It All Starts With Saline

Optimizing pre-contrast test injections—Using saline for safe and effective power injection in CT

 

The use of contrast media (CM) for diagnostic imaging and interventional studies has expanded rapidly in recent years, partly due to the efficiency of multi-detector computed tomography (MDCT) scanners that image internal organs faster.2

With this expanded use comes a wider variety of patients with different presenting conditions, including—but not limited to—congestive heart failure, renal insufficiency, and atherosclerotic cardiovascular disease.

With more procedures being carried out, more patients are at risk for development of contrast-induced nephropathy (CIN).

While relatively rare, out of the 36 million contrast-enhanced CT exams that are performed every year extravasation occurs in 0.1 to 1.2% of them, amounting to between 36,000 and 430,000 procedures annually.3

 

Strategies for Preventing CIN

 

Use of Saline

Apart from patient characteristics, procedural characteristics also impact the risk of developing CIN. Among these, one of the most important factors is the volume of CM administered—the greater the volume of administered contrast, the greater the risk of CIN.2

In this regard, of prime importance is minimizing the vulnerability of the kidney by enhancing renal perfusion and reducing any vasoconstrictive factors, which typically means volume expansion with intravenous (IV) saline.

In an early study looking at pre-contrast and post-contrast saline administration, researchers from New England Deaconess Hospital prospectively studied 78 patients with chronic renal insufficiency who underwent cardiac angiography. They were randomly assigned to receive 0.45% saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide.4

Twenty of the 78 patients (26%) experienced an increase in the serum creatinine concentration of at least 0.5 mg per deciliter after angiography. Among the 28 patients in the saline group, only 3 (11%) had such an increase in serum creatinine, as compared with 7 of 25 in the mannitol group (28%) and 10 of 25 in the furosemide group (40%) (P = 0.05). The mean increase in serum creatinine 48 hours after angiography was significantly greater in the furosemide group (P = 0.01) than in the saline group.4

The authors concluded that, in patients with chronic renal insufficiency who are undergoing cardiac angiography, hydration with 0.45% saline provides better protection against acute decreases in renal function caused by radiocontrast agents than does hydration with 0.45% saline plus mannitol or furosemide.4

Maintaining vein patency is of the utmost importance, as well, especially in terms of preventing extravasation.

 

Maintaining Vein Patency

Radiologists and technologists know that vein patency is key to minimizing extravasation risk.

In fact, in 2018 Einstein Healthcare Network, in Philadelphia, was named a finalist for the ECRI Institute’s 12th Health Devices Achievement Award for its research into reducing IV contrast extravasations that occur during contrast-enhanced computed tomography (CT) examinations.1

The Einstein researchers hypothesized that injecting a test bolus of saline using a power injector, instead of injecting it by hand, can decrease the number of subsequent IV contrast extravasations that occur during contrast-enhanced CT examinations.

To test this, the Einstein team initiated a protocol specifying that the saline test bolus be power-injected for all IV-contrast-enhanced studies. The team then compared extravasation rates for a 30-month period leading up to the start of this intervention with those observed during the 15-month period after the change.

Their review of data from over 34,000 contrast-enhanced CT examinations demonstrated that the intervention reduced extravasation rates by 54%.

Leveraging effective use of saline is critical to ensuring vein patency and reducing extravasation risk. When using Bracco SmartInject Systems, administering a test bolus of saline makes sense.

Power injection of the saline bolus more closely reproduces the force and pressure of the contrast injection.1* Plus, using saline this way makes it more likely that a weak IV line will be identified and less likely that extravasation will occur.

Using saline effectively can lead to greater overall patient safety, more efficient use of contrast and, ultimately, the highest quality images.

 

*Compared to a hand-injected test bolus.

 

References:
1. ECRI Institute. Reducing IV contrast extravasations during CT examinations—Einstein Healthcare Network validates a new approach. Health Devices. 2018 May 16.
2. Solomon R. Increasing awareness of and concern about contrast-induced nephropathy. US Cardiology. 2005;2(1):1–5.
3. The benefits of saline and dual-head injectors. Applied Radiology. August 2020. Available here: https://smartinject.com/2021/04/28/the-benefits-of-saline-and-dual-head-injectors/
4. Solomon R, Werner C, Mann D, D’Elia J, Silva P. Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331(21):1416–1420.
The views, information, or opinions expressed in the video(s) or article(s) above are solely those of the individuals involved and do not necessarily represent those of Bracco Diagnostics Inc. (“BDI”). The primary purpose of this video(s) or article(s) is to educate and inform. This information does not constitute medical or other professional advice or services.

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).

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 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://www.braccoimaging.com/us-en/products/injectors-informatics/empowercta

EmpowerCTA+ is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. http://imaging.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 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://www.braccoimaging.com/us-en/products/injectors-informatics/empowermr

EmpowerMR is manufactured by Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. http://imaging.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 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://imaging.bracco.com/us-en/products/injectors-informatics/nexo

NEXO is manufactured by Bracco Injeneering S.A., Avenue de Sévelin 46, CH-1004 Lausanne, Switzerland. http://imaging.bracco.com

 

NEXO [DOSE]® Multi-Modality Radiation Informatics

Intended Use:

NEXO [DOSE]® Multi-Modality Radiation Informatics is a server-based application that acquires, stores, and reports radiation dose index data from medical imaging procedures.

NEXO [DOSE] Multi-Modality Radiation Informatics is intended to be used by qualified medical personnel only.

NEXO [DOSE] 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 [DOSE] Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO [DOSE] questions: Nexo.Answers@diag.bracco.com; Website: https://imaging.bracco.com/us-en/products/injectors-informatics/nexo-dose NEXO [DOSE] Technical Support provided by PACSHealth, L.L.C: 1-877-299-6587

NEXO [DOSE] is manufactured by and is licensed from PHS Technologies Group, L.L.C, 32531 N. Scottsdale Road, Suite #105-282, Scottsdale, AZ 85266; a wholly-owned subsidiary of PACSHealth, L.L.C.

Not all products available in all global markets.

 

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 develop 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, NEXO Contrast Management System and NEXO [DOSE] Multi-Modality Radiation Informatics, 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, NEXO and NEXO [DOSE] 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.

© 2022 Bracco Diagnostics Inc. All Rights Reserved.