Marilyn,
I wanted to answer your questions. I will do so below:
1. The manufacturer’s (Bard) recommendation for using a power injector with Power PICCs includes instructions to remove the injection cap prior to use. I know the CT techs infuse through the injection caps on peripheral IVs, why the difference? Not all injection caps are approved by the FDA for use during power injection. As Bard can not guarantee which injection cap is being used, we are obligated to warn clinicians to remove the injection cap prior to power injection. If your hospital uses an injection cap that is approved by the FDA for power injection and / or you hospital writes a policy allowing power injection through an injection cap, that policy rules CT practice. Just be careful, if your hospital establishes a policy that goes against manufacturer's recommendations, your hospital could be open for legal action should any adverse event occur.
2. Does anyone have experience with CT techs doing this? I do know that there are institutions using injection caps for power injection--however to the best of my knowledge, they are using injection caps that are approved by the FDA for power injection of contrast media.
3. Doesn’t that open yet another door for introducing infections? You are absolutely correct, it does subject the line to yet another potential bacterial inoculation. However, if this use goes against manufacturer's recommendations, you could be opening up legal ramifications that are very costly and serious, not to mention potential negative outcomes for the patient. It is probably better to teach the technician how to do the procedure using proper aseptic technique rather than to implement a policy that requires less than the minimums the manufacturer recommends.
4. Do the CT techs heparinized them after use, or do the floor nurses do this? In most instances CT technicians infuse infusates into vascular access devices by hospital policy. The CT technician organization does not specify which infusates a technicians can infuse. In my experience, I have seen many different practices, however, most do not include infusion of heparinized saline following power injection of contrast media. Bard recommends that the CT technician flush the line with sterile saline following injection of contrast media and then send the patient back to the floor for the nurse to lock the catheter appropriately.
I hope you find this useful. Please let me know if I can provide additional assistance to you. Paul
