Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational...

Area of Science:

• Medical Imaging
• Radiology
• Interventional Procedures

Background:

• Central venous access devices (CVADs) are crucial for intravenous therapy.
• Fluoroscopic guidance during CVAD insertion exposes patients and staff to radiation.
• Optimizing radiation safety during these procedures is essential.

Purpose of the Study:

• To assess patient radiation dose from CVAD insertions via retrospective audit.
• To directly measure staff radiation exposure in simulated procedures.
• To evaluate the impact of different fluoroscopic pulse rates (7.5 pps vs. 4 pps) on radiation exposure.

Main Methods:

• Retrospective audit of Permcath and Hickman line insertions.
• Grouping patients by fluoroscopic pulse rate: 4 pps (n=24) and 7.5 pps (n=33).
• Simulated radiation exposure measurements for radiologist, nurse, and radiographer using a STEP OD-2 monitor and PMMA.

Main Results:

• Median dose area product (DAP) for CVAD insertion was 0.7 Gy·cm² at 7.5 pps and 0.3 Gy·cm² at 4 pps.
• Patient effective dose ranged from 0.1 mSv (4 pps) to 0.22 mSv (7.5 pps).
• Staff whole-body and lens exposure were significantly lower at 4 pps compared to 7.5 pps.

Conclusions:

• Lowering fluoroscopic pulse rates during CVAD insertions significantly reduces radiation dose for patients and staff.
• A statistically significant dose reduction was observed with the lower pulse rate (4 pps).
• Utilizing lower pulse rates during CVAD insertions should be considered to enhance radiation safety.