|ECR 2013 / C-2635|
|Mechanical injection of contrast media through central venous catheters and central venous catheters of peripheral insertion (PICC) for tomographic studies|
Methods and Materials
A study descriptive, longitudinal and prospective patients hospitalized in the Hospital Universitario San Vicente Foundation of the city of Medellin, Colombia from March 2010 until March 2012.
Inclusion criteria were: patients older than 18 years who had only venous access as a centerline and whose renal function was normal, or creatinine clearance 30 to 60 ml / min, depending upon local protocol nephroprotection, patients with renal CKD who were on hemodialysis or peritoneal dialysis.
Exclusion criteria were: patients who had doubts about the integrity and correct positioning of the catheter, Swan Ganz catheters, hemodialysis and chemotherapy ports.
Patients with previous allergic reactions to contrast médium.
Were recorded respective demographic and clinical data (Appendix 2) and the patient was transferred to the scanner, where images were obtained in 64-detector multislice CT scanner GE LightSpeed VCT XT based on the protocol established for the respective disease or diagnostic impression. Was administered soluble iodinated contrast medium at concentrations of 300 and 350 mg / mL (for angiotomography) through a mechanical injector 300 PSI for all patients, recording speeds at which this injection is performed.
We performed the noninvasive monitoring of vital signs before, during and after contrast medium injection and recorded any complication in the format intended for it. Records were evaluated blood pressure (SBP, systolic and diastolic, DBP), pulse oximetry and manifestations and that might suggest contrast reactions, such as nausea, vomiting, rash, pruritus, dyspnea, anaphylaxis, cardiac arrest, among others, which were monitored during and until 1 hour after administration of contrast.
Prior to injection of the contrast was confirmed adequate permeability and intravascular position of the catheter, initially administering saline, which was injected through the catheter manually without difficulty and achieving adequate blood return. If there is doubt about the integrity and correct positioning of the catheter, the patient was excluded for injection.
Were evaluated catheter related complications in terms of possible malfunction, with subsequent difficulty in the drug or liquid passage, occlusion, thrombosis, and total or partial rupture in case of the rupture site, and possible embolization the distal fragment. We reviewed medical records and contacted the nurse manager to detect the difficulties presented with the catheter up to 24 hours after power injection of contrast.
Statistical analysis of the data were used frequency distributions, when the variables were qualitative, and summary measures of central tendency and for quantitative, after checking with the Shapiro Wilk test distribution. Additionally analysis was performed for comparison of related samples if significant differences in pulse oximetry and patients from its baseline, during the time of injection and until 1 hour after being injected, for which test was used the Wilcoxon rank due to the non-normal distribution of quantitative variables involved. To evaluate changes in blood pressure values of each patient, we used the McNemar test, grouping as normal SBP values between 90 and 140 mmHg and DBP between 60 and 90 mmHg, and not as normal values, which found outside this range.
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