The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using intraosseous needle intravenous access (ION-IVA) for contrast media injection (CMI).
All CTA-TA exams at the study institution performed between 1/1/2013 and 8/14/2015 were reviewed retrospectively to identify those exams which had been performed using ION-IVA (ION-exams). ION-exams were then analyzed to determine aortic attenuation and contrast-to-noise ratio (CNR). Linear regression was used to determine how injection rate and other variables affected image quality for ION-exams. Patient electronic medical records were reviewed to identify any adverse events related to CTA-TA or ION-IVA.
17 (∼0.2%) of 7401 exams were ION-exams. ION-exam CMI rates varied between 2.5 and 4 ml/s. Mean attenuation was 312 HU (SD 88 HU) and mean CNR was 25 (SD 9.9). A strong positive linear association between attenuation and injection rate was found. No immediate or delayed complications related to the ION-exams, or intraosseous needle use in general, occurred.
For CTA-TA, ION-IVA appears to be a safe and effective route for CMI at rates up to 4 ml/s.
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The work was supported by a grant from Teleflex Incorporated and by NIH grant 8UL1TR000117.
Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j.jcct.2017.03.001.
Winkler, Michael A.; Talley, Cynthia; Woodward, Connor; Kingsbury, Alexander; Appiah, Frank; Elbelasi, Hossam; Landwehr, Kevin P.; Li, Xingzhe; and Fleischmann, Dominik, "The Use of Intraosseous Needles for Injection of Contrast Media for Computed Tomographic Angiography of the Thoracic Aorta" (2017). Radiology Faculty Publications. 8.
VR image of data from an ION-exam. Note that there is bilateral extravasation from two injection attempts via antecubital IVA. In this case, ION-IVA was used to salvage the study.
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VR image of data from a different ION-exam. Note that in this case the post contrast media saline flush was not adequate and there is residual contrast within the venous system. The image demonstrates the relationship of the intramedullary space to the veins of the upper extremity.