Difference between revisions of "Fluoroscopy of central venous catheters"
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Fibrin sheaths of ports can be suspected when it is possible to infuse into it but not to aspirate. | Fibrin sheaths of ports can be suspected when it is possible to infuse into it but not to aspirate. | ||
| − | == | + | ==Choice of investigation== |
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> | 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> | ||
| + | |||
| + | A suspicion of a thrombotic occlusion of the vein passed by the catheter indicates a [[CT angiography]].<ref name=Helsingborg/> | ||
===Preparation=== | ===Preparation=== | ||
| − | *Contrast should be non-ionic, with | + | *Contrast should be non-ionic,<ref name="KnutstadHager2016"/> with an iodine concentration of at least 270 mg/ml.<ref name=Helsingborg/> |
*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/> | *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/> | ||
| − | *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> | + | *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> It should be connected by luer taper.<ref name=Helsingborg/> |
*The system needs to be closed to air at all times.<ref name=Helsingborg/> | *The system needs to be closed to air at all times.<ref name=Helsingborg/> | ||
| Line 18: | Line 20: | ||
==Image taking== | ==Image taking== | ||
| − | + | Precontrast imaging | |
| + | *Including lateral projection of the port to confirm that the needle is in proper place before contrast infusion.<ref name=Helsingborg/> | ||
| + | |||
| + | Contrast imaging | ||
| + | *A small field-of-view.<ref name="KnutstadHager2016"/> | ||
| + | *Posteroanterior projection, or slightly oblique to avoid superimposing the spine.<ref name=Helsingborg/> | ||
| + | *First image the contrast filling of the port chamber and the catheter to exclude malfunction.<ref name=Helsingborg/> | ||
| + | *Imaging of the outflow from the catheter is imaged at 10-15 images per second.<ref name=Helsingborg/> | ||
After the procedure, the system should be flushed with 20 - 30 ml normal saline.<ref name=Helsingborg/> | After the procedure, the system should be flushed with 20 - 30 ml normal saline.<ref name=Helsingborg/> | ||
| Line 24: | Line 33: | ||
==Evaluation== | ==Evaluation== | ||
[[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.]] | [[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 | + | In a normal case, the contrast flows straight out from the catheter.<ref name=Helsingborg/> Contrast flowing at a skewed angle compared to the catheter means a suspected fibrin sheath.<ref name=Helsingborg/> |
| + | |||
| + | A definite fibrin sheath is visualized as contrast flowing backwards around the catheter, looking like a thickening of the distal part, before exiting a bit proximal on the catheter. | ||
==Report== | ==Report== | ||
Revision as of 13:27, 5 July 2018
Author:
Mikael Häggström [notes 1]
Error creating thumbnail:
Port with needle assembly inserted.
Fibrin sheaths of ports can be suspected when it is possible to infuse into it but not to aspirate.
Contents
Choice of investigation
Fibrin sheaths are usually detected by fluoroscopic catheter contrast angiography.[1]
A suspicion of a thrombotic occlusion of the vein passed by the catheter indicates a CT angiography.[2]
Preparation
- Contrast should be non-ionic,[1] with an iodine concentration of at least 270 mg/ml.[2]
- 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] It should be connected by luer taper.[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
Precontrast imaging
- Including lateral projection of the port to confirm that the needle is in proper place before contrast infusion.[2]
Contrast imaging
- A small field-of-view.[1]
- Posteroanterior projection, or slightly oblique to avoid superimposing the spine.[2]
- First image the contrast filling of the port chamber and the catheter to exclude malfunction.[2]
- Imaging of the outflow from the catheter is imaged at 10-15 images per second.[2]
After the procedure, the system should be flushed with 20 - 30 ml normal saline.[2]
Evaluation
File:Central venous catheter with a fibrin sheath.jpg
The fibrin sheath is indirectly seen in these images before and after radiocontrast infusion, as the radiocontrast collects around the catheter.
In a normal case, the contrast flows straight out from the catheter.[2] Contrast flowing at a skewed angle compared to the catheter means a suspected fibrin sheath.[2]
A definite fibrin sheath is visualized as contrast flowing backwards around the catheter, looking like a thickening of the distal part, before exiting a bit proximal on 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
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 . Porta-a-cath control. Röntgen Metodbok, Radiology Department of Helsingborg. Retrieved on 2018-07-25.
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