Proposta de procedimento operacional padrão para administração de meio de contraste iodado não iônico via cateter venoso central em exames de tomografia computadorizada

Abstract

Introduction: Intravenous iodinated contrast medium administration is often essential for optimal computed tomography evaluation and is conventionally performed via peripheral venous access. However, a substantial proportion of hospitalized patients have difficult or impossible peripheral access due to clinical, therapeutic, or situational factors, and most already have central venous catheters (CVCs) in place. These devices have traditionally been avoided for contrast injection due to safety concerns. Recent evidence supports their use when specific parameters are followed; yet institutional standardization remains lacking. Objective: To develop a standard operating procedure (SOP) for the safe administration of non-ionic iodinated contrast media through CVCs during computed tomography scans, based on scientific evidence and tailored to the institutional setting of the Diagnostic Imaging Unit at Hospital das Clínicas, Federal University of Uberlândia (HC-UFU), Brazil. Methods: This SOP development study was based on an extensive narrative review of the available scientific literature. PubMed and SciELO databases, guidelines from radiological societies (ACR, CBR, and SPR), and manufacturers' technical manuals were reviewed, encompassing publications from 2001 to 2024. Evidence synthesis was organized according to the catheter types available at HC-UFU, recommended safety parameters, and the institution's technical equipment constraints. Results: The protocol establishes conservative, uniform parameters applicable to all CVC types: maximum injection flow rate of 2.0 mL/s and a maximum pressure limit of 200 PSI for adults (150 PSI for children). It also delineates specific responsibilities for each multidisciplinary team member (radiologist, radiology technician/technologist, and nursing staff), outlines a standardized three-step procedure, mandates patency verification with a 20 mL 0.9% saline flush, and provides a clear operational flowchart. Conclusion: A comprehensive SOP tailored to the HC-UFU setting was developed, prioritizing patient safety through conservative parameters applicable to the vast majority of catheters used at the institution. This SOP offers a structured framework for standardizing practices, reducing examination cancellations, and enhancing quality of care, pending clinical validation and continuous post-implementation monitoring.