Imaging of the Vena Cava in the Intensive Care Unit Prior to Vena Cava Filter Insertion: Carbon Dioxide as an Alternative to Iodinated Contrast

Abstract

This study evaluates the safety and effectiveness of carbon dioxide (CO₂) as a contrast agent in patients in the intensive care unit undergoing vena cava filter (VCF) insertion. We prospectively evaluated patients in the intensive care unit undergoing bedside VCF insertion using CO₂ cavagraphy. Blood pressure, pulse rate, mixed venous oxygen saturation, and intracranial pressure were monitored before, during, and after the CO₂ injection. Fifty patients in the intensive care unit (mean age 48.2 ± 16.5 years) were included in the study. Five patients had decreases in blood pressure, which resolved without intervention. Two patients required iodinated contrast as a result of inadequate CO₂ imaging. All patients had successful insertion of VCF. The use of CO₂ as a contrast agent is a safe and highly effective alternative for vena cava imaging and can be considered the first-line contrast agent for all critically ill patients requiring VCF placement.