CT Chest/Abdomen with central line?

[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

 

[Xerxes1729]

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.

 

[deleted109597]

Have your director get central lines that are power rated. They make them.

 

[deleted547339]

Have your director get central lines that are power rated. They make them.

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.

 

[Tenk]

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.

 

[Fox800]

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.

Curious. Our rads will not inject contrast into EJs. I wonder how they'd react to this.

 

[Tenk]

Curious. Our rads will not inject contrast into EJs. I wonder how they'd react to this.

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

 

[Fox800]

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

I do love the Easy IJ for rapid access and getting labs. It still confuses folks that aren't familiar with it, unfortunately.

 

[TooMuchResearch]

Either the IJ people are recommending or heparin and admit.

 

[GonnaBeADoc2222]

Curious. Our rads will not inject contrast into EJs. I wonder how they'd react to this.

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

 

[Groove]

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

 

[Vandalia]

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

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.

 

[migm]

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

 

[UKEMdoc]

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.

 

[chudat]

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

Are you saying radiologists dont understand science/medicine?

 

[TooMuchResearch]

Are you saying radiologists dont understand science/medicine?

No, not radiologists. Rad techs.

 

[thegenius]

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

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.

 

[deleted547339]

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.

Some are some aren’t.

 

[Groove]

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

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.

 

[GonnaBeADoc2222]

Are you saying radiologists dont understand science/medicine?

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.

 

[Dr Mantis Toboggan]

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

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.

 

[Psai]

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

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.

 

[Groove]

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

Hmm, the hell I can’t!

 

[leviathan]

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

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