Central venous catheter injection

  • Patient preparation: none
  • Contrast used: low osmolar water soluble
  • Technique:
    — Port needs to be accessed by clinical service
    — Remove swab cap from end of catheter and clean end of catheter with alcohol wipe
    — Check return and flush the port with 5 cc sterile saline
    — Set video to high frame-rate mode
  • Images to obtain:
    — AP scout of entire chest
    — AP scout centered on entire catheter and port after magnifying image so entire catheter and port fills screen
    — Inject contrast to fill the catheter, take magnified AP image centered on entire catheter and port to check for leaks
    — Inject contrast continuously, take magnified AP image centered on entire catheter and port to check for leaks
    — Inject contrast continuously, take as magnified as possible AP image of tip of catheter to check for thrombus or fibrin sheath
  • Looking for: port leaking, catheter broken or leaking, catheter tip migrated either out of vessel or occluded against wall of vessel, fibrin sheath or thrombus at catheter tip, retained or embolized catheter fragment or fibrin sheath after catheter removal
  • Post procedure tasks: flush the line with 5 cc sterile saline and place a swab cap on the catheter and return patient to clinic where they will receive 5 cc heparin flush in the catheter