Gavecelt Consensus Statement on the Correct use of Totally Implantable Venous Access Devices for Diagnostic Radiology Procedures

Abstract

The use of totally implantable venous access devices in radiology may be associated with complications such as occlusion of the system (because of the high density of some contrast), infection (if the port is not handled in aseptic conditions, using proper barrier protections), and mechanical complications due to the high-pressure administration of contrast by automatic injectors (so-called power injector), including extravasation of contrast media into the soft tissues, subintimal venous or myocardial injection, or serious damage to the device itself (breakage of the external connections, dislocation of the non-coring needle, or breakage of the catheter). The last problem - i.e., the damage of the device from a power injection - is not an unjustified fear, but a reality. A warning by the US Food and Drug Administration of July 2004 reports around 250 complications of this kind, referring to both port and central venous catheters and peripherally inserted central catheter systems, which occurred over a period of several years; in all cases, the damage occurred during the injection of contrast material by means of power injectors for computed tomography or magnetic resonance imaging procedures. Though the risk associated with the use of ports in radiodiagnostics is thus clear, it has been suggested that administration of the contrast material via the port may have some advantage in terms of image quality, increased comfort for the patient, and maybe more accurate reproducibility of the patient's own follow-up exams. This contention needs to be supported by evidence. Also, since many cancer patients who need frequent computed tomography studies already have totally implantable systems, it would seem reasonable to try to define how and when such systems may safely be used. The purpose of this consensus statement is to define recommendations based on the best available evidence, for the safe use of implantable ports in radiodiagnostics.

Systematic review of the safety and efficacy of contrast injection via venous catheters for contrast-enhanced computed tomography

“…Twenty-three articles were considered eligible for answering the research question after selection based on title and abstract. Seventeen articles were excluded during full text screening because of the following reasons: incorrect domain (n = 1) [9], outcome not focusing on safety, efficacy, and complications (n = 1) [10], CVC use in pediatrics (n = 7) [11], [12], [13], [14], [15], [16], [17], in vitro studies (n = 4) [18], [19], [20], [21], no original article (n = 3) [1], [22], [23], and not meeting language requirements (n = 1) [24]. During cross referencing, one study was included missed by the initial search [25].…”

Power port contrast medium flushing and trapping: impact of temperature, an in vitro experimental study

“…Nowadays, it is tempting to use them in daily radiology practice. Some radiologist teams have already started to perform the “power contrast enhanced computerized tomography (CT)” examinations, namely in patients presenting with cardiovascular and oncology conditions, by using “power port” CM injections 17,21,22. Preventing patient pain or discomfort related to the superficial venipuncture (to inject CM before CT examination) is indeed essential.…”

“…Then, rinsing with saline solution was performed using a series of calibrated saline fractions of 10 mL at flow rates 0.5 mL/second17,18 that were previously thermalized either at 37°C or 23°C. There was a 1-minute time delay between the two saline solution injections.…”

“…More recently, the use of TIVADs for power contrast injection has begun to spread as a safe procedure,13–17 and is presented as highly desirable from both the patient and the radiologist’s point of view 17. Besides infectious and thrombotic complications17 that are common to all TIVADs, mechanical complications due to the high pressure administration of contrast medium (CM) by automatic injectors tend to become less important, thanks to the specification and label “high pressure resistant” of the so-called “power ports”.…”

“…Besides infectious and thrombotic complications17 that are common to all TIVADs, mechanical complications due to the high pressure administration of contrast medium (CM) by automatic injectors tend to become less important, thanks to the specification and label “high pressure resistant” of the so-called “power ports”. One other complication of injecting CM into the power port lies in the possibility of obstruction of the TIVAD.…”