CT TECHNOLOGIST:

CTCVD Power Injection Contrast Injection Policy


 

CTCVD Power Injection Contrast Injection Policy

** CVDs with TPN infusions cannot be used for contrast injection unless TPN has been disconnected and vigorously flushed by RN prior to exam, before patient leaves the floor.

NOTE: No IV medication drips should be stopped or restarted without an RN’s help. Injector should not be used with any IV that has questionable patency. IF in doubt, question the radiologist or the patient’s care givers.

ALERT– Prior to injection of acentral venous catheter the tip of the catheter should be verified prior to injections of contrast to check for migration of the catheter. This can be done by checking on a CT scout scan or on a recent Chest x-ray.



CVD’s – Adult use:

 

Catheter

Used for CT Inject.

Lumen SizeInjection RateFlow RatePSI
Power PICCSYes
Rate listed on Hub
Listed on Hub
Power Ports (Bard Power Pic)Yes5 – 6 FrenchCTA may be injected 4cc/sec.
300
Portacaths (Morpheus)Yes4 – 5 FrenchCTA may be injected 4cc/sec.
300
Micropuncture introducers placed by IRYes5 French5 cc
300
IV catheters (Jelco) in a foot veinYesAll
1 cc / sec.100
EJ, IJ (max inj. rate identified @ the hub)Yes18g, 20g IV accessUp to 5 cc/ sec.2 cc / sec.300
EJ, IJ (max inj. rate identified @ the hub)Yes22g IV accessUp to 5 cc/ sec.2 cc / sec.300
Indwelling ChemoYes


100
Triple – Lumen (Arrow)Yes

16g (brown port)

18g (blue port)

1.6 cc / sec
300
Power Mid LinesYes4 French5 cc / sec
300
Power Mid Lines
5 French7 cc / sec
300
QuintonNO10, 11, 13, 14 Fr.


Non – Power HickmanNO10, 11, 13, 14 Fr.


PermacathsNO10, 11, 13, 14 Fr.


Non Marked PICCS

NO10, 11, 13, 14 Fr.





Process –

1.) Following Hand Hygiene Policy at all times: wash or Purell, don gloves, when completed remove gloves, then wash or Purell.

2.) RN must access and de-access all indwelling Ports– CVD lumen access may be performed by the CT technologist to inject contrast.

3.) Prior to use: All CVAD lines used for contrast with injector or hand injection must have a 15 sec. hub scrub with approved disinfectant and allowed to air dry (min. 15 sec.). All CVD’s must be checked for patency and blood return, using a 10 cc saline syringe with 3 cc removed. Aspirate 3 cc to test for blood return and discarded. A CVD should not be used without verification of blood return.

4.) CT Technologist must monitor injection site for the duration of injection.

5.) The contrast for all CVD’s is Omnipaque 350 (except for Pediatrics Omnipaque 300 is used, or Adult patients with an reaction to Omnipaque Isovue 370 may be used)

 

Script –

Adult Power Hickman –IN Patients: Call the floor to check IV status. If the RN states the patient has a Hickman two (2) questions need to be asked:

1.) Is the Hickman a Power Hickman (Needs to be labeled on the clamp with maximum injection rate, if not Is a P or an X seen within the port on the Chest X-Ray)

2.) Has there been TPN running?
    a. If Yes: to flush vigorously now and Disconnect TPN and to clearly mark lumen used for TPN

    b. Send patient with no meds running. (Open flush is allowed)

    c. Instruct RN that the patient will return without the catheter being flushed with heparin.

    d. If the TPN cannot be stopped and flushed before leaving the floor, the Hickman may not be used
        for the contrast injection.

    e. Follow 15 second hub scrub and allow to air dry (min. 15 seconds).

    f. Do not disconnect injector prior to exam completion or the hub scrub will need to be repeated.

    g. Maximum flow rate will be listed on the lumen clamp.

 

Power Hickman: Out- patient: Follow 15 sec. hub scrub and allow to air dry (minimum 15 sec.) Maximum flow rate will be listed on the lumen clamp. Do not disconnect injector prior to exam completion or the hub scrub will need repeating. Call South Pavilion Core IR RN, Prep Hold RN, or RN in your respected area’s to flush heparin post injection per YNHH policy.

 


 

Injection rate for use of PEDI Injector: Including foot veins

Lumen SizeFlow RatePSI
18g, 20g IV access2cc / sec150
22 g IV access2 cc / sec150
24 g IV access1.5 cc / sec50

 

Pedi- All Central Lines including Broviac:  In- Patient patients: Call the RN. Instruct RN to accompany the patient. Pedi RN will need to follow YNHH hub scrub policy. Pedi RN will hub scrub and access the pediatric patient’s Central Line and the technologist will connect the contrast. Omnipaque 300mg. may be injected @ 1 cc / sec. at 100 PSI. With the help of the CT Tech, the Pedi RN will disconnect the injector and follow YNHH heparin flush policy.

 

Pedi Broviac:  Outpatient: Call Out Patient Pedi Nursing (follow same process as above)

 

Intraosseous  (EZ IO) Devices: Can be used with the Power Injection

Local anesthetic is needed in non-sedated patients prior to infusion of any substance through IO access.


Flow RatePSI
5 cc / sec.Max PSI of 300

_______________________________________________________________

Approved by:

Dr. Gary Israel Chief of CT Radiology

Dr. Jay Pahade Director of Radiology Safety and Quality

Patsy Twohill RT (R) (MR) CT Manager

Revised, Twohill August 16, 2016