Variant 1: Device selection. Adult or child ≥13 years of age. Intravenous access for long-term total parenteral nutrition and intermittent intravenous antibiotics.
Variant 2: Device selection. Adult or child ≥13 years of age. Sickle cell anemia requires intravenous access for the treatment of recurrent sickle cell crisis.
Variant 3: Device selection. Adult or child ≥13 years of age. Stage 3 chronic kidney disease requires central venous access for 6 weeks of antibiotic treatment.
Variant 4: Device selection. Adult or child ≥13 years of age. Intensive care unit (ICU) patient with sepsis and acute renal insufficiency requires intravenous access for approximately 7 to 10 days.
Variant 5: Site selection. Adult or child ≥13 years of age. Head and neck surgery. Central venous access required for adjuvant chemotherapy.
Variant 6: Site selection. Adult or child ≥13 years of age. Sepsis in a patient with stage 4 chronic kidney disease, requires 7 to 10 days of intravenous antibiotic therapy.
Variant 7: Site selection. Adult or child ≥13 years of age. ICU patient with sepsis. The patient receives hemodialysis via nontunneled catheter placed via the right internal jugular vein. Multilumen central venous access required.
Variant 8: Site selection for permanent hemodialysis catheter. Adult or child ≥13 years of age. End stage renal disease has undergone creation of a left arm arteriovenous fistula. The fistula has not yet matured.
Variant 9: Immunocompromised patient. Adult or child ≥13 years of age. Has a tunneled small-bore catheter placed via right internal jugular vein. Patient is pancytopenic (ANC 300/µL, PLT 32,000/µL) and presents with fevers and malaise.
Variant 10: Thrombotic complications. Adult or child ≥13 years of age. Chest port placed via right internal jugular vein is being used for chemotherapy. The infusion nurse can infuse saline but is unable to aspirate blood from the catheter.
Variant 11: Thrombotic complications. Adult or child ≥13 years of age. Permanent hemodialysis catheter placed via the right internal jugular vein. Poor flows are documented at hemodialysis via both lumens.
Variant 12: Thrombotic complications. Adult or child ≥13 years of age. Arm swelling secondary to extensive thrombus surrounding a triple lumen PICC placed via left Basilic vein. The catheter is being used for long-term parenteral nutrition and intermittent intravenous antibiotics. The catheter is functioning.
Variant 13: Infectious complications. Adult or child ≥13 years of age. Preventive measures to reduce catheter-related bloodstream infections when placing a nontunneled central venous catheter in ICU patient.
Variant 14: Infectious complications. Adult or child ≥13 years of age. Therapeutic measures to manage catheter-related bloodstream infections.
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.