Safety and Efficacy of Contrast Media Administration via Selected Vascular Access Devices in Computed Tomography

Background: The administration of intravenous contrast media using automated power injectors is fundamental for high-quality computed tomography (CT), particularly in CT angiography (CTA). The selection of an appropriate vascular access device (VAD) and adherence to technical safety standards are critical for ensuring diagnostic efficacy and patient safety. This systematic review aims to synthesize current scientific literature regarding the efficacy and safety of contrast media infusion across various vascular access routes, including peripheral intravenous cannulas (PIVC), central venous catheters (CVC), and totally implantable venous access devices (TIVAD). Methods: The review followed PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, CINAHL, Web of Science, and Scopus for studies published between 2000 and 2026. A total of 19 studies-including randomized controlled trials (RCTs), cohort studies, and systematic reviews-were analyzed. Methodological quality was assessed using Joanna Briggs Institute (JBI) appraisal tools. Results: Modern PIVCs utilizing diffuser technology (side holes) significantly reduce distal jet pressure, minimizing vessel wall damage during high-flow injections. For patients with difficult vascular access, "power-injectable" certified devices (e.g., PICCs or TIVADs) serve as a safe alternative. Standard, non-power-injectable central lines must be avoided due to the risk of catheter rupture. The selection of an appropriate vascular access device is particularly challenging in patients of older age or those with chronic conditions, such as peripheral vascular disease, obesity, or chemotherapy-related venous damage, which often lead to difficult intravenous access (DIVA). Conclusions: Utilizing certified power-injectable devices and advanced cannula designs improves the safety of high-pressure contrast administration. Adherence to technical protocols and the identification of high-risk patients are essential for mitigating complications such as contrast extravasation.