Safe use of power injectors with central and peripheral venous access devices for pediatric CT

We report our experience in the safe use of power injectors with central and small-gauge peripheral venous access devices for intravenous administration of contrast agent to children undergoing computed tomography (CT) examinations.

We reviewed the medical records of 500 patients randomly selected from the 3121 children who underwent intravenous contrast-enhanced CT examinations at our institution from November 1993 through July 1995.

The group of 500 patients, all younger than 18 years of age, accounts for 16 % of the contrast-enhanced CT examinations performed during the study period. Medrad MCT 311 Mark V or Medrad MCT Plus 311 power injectors were used to intravenously administer Omnipaque 300 (2 ml/kg, maximum dose = 150 ml) through venous access devices. These devices comprised Hickman or Broviac lines (n = 228), subcutaneous Port-A-Caths (n = 55), small-gauge butterfly needles (n = 215), and percutaneous intravenous central lines (n = 2). Two complications, one involving a Hickman line and the other a subcutaneous Port-A-Cath, occurred in the study population. These complications correspond to a frequency of 0.4 %. Six cases of contrast extravasation, all of them with the use of 23- (n = 1) and 25-gauge (n = 5) butterfly catheters (frequency = 0.2 %), occurred among the remaining 2621 cases.

In light of the low frequency of complications, power injectors and central venous access devices or small-gauge butterfly catheters are safe systems for delivery of intravenous contrast material to pediatric patients. We feel that our strict adherence to manufacturers' guidelines and previously reported techniques partially accounts for our success with these modes of delivery.