Power injection and long PIV

[Madam PICC]

We have been utilizing the longer PIV when we use ultrasound for our difficult acces patients for CT and MRI for about a year at least. One of the CT technologist has said that we should not be using the longer PIV because thay are not power injection rated, that only the short PIV catheters should be used. So I raise the question do PIV really have a power injection rating or test such as TLC now do or PICC have?

[nathanfl]

yes, PIVs are rated for power injection. I worked in radiology for a year and my hospital's policy was:

for adults:

24g - non-power injectable

22g - up to 2ml/sec

20g - up to 4ml/sec for new AC PIVs, otherwise up to 3ml/sec

18g - up to 6ml/sec and up to 8ml/sec for new PIVs in the AC at the nurses discretion

16g+ - up to 8ml/sec

Smaller kids were never power injected but rather hand bolused.

Additionally, my radiology department was performing research on extravasation events and the preliminary results showed that ultrasound placed long catheters had a significantly increased rate of extravasation, with higher amount of contrast material extravasating than traditional PIVS.

[iluvivt, BSN, RN]

Not all PIVS are!!! Saf-t-intimas by BD should never be used for any power injection ..the tubing in the design of this type of catheter can not withstand any power injection per the manufacturer and can rupture. If you are using B Brauns longer introcan either the 20 1 3/4th inch or the 18 gauge 2 1/2 inch..yes those can be used. You must also make sure any add on extension tubing can also be used. Unfortunately the packaging does not always say either...I had to call the rep and find out what tubing had been tested and which were safe to use. The Insyte autoguard can also be used. Again US guided PIVs do have a higher rate of infiltration/extravastion in the case of contrast and can be also more difficult to detect..almost half infiltrate/extravasate with 24 hrs per a recent study and I have found that to be true. It is important to make sure you have at least a third and I say at least a half of the catheter length you use in the selected vein. I rarely use US for PIVS b/c I do not need it that often...I would rather look and hot pack and use other techniques so I can get a longer dwell time.