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Impact of intravenous access site on attenuation for thoracic computed tomographic angiography: A time-matched,
Michael A Winkler1, Connor Woodward2, Timothy R Spencer3
1Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Insights
The choice of intravenous access (IVA) site does not significantly impact aortic attenuation in thoracic computed tomographic angiography (T-CTA). Alternative IVA sites offer comparable results to antecubital access with a low risk of extravasation.
Area of Science:
- Radiology
- Medical Imaging
- Vascular Access
Background:
- Thoracic computed tomographic angiography (T-CTA) relies on optimal contrast media delivery.
- The selection of intravenous access (IVA) site may influence image quality and patient safety.
- Understanding the impact of different IVA sites on aortic attenuation is crucial for T-CTA protocols.
Purpose of the Study:
- To evaluate if the intravenous access (IVA) site affects aortic attenuation during T-CTA.
- To assess the risks associated with different IVA device placements during T-CTA.
- To compare contrast media attenuation and extravasation rates across various IVA sites.
Main Methods:
- Retrospective review of 3538 T-CTA exams performed between 1/1/2013 and 8/14/2015.
- Comparison of aortic attenuation in patients with alternative (non-antecubital) IVA versus antecubital IVA using time-matched controls.
- Statistical analysis using multiple linear regression to determine the effect of IVA site on attenuation and comparison of extravasation data.
Main Results:
- Hand/wrist, arm, and central venous access device IVA showed equivalent aortic attenuation compared to antecubital IVA.
- Forearm and intraosseous IVA sites resulted in significantly higher aortic attenuation.
- Right-sided IVA was associated with a slight increase in attenuation compared to left-sided IVA, with low rates of contrast extravasation across peripheral sites.
Conclusions:
- Non-antecubital IVA sites provide satisfactory aortic attenuation for T-CTA, comparable to antecubital access.
- The risk of contrast media extravasation with peripheral IVA devices is low.
- Appropriate IVA site selection is important for successful contrast administration and preventing patient harm, especially in high-flexion areas.
Background:
The objective of this study was to evaluate whether the choice of intravenous access (IVA) site affects aortic attenuation during thoracic computed tomographic angiography (T-CTA) and any associated risks with intravenous device placement.
Methods:
All T-CTA exams performed between 1/1/2013 and 8/14/2015 were retrospectively reviewed to identify those performed with contrast media injection via alternative (i.e. non-antecubital) IVA (n = 1769). Using time matching, antecubital IVA exams (n = 1769) were selected as controls. For each exam, attenuation was measured in the ascending aorta. Patient and technical data was subsequently collected from all 3538 patients included in this study. Multiple linear regression was used to determine if IVA site affected attenuation. Lastly, data related to extravasations for the entire T-CTA cohort were collected and compared.
Results:
Hand/wrist, arm, and central venous access device IVA were all equivalent to antecubital IVA in terms of attenuation (P = 0.579, P = 0.599, and P = 0.522 respectively). Forearm and intraosseous IVA had significantly higher attenuation (P = 0.010 and P = 0.002, respectively) than antecubital IVA. Right-sided IVA was associated with a small attenuation increase of 11 Hounsfield Units (P < 0.001) compared to left-sided IVA. In terms of extravasation, antecubital IVA was equivalent to hand/wrist, forearm, and upper arm IVA (P = 0.778, P = 0.060, and P = 0.090 respectively).
Conclusions:
Satisfactory aortic attenuation achieved with non-antecubital IVA is equivalent to attenuation achieved with antecubital IVA for T-CTA imaging. The risk of contrast media extravasation in peripheral IVA devices was relatively low, however, appropriate IVA site selection should be considered an important factor for successful administration of contrast media for future imaging studies. This prevents undue harm to patients through preventable device failures when using a peripheral IV device in areas of high flexion/range of movements undergoing pressure injection for contrast media.
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