References
Misplacement of piccs following power-injected CT contrast media
Abstract
Peripherally inserted central catheters (PICCs) may be used to administer contrast injection during CT (computed tomography) scans to improve diagnostic accuracy. This is usually done with the use of a power injector. Research has shown that misplacement of catheters following contrast injection can occur. The aim of this review was to analyse appropriately positioned pre-scan PICCs that malposition following injection of contrast media during a CT scan, evaluate whether tip location or right or left insertion plays a part in the displacement of PICCs after CT, and to ensure those involved are aware of the risks and the safety checks required following such procedures. A quantitative method was used, gathering information from the team's insertion database to review 2045 records of contrast-injectable PICCs between 1 January 2015 and 30 April 2020. Analysis of the data indicated that 1% of appropriately sited PICCs malposition following contrast CT injection and that the catheter is able to self-correct back to its original position at an average interval of 24–72 hours without any other intervention. Further research is needed to explore other factors that could influence the rate of self-correction and complications of prolonged catheter malposition.
A peripherally inserted central catheter (PICC) is a central venous access device (CVAD) which by definition has the distal tip of the catheter located within the central veins. The Infusion Nurses Society suggests that, ideally, a central venous catheter should have its tip situated in the lower third of the superior vena cava at or near the cavoatrial junction (Gorski et al, 2016).
Computed tomography (CT) power-injectable PICCs are now commonly used for CT power-contrast injection, especially for patients with difficult venous access; using these lines for power injection is feasible and safe, as long as precautions are taken (Plumb and Murphy, 2011). However, studies have shown that there is a risk of PICC malposition following CT contrast injection (Lozano, 2012; Lim, 2013; Morden, 2014). The mechanism behind this is thought to obey Newton's third law of motion, that every action has an equal and opposite reaction. It is proposed that increased torque from contrast extrusion results in propulsion of the catheter tip along the vessel wall. Once the stored kinetic energy in a bent catheter is released, the tip travels in the direction of least resistance, which may be upstream and into another vein (Lim, 2013). The occurrence of catheter misplacement after contrast injection has been previously estimated to be between 8% and 15% (Lee and Ricketts, 2017).
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