For Diluted IV Bolus Technique1
The Diluted IV Bolus method is an alternative approach to the bolus technique. This simplifies the injection technique by combining activated DEFINITY® and the preservative-free saline in the same syringe.
1 This method of dosing and administration is within the dosing range and administration type listed in the DEFINITY® package insert.
Supplies Needed
- 18-20 gauge unfiltered needles (filtered needles may cause microsphere disruption)
- 10 cc syringe
- Preservative-free saline
- Additional needle to vent the vial or INTELLIPIN® Dispensing Pin2
2 If INTELLIPIN® is used, there is no need for 18-20 gauge needles.
Two Methods of Preparation
When withdrawing activated DEFINITY® from the vial it is important to use a venting method. Venting avoids negative pressure in the vial and allows for easier contrast withdrawal. Air should never be injected into the vial.
Venting with standard needle
This venting technique uses a second needle as an air vent which allows air to be drawn into the vial as the contrast is withdrawn into the syringe.
- Withdraw 8.7 mL preservative-free saline into 10 cc syringe using 18 or 20 gauge needle.
- Following activation with VIALMIX®, remove DEFINITY® vial cap and insert venting needle into the vial.
- Insert needle attached to 10 cc syringe filled with 8.7 mL preservative-free saline.
- Invert vial and ensure the needle tip is positioned approximately in the middle of the suspension.
- Slowly withdraw 1.3 mL of activated DEFINITY®.
Venting with INTELLIPIN®
This technique eliminates the use of a second needle. A built in venting port allows air to flow into the vial as the contrast is being withdrawn into the syringe.
- Withdraw 8.7 mL preservative-free saline into 10 cc syringe using 18 or 20 gauge needle.
- Following activation with VIALMIX®, remove DEFINITY® vial cap and insert INTELLIPIN®into vial.
- Remove blue cap from female port of INTELLIPIN® and attach 10 cc syringe filled with 8.7 mL preservative-free saline to female port.
- Invert vial and slowly withdraw 1.3 mL of activated DEFINITY®.
Administration
- Gently hand agitate 10 cc syringe filled with 1.3 mL of activated DEFINITY® diluted with 8.7 mL of preservative-free saline to evenly distribute microspheres.
- Slowly inject up to 3 mL of solution.
- Subsequent injections of 1 to 2 mL as needed.
- Better suited for low MI non-linear imaging3.
3 The optimal activated DEFINITY® doses and device settings for harmonic imaging have not been established.
INDICATIONS
Activated DEFINITY® (Perflutren Lipid Microsphere) Injectable Suspension is indicated for use in patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.
The safety and efficacy of DEFINITY® with exercise stress or pharmacologic stress testing have not been established.
CONTRAINDICATIONS
Do not administer DEFINITY® to patients with known or suspected right-to-left, bi-directional or transient right-to-left cardiac shunts, by intra-arterial injection, or to patients with known hypersensitivity to perflutren.
IMPORTANT SAFETY INFORMATION
WARNING: Serious Cardiopulmonary Reactions Serious cardiopulmonary reactions, including fatalities, have occurred during or following perflutren-containing microsphere administration.
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In post marketing use, rare but serious cardiopulmonary or anaphylactoid reactions have been reported during or shortly following perflutren-containing microsphere administration (see ADVERSE REACTIONS). The risk for these reactions may be increased among patients with pulmonary hypertension or unstable cardiopulmonary conditions. It is not always possible to reliably establish a causal relationship to drug exposure due to the presence of underlying cardiopulmonary disease.
Please See Full Prescribing Information and Letter to Healthcare Providers.
