Proactive Air Mitigation in CT Injection Systems Reduces Air Embolism

Background

Venous air embolism (VAE) is defined as the entry of at least one air bubble into the venous circulation. VAE appears in 7–55% of patients as a complication of contrast media administration from power injection systems in CT. This can have an impact on patient safety and comfort, diagnostic image quality, and the efficiency of workflows.

Reactive and proactive air management approaches of contemporary contrast injection systems address the issue

This study by Michael C. McDermott et al. (Bayer) compares the impact of reactive and proactive approaches on injected air volumes by simulating clinical application. 

Conclusion

The comparison of the air volumes injected under simulated clinical conditions shows: A system with a proactive air management approach injects significantly less air than the systems tested with an only reactive approach.

With the proactive air management and automated venting processes implemented in MEDRAD® Centargo, injected air volumes were significantly lower compared to CT motion and CT Exprès.

Value Proposition

MEDRAD® Centargo with its proactive air management can significantly reduce the occurrence of observable, and potentially artifact-inducing, venous air embolism in contrast-enhanced CT procedures. Proactive air management may also reduce the workflow disruptions caused by aborted injections.

Current Air Mitigation Approaches and Clinical Need

To prevent intravenous air injection, current power injectors employ a multi-stage process that includes the following:

Proactive approach

• Preventing air from entering the disposable components
• Purging internal air from the system
• Confirming air has been removed prior to patient connection

Reactive approach

• Monitoring for air during injection

When performed correctly, manual methods are effective and do not present a safety risk. However, they are not optimal for workflow efficiency in high throughput departments.

A proactive air management approach aims to prevent air from entering the system and actively removes air from the fluid path before the patient is connected for the procedure.

Methods

Three CT injection systems from three different manufacturers were tested:

• MEDRAD® Centargo injection system
• ulrich CT motionTM Contrast Media Injector (‘CT motion’)
• Bracco CT Exprès Contrast Injection System with Multi-Patient Set (‘CT Exprès’)

Two of the systems (CT motion, CT Exprès) employ reactive air management approaches, while the MEDRAD® Centargo injection system implements a proactive air management approach.

Simulated Clinical Workflow

• A total of 90 injections (30 per injector) were performed. Injected air volumes were measured under simulated clinical use via custom air trap fixture.
• To mimic the clinical workflow, the patient line was replaced and primed for every injection according to each manufacturer’s instructions.
• Catheters, contrast media, flow rates, and fluid volumes were representative of standard clinical practice.

Results

The proactive system MEDRAD® Centargo injected significantly less air compared to two systems with reactive approaches.

In this study, no injections were discontinued due to triggering of the sensors.