For every patient, a strategy that encourages performing the right imaging (with or without radiological contrast media) in order to answer the diagnostic question at the first time of asking, should always be the correct way to proceed.
Many critically ill patients have central venous catheters (CVCs) in place and, over time, reliable peripheral venous access becomes increasingly difficult to obtain. A proportion of these patients will be required to undergo contrast enhanced computed tomography (CT) or occasionally Magnetic Resonance Imaging (MRI) scans as a part of their patient journey. This procedure often involves the administration of contrast media at relatively high volumes, rates and pressures in order to obtain images of adequate diagnostic quality to answer a clinical question. In many cases, CVCs are not approved by the manufacturer for this purpose thus meaning the use of such devices is “off-label”. The need to compromise image quality or create additional risk associated with the use of central access creates professional and ethical conflict.
The aim of this guidance is to propose pragmatic recommendations (which can be used as a basis for local policy development at an organisational level), with regards to the administration of radiological contrast media via CVCs in critically ill adult patients. This guidance is aimed at the use of non-tunnelled central venous catheters (inserted either in the internal jugular, subclavian or femoral veins) rather than other central venous access devices such as tunnelled catheters, Totally Implanted Venous Access Ports (TIVAPs) or peripherally inserted central catheters (PICCs).