Implementation of Central Venous Access Device Option for IV Contrast Administration during CT Simulation

Purpose/Aim

Intravenous (IV) contrast is frequently utilized at the time of radiation CT Simulation to enhance visibility of critical anatomical structures, providing important information for the clinical team when planning for radiation treatments. At our institution, when IV contrast is ordered by the Radiation Oncologist (RO), patients are booked for an appointment with a nurse immediately prior to CT Simulation, during which they have an IV inserted. For some patients, IV initiation is extremely challenging or impossible and often this information is known in advance of the CT Simulation appointment. These challenges have resulted in scenarios where IV contrast was not a feasible option and in discussion with the Radiation Oncologist (RO), CT Simulation was performed without contrast. This is less than ideal for radiation treatment planning, as ROs must then rely on diagnostic images for target delineation, where image fusion can be difficult due to differences in patient position and anatomy. Many radiation patients have existing Central Venous Access Devices (CVAD), for the purposes of systemic therapy treatment delivery. The aim of the practice innovation was to explore the feasibility of implementing a CVAD option to administer IV contrast for CT Simulation purposes.

Methods/Process

The Diagnostic Imaging (DI) Department at our institution routinely utilizes CVADs for the purposes of contrast administration during CT scans. Radiological Technologists in the DI department access, administer contrast and de-access lines via CVADs. During a visit with the lead charge technologist in DI at our institution, members of our working group were able to gain knowledge and insights regarding their processes and procedures with safety being the priority and goal. Subsequently, the working group sought specific feedback from various radiation therapy departments to confirm any adjustments required to contrast and scanning protocols. Utilizing the expertise of our IT department, the working group developed a new order set within the clinical information system that would support the option for the RO to order contrast administration through CVAD. This order set includes specific appointments, orders for accessing and de-accessing the CVAD for nursing as well as orders for as needed emergency medications in the event of contrast induced anaphylaxis.

Results or Benefits/Challenges

This is a significant benefit to patients with poor venous access with an existing CVAD. This provides patients with equitable care and the ability to ensure adequate delineation of CT images for radiation planning purposes. A potential challenge foreseen was a large number of requests for CVAD and therefore the initial implementation included a select patient population of those who had known difficulties rather than all patients with existing CVADs. This was to allow a gradual implementation to assess impacts on resources required, specifically the addition of an appointment for de-accessing the CVAD.

Conclusions/Impact

To date, there have been several patients scanned and planned for radiation treatment utilizing the CVAD for contrast purposes. Feedback from the clinical team has been positive, however we plan to seek more formal feedback from these patients directly to ensure we are meeting their needs and to determine any opportunities for improvement.