Safety and feasibility in highly concentrated contrast material power injections for CT-perfusion studies of the brain using central venous catheters

Introduction: CT perfusion studies play an important role in the early detection as well as in therapy monitoring of vasospasm after subarachnoid hemorrhage. High-flow injections via central venous catheters are not recommended but may sometimes be the only possibility to obtain high-quality images.

Materials and methods: We retrospectively analyzed our data for CT perfusions performed with power injection of contrast material with an iodine concentration of 400mg/ml via the distal 16G lumen of the Arrow three and five lumen central venous catheter with preset flow rates of 5ml/s.

Results: 104 examinations with central venous catheters were evaluated (67 with five lumen and 37 with three lumen). No complications were observed. Mean flow rates were 4.4±0.5ml/s using the three lumen catheter and 4.6±0.6ml/s using the five lumen catheter respectively. The mean injection pressure measured by the power injector was 200.7±17.5psi for the three lumen central venous catheter and 194.5±6.5psi for the five lumen catheter, respectively.

Conclusion: Following a strict safety protocol there were no complications associated with power injections of contrast material containing 400mg iodine/ml with preset flow rates up to 5ml/s via the distal 16G lumen of the Arrow multi-lumen central venous catheter. However, since power-injections are off-label use with Arrow central venous catheters, this procedure cannot be recommended until potential safety hazards have been ruled out by the manufacturer.