The Benefits of Prefilled Syringe Utilization in MRI

Healthcare facilities understand the need to their protect staff and patients against contamination and disease.  This includes radiology, where medical imaging providers are constantly reviewing risk management and quality assurance protocols to enhance the safety of their patients and staff. According to one study, “the use of prefilled contrast syringes with single-use saline syringes is associated with time-efficient assembly of injection systems and prevents microbiologic contamination in clinical routine, especially in the care of immunocompromised patients.”¹ Guerbet offers prefilled syringes that are fully self-contained and requires no transference of contrast prior to injection, thus reducing the opportunity for contamination.¹ They are supplied in a durable plastic syringe, which allows for improved convenience and workflow efficiency.

Improving Patient Safety Workflow

Magnetic resonance imaging (MRI) technologists are embracing Guerbet’s prefilled syringes, which are manufactured for use with the OptiStar® and OptiVantage® power injectors and as individual handheld syringes. The syringe choice depends on the protocol and amount of contrast required for a particular study. TriHealth Imaging in Cincinnati, OH, which boasts 22 imaging locations with a total of 19 CT and 15 MRI scanners, has implemented contrast prefilled syringes.

“Safety is always a top concern for us,” says Don Owens, Director of Imaging Services at TriHealth. “Guerbet’s prefilled syringes have been a fantastic switch for us. They allow us to maintain safety because we don't have to draw contrast out of a vial. It's clearly made the impact that we wanted it to make, and our radiologists love the image quality that this contrast provides.”

The Guerbet prefilled syringes have also been implemented at the Phoenix VA Health Care System, which comprises the Carl T. Hayden VA Medical Center and nine outpatient VA clinics in and around Phoenix, AZ, says Doug Boyd, chief MRI technologist. Boyd notes that prefilled syringes are not handled as often as traditional non-prefilled syringes, making them easier to use.

“With prefilled syringes, you just open the package, put the prefilled syringe right on the injector, close the injector and you're ready to go,” Boyd says. “When you don't have to handle as many supplies, it's better for the patient. It’s also a time saver and better for our patients.”

Personal protective equipment (PPE) creates additional challenges related to reduced visibility and mobility, as well as reduced staffing numbers and staff fatigue resulting from working in difficult conditions.

A recent article in the American Journal of Emergency Medicine stated that in the setting of emergency medicine, especially during cardiopulmonary resuscitation of patients with suspected or confirmed COVID-19, emergency staff should consider a combination of intraosseous access and drugs in prefilled syringes to reduce infusion time and infection risk to personnel.²

The article also discusses a study conducted in CBRN-PPE conditions comparing the time of preparation and supply of drugs from different types of ampoules. It showed that the use of drugs from pre-filled syringe compared with glass ampoule with syringe and needle (GSN) was associated with significantly shorter distribution of time for drawing up drugs.³

This study showed the distribution of amount of volume drawn was statistically significantly higher for pre-filled syringes compared to GSN. Additionally, reduction of both glass ampoules and additional needles for drug delivery could reduce the risk of needlestick injuries. In the era of the COVID-19 pandemic, needlestick injuries, which require consultation and treatment in infectious wards, should be particularly avoided.

Increased Throughput and Ease of Use

Technologists are reporting significant time savings and increased throughput by using the prefilled syringes, says Owens, noting that they no longer have to prepare the contrast media injection. “Prefilled syringes give techs more time to be engaged with the patient. It's precious time because it’s the only time you get to make a connection with the patient,” says Owens.

While the Phoenix VA decided to switch to prefilled syringes because of their safety profile, the resulting workflow improvements were an extra benefit. “The technologists are ecstatic because of the ease of use and it was a huge time saver,” Boyd says. “It takes three minutes to prepare and load the injector with a non-prefilled syringe, versus 10 seconds to load a prefilled syringe. Data shows you can save hours every day by going from non-prefilled syringes to prefilled syringes.”

Appropriate Labeling Supports Compliance

The pre-labeled syringes also aid facilities in complying with The Joint Commission standards for safety and quality of care. Previously, technologists were forced to label syringes manually with information such as contrast type and lot numbers. The prefilled syringes are already clearly labeled with that information.

“Prefilled syringes are color labeled, so we know exactly what we're using,” says Boyd. “This is a time saver for our staff.” Color coded labeled syringes provide a quick reference to identify contrast from saline when preparing the power injector for set-up.

Owens says the syringes have already helped to streamline the facility’s Joint Commission inspections. “Since we've converted to prefilled syringes at both of our flagship hospitals, Joint Commission inspectors commended us for using prefilled syringes,” he says.

Supply Management and Cost Benefits

The management of supplies and the associated costs are front of mind for radiology administration. To streamline an injector fleet with the utilization of prefilled syringes allows facilities to eliminate the need to stock empty syringes and extra supplies required to support contrast injections. TriHealth’s storerooms used to be stocked with many of these supplies for multiple injectors and associated syringes. However, once the health system employed prefilled syringes and standardized its injectors, it was able to support all sites with supplies, should there be a shortage of inventory at any location.

