chapter  21
14 Pages

CO2 with Central Venous Access and Venous Interventions

WithKyung J. Cho, Aya Kamaya, Seong T. Hahn

Carbon dioxide (CO2) is a safe, useful alternative contrast agent for venous injection

studies in patients with diabetes, contrast allergies, and renal insufficiency. CO2 is used

to visualize target veins for venipuncture, to provide a central venous roadmap prior to

central venous catheter placement, and to evaluate malfunctioning central venous cath-

eters. CO2 is also used to visualize the hepatic and portal veins from a percutaneous

transhepatic or transjugular approach. We also use CO2 for various venous interventions

including angioplasty, stenting, catheter-directed thrombolysis, and declotting of throm-

bosed hemodialysis graft. The low viscosity of CO2 allows its injection through rela-

tively small needles and better visualizes the central veins via the collateral veins in the

presence of venous occlusions. The plastic bag system is very useful for the delivery of

CO2. CO2 in quantities used for venous imaging causes no changes in vital signs. Moni-

toring with frequent blood pressure measurement and capnometry is essential in early

diagnosis of significant gas embolism from air contamination. CO2 injections should be

separated by two to three minutes to allow complete absorption of the gas.