Standardization of Access for Administration of Intravenous Contrast for Computed Tomography Scans

Abstract

Problem and Purpose. The extravasation rate from Computed Tomography (CT) scans with intravenous contrast (IVC) in a large academic medical institution is 0.36% (inpatient 0.39% and outpatient 0.30%), higher than the national benchmark of 0.26%. A survey also showed that 16% of inpatients arrive at the CT scan department with peripheral intravenous (PIV) lines that may be kinked, dislodged, phlebitis or thrombose formation, or dressings are not intact. These conditions delay the CT scan procedure and put the patient in an unsafe condition. The purpose of this Quality Improvement (QI) project is to implement a protocol to standardize the preparation of PIV lines for inpatients for the administration of IVC to promote patient safety, prevent delays in CT scan, and eliminate common risk factors for extravasations. Methods. The QI project involved inpatients from a 23-bed adult medical telemetry nursing unit with CT scan orders with IVC using a PIV line. It required a coordinated effort between the bedside Registered Nurses (RNs), CT Technologists, Vascular Access Team (VAT) RNs, and Radiology RNs. The protocol involved the proper assessment of the PIV lines before leaving the bedside, using a test flush technique with 10 mL saline to flush in two seconds (5 mL/sec). Failure of the PIV line to accommodate the test flush required re-cannulation by the VAT RN. Results. During the 16-week implementation period, 17 patients (33%) ordered for CT scan with IVC underwent the protocol to standardize PIV lines' preparation. Among these patients, five (29%) did not pass the test flush and were re-cannulated by the VAT RNs. Conclusions. Bedside RNs play essential roles in preparing patients for CT scans with IVC. Adequate assessment of the PIV lines using the test flushing technique at the bedside before transporting patients to the CT Scan Department ensured that non-patent PIV lines receive re-cannulation. This protocol eliminated a common risk factor for extravasation and prevented potential harm to the patient and CT scan delays.