What kind of IV access is ideal for use for IV contrast injection?

The best site for IV access is the right antecubital fossa. This site provides a combination of optimal safety plus a good point to time delivery of contrast in studies such as cardiac CTA and pulmonary embolism studies. The left antecubital fossa would be our second choice.

We prefer an 18g angiocatheter in the antecubital fossa when possible. This typically can easily accept injection rates of 5 cc/sec without any problem. We will use a 20g when an 18g is not possible. For 20g we can inject up to 4 cc/sec safely.

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"Although 22-gauge catheters may be able to tolerate flow rates up to 5 ml/sec, a 20-gauge or larger catheter is preferable for flow rates of 3 ml/sec or higher. An antecubital or large forearm vein is the preferred venous access site for power injection. If a more peripheral (e.g., hand or wrist) venipuncture site is used, a flow rate of no greater than 1.5 ml/sec may be more appropriate."

ACR Manual on Contrast Media
Version 9 (2013)

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"A critical step in preventing significant extravasation is direct monitoring of the venipuncture site by palpation during the initial portion of the contrast medium injection. If no problem is encountered during the first 15 seconds, the individual monitoring the injection exits the CT scan room before the scanning begins. If extravasation is detected, the injection is stopped immediately. Communication between the technologist and the patient via an intercom or television system should be maintained throughout the examination."