Support Hydration and
Improve Safety With Saline
Post-medication injection of saline reduces the risk of contrast-induced nephropathy
Contrast-induced nephropathy (CIN) is a serious complication of the use of contrast media (CM) and is the third most important cause of hospital-acquired renal failure,2 accounting for 12% of all cases.3
In fact, an increasing number of patients with more risk factors for CIN are undergoing contrast-enhanced examinations, especially computed tomography (CT)—an expected result of aging populations presenting with an expanding number of comorbid conditions.4
In addition, the indications for use of CM have expanded in recent decades along with advances in interventional techniques, fast multislice CT, and three-dimensional reconstruction techniques.1
Although various measures have been recommended to prevent CIN in patients receiving contrast in CT, there is a paucity of evidence to indicate that the incidence rate of CIN is declining.1
However, one measure that has shown both consistent efficacy in supporting best contrast practices and reducing the incidence of CIN is pre- and post-contrast administration of intravenous (IV) saline.
The Importance of Intravenous (IV) Saline
There are clinical benefits to administration of saline after contrast injection, including reduced incidence of contrast-induced nephropathy (CIN).
Randomized studies have found IV hydration with normal saline to be effective in the prevention of CIN and recommended for patients of all risk categories; in fact, it is considered mandatory in the management of patients with kidney disease.
According to Fishman and Reddan,1 in a survey of radiologists participants were asked to rate the efficacy of specific interventions for lowering the risk of CIN—84% rated post-contrast intravenous (IV) administration of saline as highly effective.
Post-Contrast Saline
Importantly, IV administration has been shown to be markedly superior to oral hydration. In fact, in a small randomized controlled trial in patients undergoing cardiac catheterization, those patients receiving unrestricted oral fluids were nine times more likely to develop CIN than were those receiving IV normal saline hydration (1 ml/kg/hour) for 12 hours before and after the procedure.5
In their 2008 review, Thomsen and colleagues concluded that, “extracellular volume expansion seems to be the most effective of all the measures used to prevent CIN,” adding that, “The hydration regime should start before and continue for several hours after CM exposure.”6
In fact, after reviewing the available evidence, the CIN Consensus Working Panel concluded that IV hydration is the “only strategy that has been shown consistently to reduce the risk of CIN.”7
Using post-contrast administration of saline also supports best practices, according to the American College of Radiology, which notes that the reported incidence of post-contrast acute kidney injury (PC-AKI) can be decreased by post-contrast saline.8
In addition, supporting patient hydration via post-contrast IV fluid hydration is considered to be “the mainstay of practice in the prevention of CIN,” in that it is low-risk, poses few side effects and is cost-effective.9
References:
1. Fishman EK, Reddan D. What are radiologists doing to prevent contrast-induced nephropathy (CIN) compared with measures supported by current evidence? A survey of European radiologists on CIN associated with computed tomography. Acta Radiol. 2008;49(3):310-320. doi:10.1080/02841850701858257
2. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930-936.
3. Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74(2):243-248.
4. Solomon R. Contrast-medium-induced acute renal failure. Kidney Int. 1998;53(1):230-242.
5. Trivedi HS, Moore H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract. 2003;93(1):C29-C34.
6. Thomsen HS, Morcos SK, Barrett BJ. Contrast-induced nephropathy: the wheel has turned 360 degrees. Acta Radiol. 2008;49(6):646-657.
7. Stacul F, Adam A, Becker CR, et al. Strategies to reduce the risk of contrast-induced nephropathy. Am J Cardiol. 2006;98(6A):59K-77K.
8. American College of Radiology. ACR Manual on Contrast Media, 2021. https://www.acr.org/-/media/ACR/files/clinical-resources/contrast_media.pdf [PDF download]. Published January 2021. Accessed October 25, 2021.
9. Gupta RK, Bang TJ. Prevention of contrast-induced nephropathy (CIN) in interventional radiology practice. Semin Intervent Radiol. 2010;27
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IMPORTANT SAFETY INFORMATION | INDICATIONS AND USAGE
EmpowerCTA®+ Injector System
Caution: Federal law restricts this device to sale by or on the order of a physician.
INDICATIONS:
The EmpowerCTA®+ Injector System is indicated for the vascular administration of contrast and flushing media in conjunction with computed tomography (CT) scanning of the body with an optional interface to a CT scanner and an optional calculator for glomerular filtration rate (GFR).
