Carbon dioxide gas as a venous contrast agent to guide upper-arm insertion of central venous catheters

Evaluate in a prospective randomized study carbon dioxide (CO2) gas compared to iodinated contrast agent for image-guided placement of peripherally inserted central venous catheters (PICCs).

The upper-arm approach to the central vein was used for placement of PICCs in 74 patients requiring intermediate or long-term central venous access. Fluoroscopy was used to obtain venous access during peripheral injection of CO2 (n = 41) or low osmolar contrast material (Omnipaque 240 mgI/ml) (n = 33).

Placement of PICCs was accomplished in 88% of the CO2 group and in 100% of the contrast group, with a mean venipuncture of two in both groups. Venous access was unsuccessful in five patients with CO2 due to a small vein, venous spasm, or technical failure. The mean and range of procedure times were 22.8 min (13-64 min) with CO2 and 23.2 min (12-60 min) with contrast material. The average and range of CO2 and nonionic contrast volumes injected during the procedure were 35.4 ml (5-300 ml) and 27.8 ml (8-120 ml), respectively. Vital signs and oxygen saturation did not change significantly during or after injection of CO2. There was no incidence of adverse reaction following CO2 injection.

CO2 gas is a useful contrast agent to guide upper-arm insertion of PICCs and may be a safe alternative in patients with renal insufficiency and/or allergy to iodinated contrast material.