Maximum Flow Rates Possible During Power Injection Through Currently Available PICCs: An In-Vitro Study
Purpose Currently available 4 French and 5 French PICCs were investigated to evaluate their possible application for contrast injection using power injectors. The study was performed using an in-vitro model to demonstrate the feasibility of using PICCs for contrast enhanced studies.
Materials and Methods An evaluation of 24 catheter versions consisting of 4 French single lumen and 5 French dual lumen PICCs from 13 different manufacturers was conducted. Six of the catheter types were silicone and 18 catheter types were polyurethane. Ten catheters of each type were evaluated with five at full length and five trimmed to 40cm. Using a silicone-based simulated superior vena cava model, the catheters were infused with 50cc of intravenous contrast at each flow rate increment. Catheters were tested at increasing flow rates from 0.5cc/second to 5cc/second in 0.5cc/second increments using a Percupump CT injector. Catheters that failed to rupture were then infused at 1 cc/second increments at flow rates from 5cc/second to 17cc/second using a MedRad Mark VTM power injector. Tolerated and bursting pressures were recorded.
Results Polyurethane catheters ruptured at flow rates between 4–15.4cc/second, with one catheter not rupturing at the maximum flow rate (l7cc/second). Silicone catheters ruptured at flow rates between 0.5–3.5cc/second. Average rupture locations by type and length were at the extension leg/hub connection area on 5 of the PICCs, on the extension legs on 21 of the PICCs, on the catheter/hub connection on 4 PICCs, and on the proximal catheter on 16 of the PICCs.
Conclusion The low burst rates at which all silicone catheters ruptured suggest those catheters are not able to withstand typical flow rates used for CTA. Conversely, although a wide range of discrepancy is found in the polyurethane catheter burst pressures, many polyurethane catheters can tolerate relatively high flow rates without rupture. This suggests that they may be safely used for CTA with appropriate precautions and protocols in place.ABSTRACT
Contributor Notes
Ari I. Salis, MD of Sinai Hospital of Baltimore, Maryland, Department of Radiology. Ari I. Salis, MD is in the Corresponding Author for this Manuscript.
Anthony Eclavea, MD is Chief, MRI & Interventional Radiology, Eisenhower Army Medical Center, Ft. Gordon, GA.
Matthew S. Johnson, MD is the Director, Vascular and Interoentional Radiology, Indiana University School of Medicine, Indianapolis, IN. Dr. Johnson clinical responsibilities include angiography and vascular intervention Dr. Johnson also teaches medical students, residents and fellows and is active in the imaging research laboratory. Dr. Matthew S. Johnson also has appointments at Wishard Memorial Hospital, Richard L. Roudebush Veteran's Administration Medical Center, and Methodist Hospital.
Nilesh H. Patel, MD, FSIR is Director of Interventional Radiology/Associate Professor of Radiology, RUSH-Presbyterian-St. Lukes Medical Center, Chicago, IL.
Debie G. Wong, BS is the Technical Writing Supervisor at Bard Access Systems with nineteen years experience in technical/procedural writing including over 7 years in the medical device industry. She is a senior member of the Society for Technical Communication and is a Board member of the Rocky Chapter of the American Medical Writers Association. Debie is a graduate of Weber State University in Ogden, Utah.
Gerald Tennery, RT has been involved in the Radiology Research laboratory at Indiana University School of Medicine since March of 1999. He has over 30 years experience as a radiologic technologist. In 1972 he became the first animal research technologist at Ohio State University Department of Radiology under the direction of Dr. Sydney Nelson. He has over 40 years experience in the breeding and care of purebred swine, sheep, cattle, and horses.