Difference between revisions of "Fluoroscopy of central venous catheters"

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[[File:Central venous catheter with a fibrin sheath.jpg|thumb|The fibrin sheath is indirectly seen in these images before and after radiocontrast infusion, as the radiocontrast collects around the catheter.]]
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[[File:PAC met Gripper erin.JPG|thumb|Port with needle assembly inserted.]]
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Fibrin sheaths of central venous catheters can be suspected when it is possible to infuse into it but not to aspirate.
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Fibrin sheaths of ports can be suspected when it is possible to infuse into it but not to aspirate.
  
 
==Technique==
 
==Technique==
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Fibrin sheaths are usually detected by fluoroscopic catheter contrast angiography.<ref name="KnutstadHager2016">{{cite journal|last1=Knutstad|first1=K.|last2=Hager|first2=B.|last3=Hauser|first3=M.|title=Radiologic diagnosis and management of complications related to central venous access|journal=Acta Radiologica|volume=44|issue=5|year=2016|pages=508–516|issn=0284-1851|doi=10.1080/j.1600-0455.2003.00115.x}}</ref> Non-ionic contrast with a high iodine concentration (for example 300 mg/ml) is injected by hand using a 10 ml or 20 ml<ref name="KnutstadHager2016"/> syringe. A precontrast view is followed by a series of images at a small field-of-view.<ref name="KnutstadHager2016"/> It can be done at 2-4 images per second,<ref name="KnutstadHager2016"/> but also up to 15 images per second and a short exposure time of 3-4 seconds.
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Fibrin sheaths are usually detected by fluoroscopic catheter contrast angiography.<ref name="KnutstadHager2016">{{cite journal|last1=Knutstad|first1=K.|last2=Hager|first2=B.|last3=Hauser|first3=M.|title=Radiologic diagnosis and management of complications related to central venous access|journal=Acta Radiologica|volume=44|issue=5|year=2016|pages=508–516|issn=0284-1851|doi=10.1080/j.1600-0455.2003.00115.x}}</ref>  
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===Preparation===
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*Contrast should be non-ionic, with a high iodine concentration (for example 300 mg/ml).<ref name="KnutstadHager2016"/>
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*Syringe can be for example 10 ml or 20 ml, for injection by hand.<ref name="KnutstadHager2016"/> For pumps, the pressure should not exceed >40psi (275kPa or 2,75bar).<ref name=Helsingborg/>
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*The needle should be at least 20G (0.9mm), and needs to be designed for port use (to avoid fragmentation of the port membrane).<ref name=Helsingborg>{{cite web|url=http://www.rontgen.com/metod/lungor-cvkport-a-cath|title=Porta-a-cath control|website=Röntgen Metodbok, Radiology Department of Helsingborg|accessdate=2018-07-25}}</ref>
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*The system needs to be closed to air at all times.<ref name=Helsingborg/>
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The total amount of contrast is rather small (5-15ml) so a decreased renal function does not need to to be a contraindication.<ref name=Helsingborg/>
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==Image taking==
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A precontrast view is followed by a series of images during contrast infusion, at a small field-of-view.<ref name="KnutstadHager2016"/> It can be done at 2-4 images per second,<ref name="KnutstadHager2016"/> but also up to 15 images per second and a short exposure time of 3-4 seconds.
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After the procedure, the system should be flushed with 20 - 30 ml normal saline.<ref name=Helsingborg/>
  
 
==Evaluation==
 
==Evaluation==
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[[File:Central venous catheter with a fibrin sheath.jpg|thumb|The fibrin sheath is indirectly seen in these images before and after radiocontrast infusion, as the radiocontrast collects around the catheter.]]
 
In the presence of fibrin sheaths, the contrast flows backwards around the catheter.
 
In the presence of fibrin sheaths, the contrast flows backwards around the catheter.
  

Revision as of 12:59, 5 July 2018

Author: Mikael Häggström [notes 1]

Port with needle assembly inserted.

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

The fibrin sheath is indirectly seen in these images before and after radiocontrast infusion, as the radiocontrast collects around the catheter.

In the presence of fibrin sheaths, the contrast flows backwards around the catheter.

Report

File:Mediastinal structures on chest X-ray, annotated.jpg
Locations of the central veins.

The report should include:

  • Position of the catheter tip in relation to the central veins
  • Presence or absence of fibrin sheath

References

  1. ↑ 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:10.1080/j.1600-0455.2003.00115.x. ISSN 0284-1851. 
  2. ↑ 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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