Hemodialysis catheter integrity during mechanical power injection of iodinated contrast medium for computed
Fides R Schwartz1, Douglas S Lewis2, Amy E King3
1Department of Radiology, Duke University, 2301 Erwin Road, Box 3830, Durham, NC, 27710, USA. fides.schwartz@duke.edu.
Insights
Hemodialysis catheters can safely administer contrast media during mechanical power injection. Pressures remained below failure limits, even at higher flow rates than typically used for CT angiography.
Area of Science:
- Radiology
- Nephrology
- Medical Devices
Background:
- CT angiography (CTA) requires vascular access with flow rates of 5-7 mL/s.
- Hemodialysis (HD) procedures utilize flow rates of 6-10 mL/s.
- The structural integrity of HD catheters under contrast media administration via mechanical power injection is not well-established.
Purpose of the Study:
- To evaluate the structural integrity of hemodialysis (HD) catheters during contrast media administration.
- To assess the performance of HD catheters with a mechanical power injector under varying conditions.
Main Methods:
- An in vitro study evaluated four HD catheters.
- Tested variables included contrast media type, temperature, catheter diameter and length, and injection mode (single-lumen vs. simultaneous double-lumen).
- Peak plateau pressures were recorded at flow rates from 5 to 20 mL/s, with 864 unique injections performed.
Main Results:
- No instances of catheter failure (bulging or rupture) were observed across all 864 injections.
- Peak pressures were significantly lower for simultaneous double-lumen injections compared to single-lumen injections (p < 0.001).
- Higher viscosity contrast media resulted in significantly lower peak pressures (p < 0.001).
Conclusions:
- HD catheters demonstrate structural integrity for safe administration of iodinated contrast media via mechanical power injection under in vitro conditions.
- Maximum peak pressures remained below the manufacturer's 30 psi limit for double-lumen injections up to 20 mL/s and single-lumen injections up to 10 mL/s.
- These findings suggest HD catheters can be safely utilized for contrast media delivery at flow rates exceeding typical CT angiography requirements.
Purpose:
CT angiography (CTA) requires vascular access with flow rates of 5-7 mL/s. Hemodialysis (HD) is performed at 6-10 mL/s. The purpose of our study is to evaluate the structural integrity of HD catheters in the administration of contrast media via a mechanical power injector under varying conditions.
Methods:
Four HD catheters were evaluated in an in vitro study. Tested were contrast media type (iopamidol 300 and 370 mgI/mL), temperature (25 and 37 °C), catheter diameter (14 Fr to 16 Fr all with double-lumen capacity), catheter length (19-32 cm), and simultaneous double-lumen or single-lumen injection within each of the catheters. Peak plateau pressures (psi) were recorded with flow rates from 5 to 20 mL/s in 5 mL/s increments. In total, 864 unique injections were performed.
Results:
No catheter failure (bulging/rupture) was observed in 864 injections. Maximum pressure for single-lumen injection was 51.7 psi (double-lumen: 26.3 psi). Peak pressures were significantly lower in simultaneous double-lumen vs. single-lumen injections (p < 0.001) and low vs. high viscosity contrast media (p < 0.001). Neither larger vs. smaller diameter lumens (p = 0.221) nor single-lumen injection in arterial vs. venous (p = 0.834) were significantly different.
Conclusion:
HD catheters can be used to safely administer iodinated contrast media via mechanical power injection in in vitro operating conditions. Maximum peak pressure is below the manufacturer's 30 psi limit at flow rates up to 20 mL/s in double-lumen injections and up to 10 mL/s in single-lumen injections, which is higher than the usual maximum of 8 mL/s for CT angiography in clinical settings.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...