Impact of intravenous access site on attenuation for thoracic computed tomographic angiography: A time-matched,nested,case-control study

Abstract

Background:

The objective of this study was to evaluate whether the choice of intravenous access (IVA) site affects aortic attenuation during thoracic computed tomographic angiography (T-CTA) and any associated risks with intravenous device placement.

Methods:

All T-CTA exams performed between 1/1/2013 and 8/14/2015 were retrospectively reviewed to identify those performed with contrast media injection via alternative (i.e. non-antecubital) IVA (n = 1769). Using time matching, antecubital IVA exams (n = 1769) were selected as controls. For each exam, attenuation was measured in the ascending aorta. Patient and technical data was subsequently collected from all 3538 patients included in this study. Multiple linear regression was used to determine if IVA site affected attenuation. Lastly, data related to extravasations for the entire T-CTA cohort were collected and compared.

Results:

Hand/wrist, arm, and central venous access device IVA were all equivalent to antecubital IVA in terms of attenuation (P = 0.579, P = 0.599, and P = 0.522 respectively). Forearm and intraosseous IVA had significantly higher attenuation (P = 0.010 and P = 0.002, respectively) than antecubital IVA. Right-sided IVA was associated with a small attenuation increase of 11 Hounsfield Units (P < 0.001) compared to left-sided IVA. In terms of extravasation, antecubital IVA was equivalent to hand/wrist, forearm, and upper arm IVA (P = 0.778, P = 0.060, and P = 0.090 respectively).

Conclusions:

Satisfactory aortic attenuation achieved with non-antecubital IVA is equivalent to attenuation achieved with antecubital IVA for T-CTA imaging. The risk of contrast media extravasation in peripheral IVA devices was relatively low, however, appropriate IVA site selection should be considered an important factor for successful administration of contrast media for future imaging studies. This prevents undue harm to patients through preventable device failures when using a peripheral IV device in areas of high flexion/range of movements undergoing pressure injection for contrast media.

Keywords

Intravenous access contrast attenuation computed tomography extravasation patient safety

Get full access to this article

View all access options for this article.

References

Bae

. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 2010; 256(1): 32–61.

Saade

Deeb

Mohamad

, et al. Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know. Diagn Interv Radiol 2016; 22(2): 116–124.

Kodzwa

. ACR manual on contrast media: 2018 updates. Radiol Technol 2019; 91(1): 97–100.

Schooler

Zurakowski

Lee

. Evaluation of contrast injection site effectiveness: thoracic CT angiography in children with hand injection of IV contrast material. Am J Roentgenol 2015; 204(2): 423–427.

Buijs

Barentsz

Smits

MLJ

, et al. Systematic review of the safety and efficacy of contrast injection via venous catheters for contrast-enhanced computed tomography. Eur J Radiol Open 2017; 4: 118–122.

Winkler

Talley

Woodward

, et al. The use of intraosseous needles for injection of contrast media for computed tomographic angiography of the thoracic aorta. J Cardiovasc Comput Tomogr 2017; 11(3): 203–207.

Schindler

Helfen

Wildgruber

, et al. Intraosseous contrast administration for emergency computed tomography: a case-control study. PLoS One 2019; 14(5): e0217629.

Marshall

Chen

Nguyen

, et al. Rethinking intravenous catheter size and location for computed tomography pulmonary angiography. West J Emerg Med 2019; 20(2): 244–249.

Grimm

Cornfeld

Mojibian

. The effect of left-sided versus right-sided contrast infusion on attenuation of the main pulmonary artery when performing computed tomography angiograms of the chest. J Comput Assist Tomogr 2010; 34(1): 52–57.

10.

Stowell

Rigdon

Colglazier

, et al. Risk of contrast extravasation with vascular access in computed tomography. Emerg Radiol 2020; 27: 253–258.

11.

McCollough

Ulzheimer

Halliburton

, et al. Coronary artery calcium: a multi-institutional, multimanufacturer international standard for quantification at cardiac CT. Radiology 2007; 243(2): 527–538.

12.

Qian

Joshi

Shaukat

, et al. Relationship between chest lateral width, tube current, image noise, and radiation exposure associated with coronary artery calcium scanning on 320-detector row CT. J Cardiovasc Comput Tomogr 2011; 5(4): 231–239.

13.

Harris

Taylor

Thielke

, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2): 377–381.

14.

Demirpolat

Yüksel

Kavukçu

, et al. Carotid CT angiography: comparison of image quality for left versus right arm injections. Diagn Interv Radiol 2011; 17: 195–198.

15.

Tseng

Hsu

Lee

, et al. Venous reflux on carotid computed tomography angiography: relationship with left-arm injection. J Comput Assist Tomogr 2007; 31(3): 360–364.

16.

Wienbeck

Fischbach

Kloska

, et al. Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. Am J Roentgenol 2010; 195(4): 825–829.