Given the tortuous path of the EJ and difficulties in catheter stabilization at this site, I would not recommend it for power injection. I would dig deeper and find out why they want to use this site and who do they propose to be the inserter for this site. I have seen the horrible outcomes of severe extravasation injuries from power injection in the arm. This would be extremely serious in the neck. The total volume of contrast is injected within less than 30 to 60 seconds, so it is almost impossible for the CT tech to hear a patient complain of pain at the site and then get to the machine to stop it before the entire volume has been injected. 100 mls injected into the SC tissue around the EJ could compromise nerves, arteries, neck motion, etc. If lack of peripheral veins is the problem, I would recommend using US or infrared to find a peripheral vein first. If that is not possible, then a PICC could be inserted via the IJ but this should be a last resort if the only thing needed is a CT scan and no other IV therapy is prescribed. Lynn
Intravenous contrast material should be administered by power injector through a flexible plastic cannula. Use of metal needles for power injection should be avoided. In addition, the flow rate should be appropriate for the gauge of the catheter used. Although 22-gauge catheters may be able to tolerate flow rates up to 5 ml/sec, a 20-gauge or larger catheter is preferable for flow rates of 3 ml/sec or higher. An antecubital or large forearm vein is the preferred venous access site for power injection. If a more peripheral (i.e., hand or wrist) venipuncture site is used, a flow rate of no greater than 1.5 ml/sec may be more appropriate.
Injection of Contrast Media / 31
Extravasated iodinated contrast media, particularly HOCM, are toxic to the surrounding tissues, particularly to the skin, producing an acute local inflammatory response that peaks in 24-48 hours. Most patients recover without sequelae, but in some this response may proceed to severe adverse events. Ulceration and tissue necrosis may result and can be identified as early as 6 hours after the injury. Acute inflammation is followed by a chronic inflammatory response that may be accompanied by fibrosis and adjacent muscle atrophy. The acute tissue injury resulting from extravasation of iodinated contrast material is related primarily to the hyperosmolality of the fluid. Extravasation of a large volume of contrast material can also produce a "compartment syndrome" as a result of mechanical compression.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Given the tortuous path of the EJ and difficulties in catheter stabilization at this site, I would not recommend it for power injection. I would dig deeper and find out why they want to use this site and who do they propose to be the inserter for this site. I have seen the horrible outcomes of severe extravasation injuries from power injection in the arm. This would be extremely serious in the neck. The total volume of contrast is injected within less than 30 to 60 seconds, so it is almost impossible for the CT tech to hear a patient complain of pain at the site and then get to the machine to stop it before the entire volume has been injected. 100 mls injected into the SC tissue around the EJ could compromise nerves, arteries, neck motion, etc. If lack of peripheral veins is the problem, I would recommend using US or infrared to find a peripheral vein first. If that is not possible, then a PICC could be inserted via the IJ but this should be a last resort if the only thing needed is a CT scan and no other IV therapy is prescribed. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
From ACR Manual Of Contrast Media version 6 2008
Injection of Contrast Media / 29
Intravenous contrast material should be administered by power injector through a flexible plastic cannula. Use of metal needles for power injection should be avoided. In addition, the flow rate should be appropriate for the gauge of the catheter used. Although 22-gauge catheters may be able to tolerate flow rates up to 5 ml/sec, a 20-gauge or larger catheter is preferable for flow rates of 3 ml/sec or higher. An antecubital or large forearm vein is the preferred venous access site for power injection. If a more peripheral (i.e., hand or wrist) venipuncture site is used, a flow rate of no greater than 1.5 ml/sec may be more appropriate.
Injection of Contrast Media / 31
Extravasated iodinated contrast media, particularly HOCM, are toxic to the surrounding tissues, particularly to the skin, producing an acute local inflammatory response that peaks in 24-48 hours. Most patients recover without sequelae, but in some this response may proceed to severe adverse events. Ulceration and tissue necrosis may result and can be identified as early as 6 hours after the injury. Acute inflammation is followed by a chronic inflammatory response that may be accompanied by fibrosis and adjacent muscle atrophy. The acute tissue injury resulting from extravasation of iodinated contrast material is related primarily to the hyperosmolality of the fluid. Extravasation of a large volume of contrast material can also produce a "compartment syndrome" as a result of mechanical compression.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.