Dosis de radiación durante la inserción guiada por fluoroscopia de un dispositivo de acceso venoso central: un estudio observacional retrospectivo

Translated title of the contribution: Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study

M. K. Badawy, C. J. Witkowski, R. Baldoni, D. Carrion, E. Yildirim

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: Central venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps. Material and Methods: A retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n = 24) and 7.5 pps (n = 33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye. Results: The results show that the median dose area product (DAP) for CVAD insertion is 0.7 Gy.cm2 and 0.3 Gy.cm2 for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36 μSv, 0.1 μSv and 0.05 μSv when 7.5 pps was utilised and 0.13 μSv, 0.03 μSv and 0.02 μSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1 μSv, 1.4 μSv, and 0.6 μSv in the 7.5 pps studies and 0.7 μSv, 0.5 μSv, and 0.2 μSv when 4 pps was used. Conclusion: The patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.

Translated title of the contributionRadiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study
Original languageSpanish
Pages (from-to)5-12
Number of pages8
JournalRadiologia
Volume63
Issue number1
DOIs
Publication statusPublished - Jan 2021
Externally publishedYes

Keywords

  • Central venous access device
  • Fluoroscopy
  • Interventional radiology
  • Pulse rate
  • Radiation Dose
  • Radiation Safety
  • Staff

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