Darshit Thakrar MD, Presenter: Nothing to Disclose

Cynthia Karfias Rigsby MD, Abstract Co-Author: Nothing to Disclose

Samantha E. Schoeneman BA, Abstract Co-Author: Nothing to Disclose

Barbara Karl, Abstract Co-Author: Nothing to Disclose

Mariam Mathew Kappil MD, Abstract Co-Author: Nothing to Disclose

Our prior research has shown that a pressure limit of 25 psi produces adequate CT studies only in patients under 30 kg. With newer power injectors that grant the ability to set and monitor power injection pressure, we seek to determine the diagnostic safety and efficacy of power injecting all central lines in children.

Initially, in-vitro injections of our institution’s most commonly used central lines were done with pressures from 50 to 250 psi and a standard maximum flow rate of 2 ml/s. All central lines remained intact up to 250 psi except for one that burst at 100 psi, which we then excluded from our protocol. We then set our standard clinical power injection protocol pressure to 100 psi.  Two pediatric radiologists retrospectively assessed CT contrast enhancement on a scale of 1 (poor) to 5 (excellent) of CT chest, abdomen, and pelvis studies of patients over a 3 month period whose central lines were power injected at 100 psi. Patient demographics, types of central lines, original CT reports, and catheter adverse events were reviewed.  

25 chest, 21 abdomen, and 23 pelvis CT studies were performed on 26 patients (mean age 12.6 years; mean weight 48 kg). 17 had ports injected with an average pressure limited flow rate of 1.64 ml/s, and 9 had central lines power injected with an average pressure limited flow rate of 1.96 ml/s. Mean enhancement scores were 4.9, 4.5, and 4.8 for chest, abdomen and pelvis studies, respectively. The lowest scored studies (2= suboptimal) was a CT abdomen in a 91 kg patient with a port and pressure limited flow rate of 1.1 ml/s. No comment was made in the official report about contrast opacification. No central line adverse events were observed.

Most central lines can safely be used for power injection at 100 psi resulting in diagnostic CT studies.

Power injection of central lines avoids the discomfort, time and cost of placing an IV for a CT study and yields diagnostic quality contrast enhancement.

Thakrar, D, Rigsby, C, Schoeneman, S, Karl, B, Kappil, M, Optimizing Power Injection of Central Lines in Children.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026404.html