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Safety and Efficacy of Pressure-Limited Power Injection of Iodinated Contrast Medium Through Central Lines in Children

¹ Department of Medical Imaging, Children's Memorial Hospital, 2300 Children's Plaza, Box 9, Chicago, IL 60614.
² Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611.
³ Department of Pediatrics and Preventive Medicine, Children's Memorial Hospital, Chicago, IL 60614.
⁴ Mary Ann and J. Milburn Smith Child Health Research Program, Children's Memorial Hospital, Chicago, IL 60614.

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of pressure-limited power injection of contrast medium through central lines for pediatric body CT examinations.

SUBJECTS AND METHODS. All patients with a central line who were referred for body CT examinations requiring an IV contrast agent were prospectively evaluated. The power injector was pressure limited to 25 psi (172 kPa). A standard dose of 2 mL/kg of iodinated contrast medium was power-injected through the central line. Two pediatric radiologists scored all examinations on a scale of 1 (poor) to 5 (superior) for adequacy of contrast enhancement. Regression and receiver operating characteristic analyses were performed.

RESULTS. The subjects were 63 patients 0.3-22 years old. Nineteen of these patients had tunneled lines, 18 had ports, and 26 had peripherally inserted central catheters. There were no complications related to power injection. Regression analysis showed a significant association between patient weight and contrast enhancement adequacy score (p < 0.001), higher patient weights yielding lower contrast enhancement adequacy scores. Receiver operating characteristic analysis showed a weight cutoff of 30 kg as a reasonable predictor of adequacy of contrast enhancement. For patients weighing 30 kg or more, the average contrast enhancement score was 2.4 (suboptimal to adequate). For patients weighing less than 30 kg, the average contrast enhancement score was 3.4 (adequate to good).

CONCLUSION. Pressure-limited power injection through central lines in children is safe. The contrast enhancement obtained with 25 psi (172 kPa) pressure-limited injection is acceptable only for patients who weigh less than 30 kg.

Keywords: catheters • contrast media • CT technique • pediatrics • safety

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