcclea]

I usually use a 18, 20 catheter in or around the ac site. if a new admit needs a site i will give them this site so that they do not have to be stuck again, our ct dept will not even look at a 22g with any contrast.

[iluvivt, BSN, RN]

Are talking about giving a power injection of contrast median to obtain a CT scan or other radiology test. If so there are a FEW THINGS YOU NEED TO KNOW. A power injection is a very fast injection anywhere from 1-8 cc per second...the ones I have seen usually go to a max of 5 ml/per sec..the device that injects it is called a power injector. As you can see you must have a good PIV for this or a power injectable catheter to achieve this.This rapid injection is needed in order to get good pictures especially of the deeper tissues and organs. The second thing you need to know is that all contrast whether it be ionic or non-ionic is a vesicant and if inadvertently given into tissue can cause tissue damage and necrosis...ionic is the worst and a lower volume is needed to cause damage. OK here is what the American College of Radiology says in their guidelines....Use a large vein in the Forearm preferably a 20 or 18 gauge.....yes you can use the ACF but this contradicts what INS says in that it is an area of flexion and the ACF should be avoided for routine IV therapy...so in response to this they say if you have to place it there for contrast...use it for that and then DC it........so what I do since I can never trust that it will be D/ced after use(Unless it is an outpatient) is I place just below the ACF or in the mid forearm. The average 22 gauge can only withstand a max of 1.5 ml per second and on the average CT scan the techs tell me they usaully inject at 2-4 ml per sec. Our power PICCS go to max of 5 ml per sec. The Triple lumen percutaneously CVC that I just looked at went up to 7 ml per second . NEVER send a pt bad IV or old IV site that will be used for CT scan injection...there have been many lawsuits b/c of extravasations as many nurses do not realize how damaging contrast can be. if you have any CVC that is power injectable...always use that over a PIV..even if you have to switch things around and communicate with the CT tech...I talk to them all the time and tell them the plan for a pt.

[alicecen]

Agree with iluvivt. I just had this discussion in an IV insertion class with some of the Radiology Techs attending that typically insert the IV site in the ACF. The complications potential with use of the ACF is often an eye opener for many of the newer staff to learn that there are large veins in the mid to upper forearm that are more suitable.