Using prefilled syringes and reducing the need for extra supplies resulted in a considerable cost savings. “When we switched to prefilled syringes, we didn't perform fewer exams or use less contrast, but we saved about $130,000 in one fiscal year on supplies alone,” Owens says. “Now we can share injectors and prefilled syringes across our network. It helps us maintain our supplies while reducing storage space in areas where space is at a premium.”⁵

For more information, visit https://www.guerbet.com/products-solutions/

References

1. Buerke B. et al. Microbiologic Contamination and Time Efficiency of Use of Automatic MDCT Injectors With Prefilled Syringes: Results of a Clinical Investigation. AJR: February 2010; 194: 299:303.
2. Ludwin K. et al. Place of prefilled syringes in COVID-19 patient based on current evidence. Am J Emerg Med: May 2020; 10.1016/j.ajem.2020.05.016.
3. Castle N., Bowen J., Spencer N. Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs? Clin Toxicol (Phila) 2010;48(6):522–527. doi: 10.3109/15563650.2010.491483. [PubMed] [CrossRef] [Google Scholar][Ref list]
4. Supplement to November 2017 issue of Applied Radiology. Prefilled Syringes: Optimize Workflow, Increase Productivity and Staff Satisfaction While Ensuring Patient Safety. https://cdn.agilitycms.com/applied-radiology/PDFs/Issues/AR_11-17_Guerbet_supp.pdf
5. https://www.appliedradiology.com/articles/a-growing-number-of-ct-departments-are-making-the-switch-to-prefilled-syringes-to-optimize-patient-care

Dotarem® Important Safety Information

Indications and Usage
DOTAREM® (gadoterate meglumine) injection is a prescription gadolinium-based contrast agent indicated for intravenous use with magnetic resonance imaging (MRI) in brain (intracranial), spine and associated tissues in adult and pediatric patients (including term neonates) to detect and visualize areas with disruption of the blood brain barrier (BBB) and/or abnormal vascularity.

Contraindications
History of clinically important hypersensitivity reactions to DOTAREM.

Warnings and Precautions

• Hypersensitivity Reactions: Anaphylactic and anaphylactoid reactions have been reported with DOTAREM, involving cardiovascular, respiratory, and/or cutaneous manifestations. Some patients experienced circulatory collapse and died. In most cases, initial symptoms occurred within minutes of DOTAREM administration and resolved with prompt emergency treatment.
• Before DOTAREM administration, assess all patients for any history of a reaction to contrast media, bronchial asthma and/or allergic disorders. These patients may have an increased risk for a hypersensitivity reaction to DOTAREM.
• Administer DOTAREM only in situations where trained personnel and therapies are promptly available for the treatment of hypersensitivity reactions, including personnel trained in resuscitation.
• Gadolinium Retention: Gadolinium is retained for months or years in several organs. The highest concentrations have been identified in the bone, followed by brain, skin, kidney, liver and spleen. The duration of retention also varies by tissue, and is longest in bone. Linear GBCAs cause more retention than macrocyclic GBCAs.
• Consequences of gadolinium retention in the brain have not been established. Adverse events involving multiple organ systems have been reported in patients with normal renal function without an established causal link to gadolinium retention.
• Acute Kidney Injury: In patients with chronically reduced renal function, acute kidney injury requiring dialysis has occurred with the use of GBCAs. The risk of acute kidney injury may increase with increasing dose of the contrast agent; administer the lowest dose necessary for adequate imaging.
• Extravasation and Injection Site Reactions: Ensure catheter and venous patency before the injection of DOTAREM. Extravasation into tissues during DOTAREM administration may result in tissue irritation.

Adverse Reactions

• The most common adverse reactions associated with DOTAREM in clinical trials were nausea, headache, injection site pain, injection site coldness and rash.
• Serious adverse reactions in the Postmarketing experience have been reported with DOTAREM. These serious adverse reactions include but are not limited to: arrhythmia, cardiac arrest, respiratory arrest, pharyngeal edema, laryngospasm, bronchospasm, coma and convulsion.

Use in Specific Populations

• Pregnancy: GBCAs cross the human placenta and result in fetal exposure and gadolinium retention. The human data on the association between GBCAs and adverse fetal outcomes are limited and inconclusive. Advise pregnant women of the potential risk of fetal exposure to GBCAs.
• Lactation: There are no data on the presence of gadoterate in human milk, the effects on the breastfed infant, or the effects on milk production. However, published lactation data on other GBCAs indicate that 0.01 to 0.04% of the maternal gadolinium dose is present in breast milk.
• Pediatric Use: The safety and efficacy of DOTAREM at a single dose of 0.1 mmol/kg has been established in pediatric patients from birth (term neonates ~ 37 weeks gestational age) to 17 years of age based on clinical data. The safety of DOTAREM has not been established in preterm neonates. No cases of NSF associated with DOTAREM or any other GBCA have been identified in pediatric patients age 6 years and younger.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

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