CT Chest/Abdomen with central line?

Discussion in 'Emergency Medicine' started by migm, Feb 2, 2019.

  1. migm

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    Critically ill patient
    I got an us guided IV in the L axillary (yes, axillary) vein which infiltrated. No other access possible. I was told I cannot get a CTPE with the central line we have (arrow TLC) or mac as they aren't rated for power injection. Is there some alternative? Im sure others have run into this before and curious your experience
     
  2. Xerxes1729

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    Immediate alternatives? VQ scan or empiric treatment and admission after non-contrast scans, depending on your level of suspicion.

    Long-term alternative? Talk to your hospital about stocking pressure-injectable CVCs.
     
  3. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Have your director get central lines that are power rated. They make them.
     
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  4. TimesNewRoman

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    This. Not all CVLs (even from the same company that are essentially identical) are power injectable. You can likely just order new ones that are.
     
  5. Tenk

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    Stick a long 18 or 20 in their IJ using ultrasound and sterile technique. If you don’t have them, there is one in the central line kit.
     
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  6. Fox800

    Fox800 That drug that starts with "d"...
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    Curious. Our rads will not inject contrast into EJs. I wonder how they'd react to this.
     
  7. Tenk

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    It produces the most beautiful CTAs I’ve ever seen.
     
  8. Fox800

    Fox800 That drug that starts with "d"...
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    I do love the Easy IJ for rapid access and getting labs. It still confuses folks that aren't familiar with it, unfortunately.
     
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  9. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu...
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    Either the IJ people are recommending or heparin and admit.
     
  10. GonnaBeADoc2222

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    Yeah they'd probably freak out about this where I work. Once again, we've let people who don't understand science/medicine to dictate what we do.

    Sent from my SM-G928V using SDN mobile app
     
  11. Groove

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    Easy IJ for the win. 1.8 inch 20g angio.
     
  12. Vandalia

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    Hmm. So I guess the guy who said his 18 year old granddaughter had almost completed her radiology training program was right. I always assumed radiologists were physicians.
     
  13. OP
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    migm

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    I saw some studies that discuss decreasing the injection ml/s and increasing the time until scan is performed as an alternative. Has anyone gotten that to work and used a non-power rated CVC?

    I don't know what they would think about the easy-IJ line.. they will not inject EJs
     
  14. UKEMdoc

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    Our radiographers hand inject the contrast. With a sick patient either you can see the lesion with a sub-optimal scan or it doesn't matter.

    The worry is that the line fragments with the pressure.
     
  15. chudat

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    Are you saying radiologists dont understand science/medicine?
     
  16. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu...
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    No, not radiologists. Rad techs.
     
  17. thegenius

    thegenius Senior Wharf Rat
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    The 16g port on a TLC (the one with a brown cap) is not rated enough to take power-injected IV contrast? I think all they need for a flow rate for PE studies is like 4cc/second. A good flowing 16g on a TLC should be able to accomplish that.
     
  18. TimesNewRoman

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    Some are some aren’t.
     
  19. Groove

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    Our radiologists will use non pressure rated CVLs and any PIV including EJ/IJ. Good quality studies too. Man, I had no idea some of you were having such a hard time with these line nazis.
     
  20. GonnaBeADoc2222

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    No. Referring to nursing and rad tech "protocols."

    Similar to how I have to push the gastrograffin after i replace a g tube, like the patient's head will explode if it's not pushed by a physician.
     
  21. Dr Mantis Toboggan

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    Don’t you remember that rash of exploding catheters a few years back?!? So many fatal plastic emboli...




     
  22. Psai

    Psai This space for lease
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    I can't tell if you're joking or not because I've heard of catheters shearing off for whatever reason and leaving pieces behind. I think it was unrelated to power injections though.
     
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  23. Groove

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    Hmm, the hell I can’t!

     
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  24. leviathan

    leviathan Drinking from the hydrant
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    Arrow makes TLC that are pressure injectable. Nicer kits too that come with a full drape inside, suture, needle driver etc.
     

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