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, accounting for 12% of all cases.1
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.2
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.3
At this point, hydration with normal saline remains the standard of care for the prevention of CIN with adjunctive therapies being utilized in specific high-risk patient populations although their utility continues to be questioned.4
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.”5
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.6
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.7
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. Solomon R. Contrast-medium-induced acute renal failure. Kidney Int. 1998;53(1):230-242.
3. 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.
4. Kantorovich A. Prevention of contrast-induced nephropathy: what is the best approach? Pharmacy Times. Published March 27, 2018. Accessed May 1, 2024. https://www.pharmacytimes.com/view/prevention-of-contrastinduced-nephropathy-what-is-thebest-approach
5. 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.
6. 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.
7. Gupta RK, Bang TJ. Prevention of contrast-induced nephropathy (CIN) in interventional radiology practice. Semin Intervent Radiol. 2010;27
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US-N/A-2100060 06/24
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).
INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION
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).
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); Scientific Information: 1-800-257-5181 (Option 2); EmpowerCTA+ Email: empowerinfo@diag.bracco.com; Website: https://smartinject.com/ct-solutions/
EmpowerCTA+ is manufactured by 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); Scientific Information: 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 can 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 appropriately licensed healthcare facility.
The NEXO Contrast Management System is compatible with the EmpowerCTA Injector System version 8.0, and EmpowerCTA®+ Injector System version 10.0 and higher.
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 ACIST Medical Systems, 7905 Full Road, Eden Prairie, MN 55344 USA.
ulricheasyINJECT Max 3™
ulricheasyINJECT Max 3 is manufactured by ulrich GmbH & Co. KG.
ulricheasyINJECT Max 3 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); Scientific Information: 1-800-257-5181 (Option 2); Website: https://smartinject.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 EmpowerCTA®+ Injector System and EmpowerMR Injector System Bracco Imaging will be able to focus on constant innovation, not only for devices but also for software development and data management.
EmpowerCTA, EmpowerMR, NEXO, and IRiSMR are registered trademarks of ACIST Medical Systems, Inc.
FastLoad is a trademark of ACIST Medical Systems, Inc.
ulrich medical is a registered trademark of ulrich GmbH & Co. KG.
ulricheasyINJECT Max 3 is a trademark of ulrich GmbH & Co. KG.
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