EmpowerCTA®+ Injector System
INDICATIONS:
The EmpowerCTA®+ Injector System is indicated for the vascular administration of contrast and flushing media in conjunction with computed tomography (CT) scanning of the body with an optional interface to a CT scanner and an optional calculator for glomerular filtration rate (GFR).
The Extravasation Detection Accessory (EDA™) is an optional accessory and is indicated for the detection of extravasations of ionic and nonionic contrast during CT procedures using a power injector.
Protocols have been independently developed and are not intended as medical advice. Bracco and Bracco Injeneering S.A. shall not be responsible for any physicians’ reliance on these or any other products.
CONTRAINDICATIONS:
The EmpowerCTA®+ Injector System is not intended for use as a long-term infusion pump, nor is it intended to be used to inject any agents other than contrast or flushing media. Do not attempt to use the Injector for any other purpose (such as chemotherapy or drug infusion). The EmpowerCTA+ Injector System should not be used to inject substances into nonvascular body cavities. Any applications of the EmpowerCTA+ Injector System other than those described in its Operator Manual are inappropriate and should not be attempted.
Not all products are available in all global markets.
EmpowerCTA+ is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Bldg. H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Professional Services: 1-800-257-5181 (Option 2); EmpowerCTA+ Email: empowerinfo@diag.bracco.com; Website: https://smartinject.com/ct-solutions/
EmpowerCTA+ is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. https://www.bracco.com/
EmpowerMR® Injector System
Caution: Federal law restricts this device to sale by or on the order of a physician.
INDICATIONS:
The EmpowerMR® Injector System is indicated for vascular administration of contrast media and flushing media in conjunction with magnetic resonance imaging (MRI).
Protocols have been independently developed and are not intended as medical advice and Bracco shall not be responsible for any physicians' reliance on these or any other protocols.
Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.
Not all products are available in all global markets.
EmpowerMR is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Bldg. H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Professional Services: 1-800-257-5181 (Option 2); Website: https://smartinject.com/mr-solutions/
EmpowerMR is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46 CH – 1004 Lausanne, Switzerland. https://www.bracco.com/
NEXO® Contrast Management System
Intended Use:
The NEXO® Contrast Management System is a server-based application intended to be used as a data-management and visualization system. The NEXO Contrast Management System is able to read, store, share, compare/relate, as well as graphically display data and injection programs coming from RIS, PACS and multiple enabled EmpowerCTA®Injector Systems. This device provides users with record-lists, graphics and reports about data and performances.
This device is intended for retrospective and statistical data management and visualization. It is not intended for real-time data visualization, diagnostic applications or for any other use for which the device is not indicated. This device is only to be operated by and under quasi-continuous supervision of qualified and trained staff in an appropriate licensed healthcare facility.
The NEXO Contrast Management System is compatible with the EmpowerCTA Injector System version 8.0, and EmpowerCTA®+ Injector System version 9.0 and higher.
Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.
Not all products are available in all global markets.
NEXO is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Building H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; NEXO Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO questions: Nexo.Answers@diag.bracco.com; NEXO U.S. Technical Service and Support: Phone: 888-670-7701; Fax: 609-514-2448; NEXO Email: customer.support@acistmedical.com; Website: https://smartinject.com/digital-solutions
NEXO is manufactured by Bracco Injeneering S.A., Avenue de Sévelin 46, CH-1004 Lausanne, Switzerland. https://www.bracco.com/
About Bracco Injeneering S.A.
Bracco Injeneering S.A., located in Lausanne, Switzerland, is the most recently added Business Unit of Bracco Imaging. Bracco Injeneering is committed to developing the best-in-class integrated injection solutions with a strong heritage in research and innovation. It provides quality solutions for state-of-the-art radiology centers, offering proven injection technology, built on Bracco Imaging’s expertise.
Thanks to this strengthened product portfolio, including the CT Exprès® 3D Contrast Media Delivery System, EmpowerCTA+ Injector System, EmpowerMR® Injector System, and NEXO® Contrast Management System, Bracco Imaging will be able to focus on constant innovation, not only for devices but also for software development and data management.
CT Exprès, EmpowerCTA, EmpowerMR, IRiSCT, and NEXO are registered trademarks of Bracco Injeneering S.A.
EDA and FastLoad are trademarks of Bracco Injeneering S.A.
These are representative images from reference studies; individual results may vary.
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