The Sonographer Attachment Programme At USA Report : Aurora St Luke's Echo Protocol =Contrast Agent=

5.5 Aurora St Luke’s Medical Center:

Protocol For Contrast Agent

Patient Screening

• Definity will not be administered to the following patient population with a known history of

§  Right to left, bidirectional shunts or transient right to left cardiac shunt

§  Sensitivity of Perflutren

§  Prior reaction of Definity

§  Pregnant and nursing mothers

§  Congenital heart defect

• Definity can be administered to the following patient population upon MD approval and with continuous monitoring of BP, ECG and pulse ox during and up to ½ hour after injection

§  Significant pulmonary hypertension

§  Unstable cardiopulmonary conditions

Criteria For Definity Studies

• Definity is used at the discretion of the physician or sonographer
• Studies ordered specifically for LV function where all wall segments are not well visualized and a bi plane EF cannot be accurately measured
• Use of contrast is ordered by physician
• Patient with suboptimal images due to lung interference, obesity, and/or other conditions that might warrant poor visualization of endocardial borders
• Suspicion of other cardiac anomalies ie Apical thrombus

Adverse effects

• Complications are immediately addressed by physician and/or technician
• Patients adverse reaction is documented on the patient report
• Contrast reaction is documented and alerted in patients medical record
• Medical imaging company is notified of the adverse effect and documentation of complication is recorded

Administration

• Definity is stored in refrigerator at 36-46 degrees F
• Vial is at room temperature before activation
• Vial mixer is used to agitate Definity for 45 seconds

§  Do not reactivate the vial if the vial mixer did not complete a full 45 seconds

§  Do not reactivate a successfully activated vial

§  Do not use a vial mixer that is not functioning properly

• Definity is vented with sterile vent spike or needle, ensuring that air is not injected into vial
• Withdraw Definity slowly into injection syringe containing 8.5 cc saline using a plastic cannula, withdrawing the liquid from the middle of the inverted vial, again ensuring that air is not injected into vial
• Intravenous injection (IV using a 20 gauge or larger angiocath) of up to 2 cc diluted Definity is administered slowly at a rate of 1 cc every 10 seconds prior to imaging (Do not administer Definity intraarterial)
• Resuspend Definity with 10 seconds of hand agitation prior to each additional injection or if the product has not been used within 5 minutes of the original activation in the vial mixer
• Discard unused Definity
• Activated Definity is stored at room temperature and should be used within 12 hours
• Definity is a single vial dose and must not be used for more than one patient