Carbon dioxide gas as a venous contrast agent to guide upper-arm insertion of central venous catheters.

PURPOSE: Evaluate in a prospective randomized study carbon dioxide (CO2) gas compared to iodinated contrast agent for image-guided placement of peripherally inserted central venous catheters (PICCs).

METHODS: The upper-arm approach to the central vein was used for placement of PICCs in 74 patients requiring intermediate or long-term central venous access. Fluoroscopy was used to obtain venous access during peripheral injection of CO2 (n = 41) or low osmolar contrast material (Omnipaque 240 mgI/ml) (n = 33).

RESULTS: Placement of PICCs was accomplished in 88% of the CO2 group and in 100% of the contrast group, with a mean venipuncture of two in both groups. Venous access was unsuccessful in five patients with CO2 due to a small vein, venous spasm, or technical failure. The mean and range of procedure times were 22.8 min (13-64 min) with CO2 and 23.2 min (12-60 min) with contrast material. The average and range of CO2 and nonionic contrast volumes injected during the procedure were 35.4 ml (5-300 ml) and 27.8 ml (8-120 ml), respectively. Vital signs and oxygen saturation did not change significantly during or after injection of CO2. There was no incidence of adverse reaction following CO2 injection.

CONCLUSION: CO2 gas is a useful contrast agent to guide upper-arm insertion of PICCs and may be a safe alternative in patients with renal insufficiency and/or allergy to iodinated contrast material.