CT TECHNOLOGIST: Policy for Power Injection

The CT technologist or RN may start an IV for use during CT scan exams requiring contrast.

ALL existing peripheral or central lines must be check for patency (see protocol below).

Policy for power injection of Central Venous Devices (CVAD): After all injections flush catheter. 

CVADs (Quinton, Non-power Hickman, Permacaths, non-power PICCS, should not be used in CT Scan. CVADs with TPN infusions cannot be used for contrast injection unless TPN has been disconnected and vigorously flushed by RN prior to exam before patient leaves floor.

The following lines are acceptable CVADs for any CT scan: Power PICCS, non-Power Ports and Triple lumens @ 1cc/sec/100 PSI and Power Ports:

  • Following Hand Hygiene Policy at all times: wash or Purell, don gloves, remove gloves, then wash or Purell.
  • CVAD lumen access may be performed by the CT technologist.
  • Prior to use: All CVAD lines used for contrast with injector or hand injection must have a 15 sec hub scrub with approved disinfectant and allowed to air dry (minimum 15 seconds).
  • All CVAD’s must be checked for patency and blood return, using a 10 cc saline syringe with 3 cc removed. Aspirate 3 cc to test for blood return and discard. A CVAD should not be used without verification of blood return.
  • The contrast for all CVAD’s is Omnipaque 350 (except Pediatrics).

Policy for Contrast injection of Portacaths   (RN must access and de-access all Indwelling Ports):

CVDLumen SizeFlow RatePSI
Indwelling
Portacaths
All
1 cc/sec
100
Power Ports

CTAs may be injected
3 cc/sec
300
(Must be accessed with Power Port needle. See recommendation rates on Power Port needle tag)


Policy for injection of Power PICC lines:

  • All hubs should be hub scrubbed with approved disinfectant prior to use (follow above protocol).
  • Contrast may only be injected on a Power PICC line at rate and PSI that is listed on the hub.   
  • Non-power PICC lines should never be injected with contrast.
Policy for power injection of IV catheters in a foot vein:
  • For all sizes, this can be performed if there is no other IV access.
  • Contrast is to be injected at 1 cc/sec with 100 PSI.
  • CT technologist must monitor injection site for the duration of injection.
  • All hubs should be hub scrubbed with approved disinfectant prior to use (follow above protocol).

Policy for use of injector for 5F micropuncture introducers placed by IR:

  • These may be used for power injection up to 5 cc/sec at 300 PSI.
  • All hubs should be hub scrubbed with approved disinfectant prior to use (follow above protocol).

Policy for use of injector for EJ and IJ catheter access: with 15 sec Hub scrub:

  1. All EJ and IJ IV catheters must be checked for patency and blood return. Access may be performed by the CT technologist.
  2. An EJ or IJ IV catheter should not be used without verification of blood return. (see above protocol)
  3. The contrast for all EJ and IJ catheters is Omnipaque 350.
  4. CT technologist should monitor injection site for as long as possible during the injection.
Location and Lumen Size
Injection rate
Flow Rate
PSI
18, 20g IV access
(up to a 5cc/sec)
2 cc/sec
300
22g IV access

(lower rate to 2 or 

2.5 cc's/sec)

2 cc/sec
300

Injection rate use in PEDI patients: Including foot veins:

Injection rate
Flow Rate
PSI
18 or 20 g
2 cc/sec
150
22 g
2 cc/sec
150
24 g1.5 cc/sec50

Note: No IV medication drips should be stopped or restarted without a RN’s help. Injector should not be used with an IV that has questionable patency. If in doubt, question the radiologist or the patient’s care givers. 


Pedi Broviac: 

  • In-Patient Pediatric patients:
    • call the RN.
    • Instruct RN to accompany the patient.
    • Pedi RN will need to follow YNHH hub scrub policy.
    • Pedi RN will hub scrub and access the pedi patient’s Broviac. 
    • Omni 300 may be hand injected by the nurse or technologist using a 10 cc syringe.
    • The RN should then follow YNHH heparin flush policy.
  • Out-patients: Call Jeff Agli/ Pedi RNs as above

Power Hickman:

  • In-Patients:
    • Call the floor to check IV status.
    • If the RN states the patient has a Hickman: Question the RN: Is the Hickman a Power Hickman (labeled on the clamp: with maximum injection rate)?
    • Has there been TPN running: If yes: flush now and DC TPN and clearly mark lumen used for TPN.
    • Send patient with no meds running.
    • Keep open flush is allowed.
    • Instruct RN that the patient will return without the catheter being flushed with heparin.
    • If the TPN cannot be stopped and flushed before leaving the floor, the Hickman may not be used for the contrast injection.
    • Follow 15 second hubs scrub and allow to air dry (minimum 15 seconds). 
    • Do not disconnect injector prior to exam completion or the hub scrub will need to be repeated. 
    • Maximum flow rate will be listed on the lumen clamp.
  • Out-patients: 
    • Follow 15 second hubs scrub and allow to air dry (minimum 15 seconds).
    • Maximum flow rate will be listed on the lumen clamp. 
    • Do not disconnect injector prior to exam completion or the hub scrub will need to be repeated.
    • Call Core IR RN to install heparin post injection per YNHH policy.