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Wendy Erickson RN
Infiltration of CAT dye
Our PICC nurses are occasionally called to CAT Scan to use our portable ultrasound to insert a peripheral antecubital 18 gauge catheter, primarily for Coronary CATs.  Vein is identified, catheter is placed, excellent blood return obtained, trial of hand-injected dye goes in fine, but when the pressure infusion begins, the catheter either infiltrates and/or backs out of the vessel.  Anyone else experiencing similar situations?  Is a longer catheter the answer?  I suspect that since the ultrasound is required, we are accessing deeper vessels where the catheter might not be well-seated in the vessel and the force of the power injection backs it out, but am certainly open to other thoughts. 
lynncrni
I have a huge word of

I have a huge word of warning. The antecubital sites, along with the sites in the hand and wrist are associated with the greatest number and severity of infiltraiton/extravasation injuries. So those sites need to be avoided if at all possible. The antecubital fossa sites are closely aligned with critical nerves and arteries. I have several legal cases of damage in those sites that have caused life-long permanent injury to the patient. So I would urge you to use that ultrasound to find sites in the forearm away from the ACF. For deep veins, you may need a longer catheter (bariatric patients, etc.) I think BD makes one that is 1.8 inches long. The reported rates of infiltration with high pressure injectors is low, but when it happens the severity is great.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Wendy Erickson RN
I have a little more
I have a little more information about this.  These tests are actually Coronary Computed Tomography Angiograms.  They REQUIRE an antecubital IV because of timing of the injection of the dye and distance from the heart etc.  I am not a cardiac nurse by ANY stretch of the imagination so I am not sure I am describing this correctly, but that apparently is the reason that they need to use the antecubital fossa, with an 18 g. IV.  I hear you loud and clear about the risks here, but I'm not sure we can change this.  Would putting some gentle pressure on the catheter, pushing it into the vein to prevent it from backing out be an option as the power injeciton is occuring?  Just to hold it in place?

Wendy Erickson RN
Eau Claire WI

lynncrni
This is a risky site, but

This is a risky site, but understand your dilemma. I think the best thing you can do is to make sure the people doing the venipuncture have the highest level of knowledge and skill about these risks, great stabilization of the catheter with a manufacturerd stabilization device, a thorough assessment of vein patency prior to each injection (flushing, brisk blood return), and instructing the patient about s&s of infiltraiton and extravasation so they can let you know ASAP of problems and the injection can be stopped. Are these patients moving from chair to table, etc while the catheter is in place? If so, I would want an arm board to remind them no to bend the arm. And I would investigate longer catheters to make sure that the catheter has adequately purchased the vein. I would hesitate about the the gentle pressure on the catheter during injection as this could force the catheter through the opposite vein wall and cause infiltration. Lynn

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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