From the Guidelines
Contrast media can be used in the midline, but it is crucial to use low- or iso-osmolar contrast media at the lowest possible volume, as recommended for patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome 1. When considering the use of contrast media in the midline, several key factors must be taken into account to minimize potential risks and complications.
- The type of contrast media used is vital, with low- or iso-osmolar contrast media being preferred due to their reduced nephrotoxicity, especially in patients with chronic kidney disease (CKD) 1.
- The volume of contrast media should be kept as low as possible to further reduce the risk of contrast-induced nephropathy, a significant concern in patients undergoing invasive strategies 1.
- Pre- and post-hydration with isotonic saline may be considered, particularly if the expected contrast volume exceeds 100 mL, to help mitigate the risk of kidney injury 1.
- It is also essential to assess kidney function by estimated glomerular filtration rate (eGFR) in all patients before proceeding with contrast media administration through a midline catheter, as this can influence the choice of contrast and the volume used 1.
- The technical aspects of administering contrast through a midline, such as using a power-injectable midline and following specific protocols for injection rates and pressures, are critical to prevent mechanical complications like catheter rupture or vascular injury. Given the potential risks associated with contrast media administration, especially in vulnerable populations like those with CKD, it is imperative to adhere to guidelines that prioritize the use of low- or iso-osmolar contrast media at the lowest possible volume, as outlined in the 2020 ESC guidelines for the management of acute coronary syndromes 1.
From the Research
Use of Contrast Media in the Midline
- There is no direct evidence in the provided studies that specifically addresses the use of contrast media in the midline.
- However, the studies discuss the safety and use of contrast media in various medical imaging procedures, including the potential risks and benefits 2, 3, 4, 5, 6.
- The use of contrast media is generally considered safe when administered correctly, but reactions can occur and can be life-threatening 4.
- It is essential to weigh the theoretical risks and benefits and avoid contrast agent administration unless it is truly necessary, especially in certain populations such as pregnant or breast-feeding women 2, 6.
- The studies also discuss the importance of patient information, legal aspects, and risk-benefit analysis in the use of contrast media 5, 6.