Power-Injectable Peripherally Inserted Central Catheter Tip Malposition After Power Injection of Intravenous Contrast Media for Computed Tomography Examinations

The aim of this study is to describe the incidence of peripherally inserted catheter tip (PICC) migration after power injection of intravenous contrast for computed tomography (CT) examinations. Retrospective review was conducted of all PICC power injections for CT examinations during the study period: October 16, 2017 through October 23, 2018. Review included evaluation of preinjection and postinjection topograms to assess PICC tip position. Chi-squared statistical analysis was applied. A total of 594 topograms were obtained of power-injectable PICCs during the study period in anticipation of power injection with iodinated contrast media. Of those, 550 patients had satisfactory preinjection topograms and available postinjection topograms; 43 (7.8%) demonstrated tip malposition attributable to power injection of contrast media. Anatomic side of PICC placement and subsequent malposition were independent variables by chi-square test (chi-square =.09, P =.76); 32 of 429 (7.5%) right-sided PICCs versus 11 of 121 (9.1%) left-sided PICCs demonstrated new malposition after contrast media power injection. No complications related to power injection of contrast media through these PICCs were observed. PICC tip malposition secondary to power injection of iodinated contrast media is common and readily identifiable. Obtaining both preinjection and postinjection topograms ensures appropriate catheter position during injection and upon patient departure. Rapid saline flush is a noninvasive maneuver that allows a high chance of successful repositioning of catheter tips. Power injection of contrast media through a power injectable PICC is safe.