Angiography Contrast Injector Safety: Visualizing the Marketplace

Automatic contrast injectors are routinely used to administer iodine-based contrast medium during angiographic studies. The contrast medium allows the vasculature to be visualized on x-ray images.

However, use of these injectors can have dangerous consequences: Because angiography exams often require the injection of contrast medium directly into an artery, the potential exists for the inadvertent injection of air into the vasculature—and even a small air embolus is potentially fatal. In fact, ECRI Institute identified air embolism from contrast injectors as one of its Top 10 Health Technology Hazards for just this reason (see our November 2008 issue). And although most angiography studies are completed without incident, the potential for serious harm cannot be ignored. (For further discussion, see the box on page 186. )

To reduce the risk of air embolism, most angiography contrast injectors include air detection devices. However, these detectors, typically referred to as air-column detectors or gross air detectors, are not intended to detect very small air bubbles. Additionally, vendors make no claims that these devices are 100% effective, and incidents still occur even when air detectors are being used, usually attributable to human error. As a result, many manufacturers have begun equipping angiography contrast injectors with additional safety features to reduce the likelihood of user error.

In this Evaluation, we examine the overall safety of automatic angiography contrast injectors. While selection of an injector with appropriate safety features is important, it is essential to remember that it is still the responsibility of the angiography team to maintain vigilance during contrast injection to prevent air from being injected.

We tested the following products:

We evaluated the most advanced automatic angiography contrast injectors available from the three suppliers in the United States. Two of the systems we evaluated—the ACIST CVi and the Medrad Avanta—are able to deliver...