Category: CVi/ Angiography

Radiation safety is of utmost importance in the catheterization lab, as invasive cardiac diagnostic and interventional procedures can contribute significantly to a patient’s overall radiation exposure. In the cath lab there is an increasing need for operators and staff to find ways to minimize their exposure in every case until radiation is at a level that is as low as reasonably achievable (ALARA). One of the ways to limit radiation exposures to staff is to increase the distance between the operator and the source of radiation. The ACIST CVi® Contrast Delivery System makes it easier to step back, moving one’s hand farther away from the radiation source during the image acquisition. This task is more difficult to do with the simple hand manifold. Continue reading to learn more about radiation safety in the Cath lab using CVi® along with other important measures.

Important measures that can be taken to reduce radiation exposure specific to the X-ray imaging system are listed below:

• Stay off the pedal
• Maximize table height and source to intensifier distance (SID)
• Use the appropriate image size
• Use collimation and filters
• Balance kVp and mA
• Used pulsed fluoro
• Use the lowest frame rate possible
• Use the tools provided to determine dose
• Think about the angles used for the procedure
• Use fluoroscopy storage

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Dr. Richard Solomon, Chief of Nephrology in the Department of Medicine at the University of Vermont College of Medicine and Fletcher Allen Health Care, introduces causes of Contrast-Induced Nephropathy (CIN) in the catheterization lab and its impact on patient outcomes. He became involved with contrast-induced nephropathy (CIN) from a research perspective in the early 1990s, when he designed and conducted the first prospective randomized trial evaluating different therapies for prevention of CIN. CIN, an acute kidney injury resulting from exposure to radiopaque contrast agents during catheterization, possesses long-term risks of systemic adverse events for affected patients. Moreover, CIN bears a significant economic burden. This comes with higher immediate costs stemming from extended hospital stays, intensified patient care, and increased long-term financial responsibilities associated with managing future adverse events. Dr. Solomon outlines the prerequisites for CIN prevention and presents diverse strategies to mitigate its occurrence. Notably, one key aspect in reducing the risk of CIN lies in optimizing contrast delivery. The ACIST CVi® Contrast Delivery System enables precise control over contrast volume and flow rate, surpassing the capabilities of manual hand injectors. This precise control potentially leads to shorter procedures, decreased contrast administration, and the possibility of earlier post-procedural hydration. For further insights into CIN reduction, prevention strategies, and how ACIST CVi® can play a pivotal role in mitigating CIN for patients through optimal contrast delivery, read on.

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Background:

Contrast-sparing devices have been slowly adopted into routine patient care. Randomized trial evidence of automated contrast injectors (ACIs) has not been analyzed to evaluate the true reduction in contrast volume during coronary angiography and intervention. It has been thought that reducing the amount of contrast exposure will result in a simultaneous reduction in the risk of contrast-induced nephropathy (CIN). Therefore, we sought to synthesize published evidence on contrast-sparing devices, contrast volume, and the incidence of CIN. We searched Medline, the Cochrane Library, and Clinicaltrials.gov. The search criteria included ACIs versus manual injection, contrast media volume, and the incidence of CIN. Data were extracted by 2 independent reviewers. The weighted mean difference of contrast volume was calculated using random effects models in RevMan, version 5.4.1, software to derive a summary estimate. A total of 79,694 patients from 10 studies were included (ACI arm, n [ 20,099; manual injection arm, n [ 59,595). On average, ACIs reduced contrast volume delivery by 45 ml/case (p (p <0.001, 95% confidence interval L54 to L35). The CIN incidence was significantly reduced by 15%, with an odds ratio of 0.85 (p <0.001, 95% confidence interval 0.78 to 0.93) for those using ACIs compared with manual injection. In conclusion, the use of ACIs in angiography significantly reduces the volume of contrast delivered to the patient and the incidence of CIN.

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This document focuses on contemporary measures, including automated contrast injection (ACI) systems, to prevent contrast-induced nephropathy (CIN) following catheterization and percutaneous coronary intervention (PCI). The use of automated contrast injection systems, such as the ACIST CVi® Contrast Delivery System, can effectively decrease the volume of contrast used during procedures. It remains uncertain whether lower contrast volume is associated with a reduced incidence of CIN; however, a trial was conducted at Wake Forest University Medical Center involving 1,798 patients who underwent diagnostic catheterization or PCI using handheld manifold injection systems, followed by 377 subsequent patients utilizing an automated contrast injection system. The study’s findings demonstrate that when combined with contemporary hydration and pharmacologic strategies, the use of an automated contrast injection system significantly reduces both contrast volume and the incidence of CIN. For further details on ACIs, such as CVi®, and their positive impact on mitigating contrast-induced nephropathy, continue reading.

Study Objectives: To evaluate the incidence of contrast-induced nephropathy (CIN) with the use of an automated contrast injection system in conjunction with contemporary measures to prevent CIN after cardiac catheterization and percutaneous coronary intervention (PCI).

Background: The use of automated contrast injection systems can reduce the volume of procedural contrast, but whether lower contrast volume is associated with lower incidence of CIN is uncertain

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Join a conversation with Dr. Bob Wilson, founder of ACIST Medical Systems, about the ACIST CVi® Contrast Delivery System. ACIST CVi® System is an automated, variable-rate contrast injection system for angiographic procedures. Some key features of the CVi® mentioned are the variable rate injection controlled by the handheld AngioTouch®, 4 active safety sensors, peristaltic pump for saline delivery, and integrated hemodynamic monitoring from the catheter. Dr. Wilson mentions how CVi® uses pressure to achieve the desired flow rate selected, and how the limit can be set by the operator on the CVi® monitor. Pressure works closely with flow rate, which is the volume of fluid delivered in a specified amount of time. Read on to learn more about ACIST CVi® Contrast Delivery System and valuable insights regarding flow rate parameters and pressure.

Background of Bob Wilson, MD:

Clinical Chief, Cardiovascular Division, University of Minnesota, Dr. Bob Wilson has spent decades focusing on the development of medical, devices for the diagnosis and treatment of cardiovascular diseases. His research into methods for studying the coronary circulation in humans led to the development of the first coronary Doppler catheter to measure coronary blood flow, one among many contributions to science and biomedical engineering projects. He was Founder and Chairman of the Board of Directors of ACIST Medical systems, which now markets a range of devices in 44 countries worldwide.

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