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Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography
INTRODUCTION: Computed tomography pulmonary angiography (CTPA) is the test of choice for diagnosis of pulmonary embolism (PE) in the emergency department (ED), but this test may be indeterminate for technical reasons such as inadequate contrast filling of the pulmonary arteries. Many hospitals have...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404715/ https://www.ncbi.nlm.nih.gov/pubmed/30881543 http://dx.doi.org/10.5811/westjem.2018.11.40930 |
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author | Marshall, Travis Chen, Nae Meng Nguyen, Eric Slattery, David E. Zitek, Tony |
author_facet | Marshall, Travis Chen, Nae Meng Nguyen, Eric Slattery, David E. Zitek, Tony |
author_sort | Marshall, Travis |
collection | PubMed |
description | INTRODUCTION: Computed tomography pulmonary angiography (CTPA) is the test of choice for diagnosis of pulmonary embolism (PE) in the emergency department (ED), but this test may be indeterminate for technical reasons such as inadequate contrast filling of the pulmonary arteries. Many hospitals have requirements for intravenous (IV) catheter size or location for CTPA studies to reduce the chances of inadequate filling, but there is a lack of clinical data to support these requirements. The objective of this study was to determine if a certain size or location of IV catheter used for contrast for CTPA is associated with an increased chance of suboptimal CTPA. METHODS: This was a retrospective chart review of patients who underwent CTPA in the ED. A CTPA study was considered suboptimal if the radiology report indicated it was technically limited or inadequate to exclude a PE. The reason for the study being suboptimal, and the size and location of the IV catheter, were abstracted. We calculated the rate of inadequate contrast filling of the pulmonary vasculature and compared the rate for various IV catheter sizes and locations. In particular, we compared 20-gauge or larger IV catheters in the antecubital fossa or forearm to all other sizes and locations. RESULTS: A total of 19.3% of the 1500 CTPA reports reviewed met our criteria as suboptimal, and 51.6% of those were due to inadequate filling. Patients with a 20-gauge IV catheter or larger placed in the antecubital fossa or forearm had inadequate filling 9.2% of the time compared to 13.2% for patients who had smaller IVs or IVs in other locations (difference: 4.0% [95% confidence interval, −1.7%–9.7%]). There were also no statistically significant differences in the rates of inadequate filling when data were further stratified by IV catheter location and size. CONCLUSION: We did not detect any statistically significant differences in the rate of inadequate contrast filling based on IV catheter locations or sizes. While small differences not detected in this study may exist, it seems prudent to proceed with CTPA in patients with difficult IV access who need emergent imaging even if they have a small or distally located IV. |
format | Online Article Text |
id | pubmed-6404715 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-64047152019-03-15 Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography Marshall, Travis Chen, Nae Meng Nguyen, Eric Slattery, David E. Zitek, Tony West J Emerg Med Critical Care INTRODUCTION: Computed tomography pulmonary angiography (CTPA) is the test of choice for diagnosis of pulmonary embolism (PE) in the emergency department (ED), but this test may be indeterminate for technical reasons such as inadequate contrast filling of the pulmonary arteries. Many hospitals have requirements for intravenous (IV) catheter size or location for CTPA studies to reduce the chances of inadequate filling, but there is a lack of clinical data to support these requirements. The objective of this study was to determine if a certain size or location of IV catheter used for contrast for CTPA is associated with an increased chance of suboptimal CTPA. METHODS: This was a retrospective chart review of patients who underwent CTPA in the ED. A CTPA study was considered suboptimal if the radiology report indicated it was technically limited or inadequate to exclude a PE. The reason for the study being suboptimal, and the size and location of the IV catheter, were abstracted. We calculated the rate of inadequate contrast filling of the pulmonary vasculature and compared the rate for various IV catheter sizes and locations. In particular, we compared 20-gauge or larger IV catheters in the antecubital fossa or forearm to all other sizes and locations. RESULTS: A total of 19.3% of the 1500 CTPA reports reviewed met our criteria as suboptimal, and 51.6% of those were due to inadequate filling. Patients with a 20-gauge IV catheter or larger placed in the antecubital fossa or forearm had inadequate filling 9.2% of the time compared to 13.2% for patients who had smaller IVs or IVs in other locations (difference: 4.0% [95% confidence interval, −1.7%–9.7%]). There were also no statistically significant differences in the rates of inadequate filling when data were further stratified by IV catheter location and size. CONCLUSION: We did not detect any statistically significant differences in the rate of inadequate contrast filling based on IV catheter locations or sizes. While small differences not detected in this study may exist, it seems prudent to proceed with CTPA in patients with difficult IV access who need emergent imaging even if they have a small or distally located IV. Department of Emergency Medicine, University of California, Irvine School of Medicine 2019-03 2019-02-06 /pmc/articles/PMC6404715/ /pubmed/30881543 http://dx.doi.org/10.5811/westjem.2018.11.40930 Text en Copyright: © 2019 Marshall et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Critical Care Marshall, Travis Chen, Nae Meng Nguyen, Eric Slattery, David E. Zitek, Tony Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography |
title | Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography |
title_full | Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography |
title_fullStr | Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography |
title_full_unstemmed | Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography |
title_short | Rethinking Intravenous Catheter Size and Location for Computed Tomography Pulmonary Angiography |
title_sort | rethinking intravenous catheter size and location for computed tomography pulmonary angiography |
topic | Critical Care |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404715/ https://www.ncbi.nlm.nih.gov/pubmed/30881543 http://dx.doi.org/10.5811/westjem.2018.11.40930 |
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