Implementation plan

Recommendation	Time frame for implementation: <1 year, 1 to 3years or >3 years	Expected effect on costs	Limitations for implementation	Barriers to implementation¹	Actions needed for implementation²	Parties responsible for actions³	Other remarks
Use a peripheral venous access catheter for IV power injected contrast administration to obtain the best quality level of contrast images.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
Check the position of the CVC TIVAD or PICC line and its patency before and after the power injected contrast administration, when a peripheral venous access catheter is unavailable.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
When optimal quality of contrast-enhanced images in CT is needed, the use of a power injector and a peripheral venous access catheter for IV contrast administration is recommended.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
Power-injectable central venous catheters may be safely used for administration of CM using a power injector, when recommendations of the catheter manufacturer are followed.	1-3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
Power-injectable haemodialysis catheters may be safely used for administration of CM using a power injector, when recommendations of the catheter manufacturer are followed.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
There is a risk of catheter tip migration of PICCs and TIVADs when CM is injected via a power injector in patients with a catheter tip position above the tracheobronchial angle. When a power-injectable PICC or TIVAD is used for CM administration, check the position of the catheter tip with a CT scout radiograph before and after power-injection of CM.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
When a power-injectable CVC, HC, PICC or TIVAD is used for CM administration with a power injector, check the patency of the catheter after the procedure by manual flush of 20ml normal saline.	1-3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR

¹ Barriers can be found at multiple levels. They can exist at the level of the consultant, the hospital organisation, and the health care system.

² Actions needed for implementation, but also actions to promote implementation. Think about checks during quality visits, guideline publication, information of hospital management, et cetera.

³ Who is responsible for implementation of recommendations will largely be determined by the level where the barriers are expected to be.