Comparison of 18-gauge and 20-gauge catheters for IV contrast infusion

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“A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to IV contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.” Johnson et al (2014).

Reference:

Johnson, P.T., Christensen, G.M. and Fishman, E.K. (2014) IV Contrast Administration With Dual Source 128-MDCT: A Randomized Controlled Study Comparing 18-Gauge Nonfenestrated and 20-Gauge Fenestrated Catheters for Catheter Placement Success, Infusion Rate, Image Quality, and Complications. AJR American Journal of Roentgenology. 202(6), p.1166-70.

Abstract:

OBJECTIVE: The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for IV contrast infusion during MDCT.

SUBJECTS AND METHODS. Two hundred five adult outpatients imaged on a dual-source 128-MDCT scanner with arterial phase body CT (flow rates, 5.0-7.5 mL/s) were randomized to either an 18-gauge nonfenestrated or 20-gauge fenestrated catheter. After randomization, any 18-gauge nonfenestrated subjects whose veins were deemed insufficient for that catheter gauge were assigned to a third cohort for placement of a 20-gauge fenestrated catheter. Catheter placement success, infusion rate, contrast volume, maximum pressure, complications, and aortic enhancement levels were recorded.

RESULTS. Catheters were placed on the first attempt in 97% (100/103) for 18-gauge nonfenestrated and 94% (96/102) for 20-gauge fenestrated placements and in two or fewer attempts in 99% of both groups. Mean infusion rates (5.74 mL/s for 18-gauge nonfenestrated and 5.58 mL/s for 20-gauge fenestrated placements) and aortic enhancement levels were not significantly different. Maximum pressure was higher with 20-gauge fenestrated catheters (mean ± SD, 230.5 ± 27.6 pounds per square inch ) than 18-gauge nonfenestrated catheters (mean ± SD 215.6 ± 32.8 psi) (p = 0.002). One subject with an 18-gauge nonfenestrated catheter had a high-pressure alarm. In the third cohort, a 20-gauge fenestrated catheter was successfully placed in two or fewer attempts in 85% (28/33), with one minor extravasation attributed to vein insufficiency.

CONCLUSION. A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to IV contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.

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