Fluoroscopy of central venous catheters
Author:
Mikael Häggström [notes 1]
Fibrin sheaths of ports can be suspected when it is possible to infuse into it but not to aspirate.
Technique
Fibrin sheaths are usually detected by fluoroscopic catheter contrast angiography.[1]
Preparation
- Contrast should be non-ionic, with a high iodine concentration (for example 300 mg/ml).[1]
- Syringe can be for example 10 ml or 20 ml, for injection by hand.[1] For pumps, the pressure should not exceed >40psi (275kPa or 2,75bar).[2]
- The needle should be at least 20G (0.9mm), and needs to be designed for port use (to avoid fragmentation of the port membrane).[2]
- The system needs to be closed to air at all times.[2]
The total amount of contrast is rather small (5-15ml) so a decreased renal function does not need to to be a contraindication.[2]
Image taking
A precontrast view is followed by a series of images during contrast infusion, at a small field-of-view.[1] It can be done at 2-4 images per second,[1] but also up to 15 images per second and a short exposure time of 3-4 seconds.
After the procedure, the system should be flushed with 20 - 30 ml normal saline.[2]
Evaluation
In the presence of fibrin sheaths, the contrast flows backwards around the catheter.
Report
The report should include:
- Position of the catheter tip in relation to the central veins
- Presence or absence of fibrin sheath
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Knutstad, K.; Hager, B.; Hauser, M. (2016). "Radiologic diagnosis and management of complications related to central venous access ". Acta Radiologica 44 (5): 508–516. doi:. ISSN 0284-1851.
- ↑ 2.0 2.1 2.2 2.3 2.4 . Porta-a-cath control. Röntgen Metodbok, Radiology Department of Helsingborg. Retrieved on 2018-07-25.
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