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Injection


GENERAL INJECTION GUIDELINES

   
1. Always test line first with 10 cc NS rapid injection and flush line with 20 cc NS after injection
2. Stay in room after injection to ensure no extravasation
   
3. EJ: MANUALLY inject in emergency situations if no other line available.
            Avoid injecting if possible.
   
4. Triple Lumen central venous catheter
             Brown port can tolerate 3.5cc/s max and can be used for angio studies
             Can only power inject through brown port for angio study if TPN not running
             White/blue ports can handle 1.7cc/s max, only hand inject through white/blue ports!
                         
5. Never inject leg/ foot. Hands ok with slow injection
   
6. Raise arm up onto scanner to ensure adequate contrast flow
   
7. Increase flow rates for larger patients
   
8. Decrease flow rates for smaller patients with fragile veins
   
9. MEDIPORT – FLUSH AFTER!


GAUGES AND MAXIMUM INJECTION RATES

    GAUGE                     RATE cc/sec
     
    24 (yellow)               1.5-1.7
   
    22 (blue)                  2.0 – 3.0
   
    20 (pink)                  3.0-4.0 (really up to 5.0)
   
    18 (green)                up to 5.0
 
    Power PICC (purple) First check manufacturer (if in doubt if it is a power picc, do hand injection) 
                                   if Power PICC (purple), follow manufacturer's max allowed injection rate
    MediPort                  First check manufacturer (if in doubt if it it is a power port, do hand injection)
                                   if Power PORT to be injected at high rate ( i.e. PE study), you need SPECIAL NEEDLE access


GAD CONTRAST & DOSE
    eGFR>45         routine agent Magnevist, dosed approximately 2 cc/kg~1 cc/lb, max 20cc
    eGFR<45         Follow departmental guidelines


IODINATED CONTRAST & DOSAGES
Isovue 300 Intravenous contrast is the routine agent


Chest/Abdomen/Pelvis (not PE/dissection)
GAUGE           22            20
RATE             1.5-1.7     1.7-2.0 (3.0)
VOLUME        100          100
DELAY           Chest 25 sec, A/P 70 sec 


Abdomen/Pelvis Routine
GAUGE          22           20
RATE             1.5-1.7     2.0-2.5
VOLUME        100         100
DELAY           70-75 seconds



Abdomen/Pelvis Angio
GAUGE          20           18
RATE             3.0          3.5-4.0
VOLUME        100         100
DELAY           25 seconds or SureStart

PE/Dissection
GAUGE         18           20***
RATE            3.5-4.0    2.5-3.0
VOLUME       140

DELAY          SureStart, Dissection is appxm 20-24s, PE is 16s
                      If only 20 Gauge is available, study may be limited.
                      Dissection study preferably get right arm IV

CT Brain (not CTA)
RATE          2.0 cc/sec
VOLUME   100cc


Neck and Chest
RATE          2.0 cc/sec
VOLUME     70 cc volume for neck
then another injection of 70cc for chest

CTA Neck
GAUGE     18 in right arm
RATE         4 cc/sec
DELAY       8-10s

CTA Head
GAUGE     18
RATE        4 cc/sec required