A Randomized Controlled Study to Compare Image Quality between Fenestrated and Non-Fenestrated Intravenous Catheters for Cardiac MDCT

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1 A Randomized Controlled Study to Compare Image Quality between Fenestrated and Non-Fenestrated Intravenous Catheters for Cardiac MDCT Poster No.: C-0623 Congress: ECR 2017 Type: Authors: Keywords: DOI: Scientific Exhibit J. Kim, E. J. Kim, J. O. Ham, J. H. Hur, Y. K. Kim, S. I. Choi; Seongnam-Si/KR Hemodynamics / Flow dynamics, Catheters, CT-Angiography, Cardiovascular system /ecr2017/C-0623 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Aims and objectives The use of multi-detector computed tomography (MDCT) with high pressure injection of iodinated contrast has become the standard of care for certain types of imaging studies. These contrast studies require protocols that deliver the contrast to the targeted organs at the time the imager is focused on the target. The quality of the images produced are dependent on consistent contrast delivery at high flow rates.1 One of the most common MDCT studies that utilize high pressure injected contrast media are cardiac and pulmonary angiography.2 It has been proposed that peripheral intravenous (IV) catheters with side holes may provide a benefit during high pressure injections of radiologic contrast media by reducing pressures at the exit site of the contrast, stabilizing the catheter in the vein lumen, reducing trauma to the vein, and providing a more and more uniform contrast concentration at the target organs.3-6 Johnson et al demonstrated the ability to deliver contrast with a 20 g fenestrated IV catheter to produce images that were not significantly different that images produced with an 18 g conventional IV catheter.7 Fig. 1: Fenestrated, intravenous catheter (BD Nexiva Diffusics ) High flow iodinated contrast during high pressure MDCT imaging will improve image quality when delivered through a fenestrated intravenous catheter as compared to a nonfenestrated catheter. This can be assessed by measuring Hounsfield units (a measure of contrast density) at specific anatomic landmarks and comparing the images produced when using the different catheters for contrast delivery. Therefore, the purpose of this study is to compare multidetector computed tomography (MDCT, a form of CECT) image quality following peripheral venous high pressure injection of iodinated intravenous contrast media between a 20 G fenestrated, intravenous catheter (BD Nexiva Diffusics ) and an 20 G non-fenestrated, intravenous catheter. Page 2 of 7

3 Images for this section: Fig. 1: Fenestrated, intravenous catheter (BD Nexiva Diffusics ) - Seongnam-Si/KR Page 3 of 7

4 Methods and materials The study is designed to compare the image quality of MDCT cardiac/pulmonary scans using high flow rates of iodinated contrast. Three cohorts of patient images were obtained. 1. Patients who have suitable vein anatomy to place a 20 gauge IV catheter was randomized into 2 groups. Group 1 (n=100) received a 20 gauge conventional IV catheter and Group 2 (N=100) received a 20 gauge Diffusics IV catheter. 2. Patients who do not have suitable anatomy to support a 20 gauge IV catheter received a 22 gauge Diffusics IV catheter. This Group 3 continued enrollment until 100 patients are identified (n=100). Once all of the images are acquired, they were analyzed to determine the Hounsfield units at these specific locations: Cardiac CT angio- Ascending aorta, left coronary artery, left ventricular cavity, descending aorta at the level of the left bronchus. All patients were scanned using the same cardiac/pulmonary scan protocols and measurements were assessed for images. Once the images have been obtained and Hounsfield units data captured, comparative statistics were used to determine variance among the three Groups. 1. Group 1 and Group 2 were compared to determine the quantitative improvement of contrast delivery with the same gauge fenestrated IV catheter (Group 2) versus a conventional IV catheter (Group 1). This was the assessment for the primary endpoint. 2. Group 1 and Group 3 were compared to determine the ability of a 22 gauge fenestrated IV catheter to deliver IV contrast as efficiently as a 20 gauge non-fenestrated conventional IV catheter. This was the assessment for the secondary endpoint. Page 4 of 7

5 Fig. 2: The Figure below visually displays the study design Results No severe adverse reactions such as extravasation were recorded. According to the final assessment, mean density of the left main coronary artery, LV cavity, and descending aorta were significantly higher in the 20 G fenestrated, intravenous catheter (Diffusics) than in the 20 G non-fenestrated (conventional), intravenous catheter group (p < 0.05). However, mean densities of the ascending aorta was not different between the two groups. Moreover, PSI was significantly lower in the 20 G fenestrated, intravenous catheter (Diffusics) than in the 20 G non-fenestrated (conventional), intravenous catheter group (p < 0.05). In the evaluation of the ability of a 22 gauge fenestrated IV catheter Diffusics) to deliver IV contrast as efficiently as a 20 gauge non-fenestrated (conventional) IV catheter, mean density of the left main coronary artery,, LV cavity, and descending aorta were significantly higher in the 22 G fenestrated, intravenous catheter (Diffusics) than in the 20 G non-fenestrated (conventional), intravenous catheter group (p < 0.05). However, mean densities of the ascending aorta were not different between the two groups. In addition, PSI was also significantly lower in the 22 G fenestrated, intravenous catheter (Diffusics) than in the 20 G non-fenestrated (conventional), intravenous catheter group (p < 0.05). Page 5 of 7

6 Fig. 3: Mean densities and PSI of 20G nonfenestrated (conventional) and 20G fenestrated, intravenous catheter(diffusics) Fig. 4: Mean densities and PSI of 20G nonfenestrated (conventional) and 22G fenestrated, intravenous catheter(diffusics) Conclusion In conclusion, 20 G or 22 G fenestrated, intravenous catheter (BD Nexiva Diffusics ) can provide improved enhancement of the left main coronary artery, LV cavity, and descending aorta. It can also shows similar attenuation in the ascending aorta without any increase in adverse drug reactions, as compared with 20 G non-fenestrated (conventional), intravenous catheter. Moreover, PSI was also significantly lower in the 22G or 22 G fenestrated, intravenous catheter (Diffusics) than in the 20 G non-fenestrated (conventional), intravenous catheter. Page 6 of 7

7 Personal information References 1. Paparo F, Garello I, et al. CT of the abdomen: Degree and quality of enhancement obtained with two concentrations of the same iodinated contrast medium with fixed iodine delivery rate and total iodine load. European Jour Rad 83:(2004) Kang E, Lee K, et al. Triple rule-out acute chest pain evaluation using 320-row-detector volume CT: a comparison of the wide-volume and helical modes. Int J Cardiovasc Imaging. 28: Grigioni M, Daniele C, Morbiducci U, et al. Computational model of the fluid dynamics of a cannula inserted in a vessel: incidence of the presence of side holes in blood flow. J Biomech 2002;35: Weber PW, Coursey CA, et al. Modifying peripheral IV catheters with side holes and side slits results in favorable changes in fluid dynamic properties during the injection of iodinated contrast material. AJR 2009; 193: Daniel TB, Akins EW, Hawkins IF Jr. A solution to the problem of high-flow jets from miniature angiographic catheters. AJR 1990; 154: Park JY, Park CY, Min BG. A numerical study on the effect of side hole number and arrangement invenous cannulae. J Biomech 2007; 40: Johnson P, Christensen G, Fishman E. IV Contrast Administration WithDual Source 128-MDCT: A RandomizedControlled Study Comparing 18-Gauge Nonfenestrated and 20-Gauge Fenestrated Catheters for Catheter Placement Success, Infusion Rate, Image Quality, and Complications. AJR 2014;202: Page 7 of 7