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

Abstract

PurposeThe use of totally implantable venous access devices (TIVADs) certified as “high pressure resistant” or “power port” has begun to spread worldwide as a safe procedure for power contrast injection. Owing to the thermo-rheological properties of the contrast media, the primary aim of this work is to present an in vitro experimental impact study concerning the impact of the temperature level on flushing efficiency after contrast medium injection. Moreover, we report experimental data that confirms the role of needle bevel orientation. The secondary aim is to answer the following questions: Is there significant device contrast medium trapping after contrast medium injection? Is saline flushing efficient? And, finally, is it safe to inject contrast medium through an indwelled port catheter?ResultsThe experimental results show that in addition to hydrodynamics, temperature is a key parameter for the efficiency of device flushing after contrast medium injection. It appears that this is the case when the cavity is incompletely rinsed after three calibrated flushing volumes of 10 mL saline solution, even by using the Huber needle bevel opposite to the port exit. This leads to a potentially important trapped volume of contrast medium in the port, and consequently to the possibility of subsequent salt precipitates and long term trisubstituted benzene nuclei delivery that might impair the solute properties, which may be further injected via the power port later on.ConclusionWe thus suggest, in TIVADS patients, the use of a temporary supplementary intravenous line rather than the port to perform contrast medium injections in daily radiology routine practice.

Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices

“…The flushing of venous catheters is a complex process, where convection and diffusion are coupled with chemical interactions associated with protein adhesion and disadhesion 9. Moreover, the flushing efficacy could be enhanced by heating up the flushing solution to body temperature, as shown by Guiffant et al31…”

Impact of the Shape of the Needle Tip on the Efficacy of Flushing Implantable Port Chambers

“…1B), with the orientation of the bevel opposite to the catheter outlet. This type of geometry has been used in previous studies (14, 16, 17) and has been found to be the best configuration for flushing efficacy. Figures 1C, D, E and F show the situation when introducing a BFC.…”

“…Such an effect is clearly missing in the situation depicted in Figure 2B with a bevel-free extremity: the outlet flow exhibits a cylindrical symmetry leading to a circular spreading of the flow. The interaction of the outlet stream from a beveled extremity with the bottom and side walls of the port provides the best conditions to flush and use the port chamber (14, 16, 17). To include the reservoir's design as a contributing factor in flushing efficiency, we tested lines of flow in both curved side wall and straight wall ports.…”

Power contrast injections through a totally implantable venous power port: A retrospective multicenter study

“…For more than 20 years, totally implantable venous access ports have been used in patients with cancer or chronic diseases. 1,2 Patients with a totally implantable venous access port often undergo a computed tomography (CT) scan with contrast media (CM) injection for clinical examination or follow-up, usually with easy and safe peripheral IV access. However, in some patients, peripheral IV access is difficult, and the implanted venous port is the only access route.…”