How to Use
DEFINITY®


How to Activate DEFINITY®
DEFINITY® is activated using a VIALMIX® or VIALMIX® RFID, which ensures consistent activation of DEFINITY®.1 Before activating DEFINITY®, allow the refrigerated vial to warm to room temperature.1


DEFINITY® is the only ultrasound enhancing agent that uses mechanical activation, which contributes to its consistent image quality1-4
DEFINITY® can be reactivated, allowing up to 48 hours of use from the initial activation5
Dosing
DEFINITY® is the only ultrasound enhancing agent with flexible dosing options,
including diluted bolus, continuous infusion, and bolus.1,3,4 Each option can be
implemented using the PINSYNC® or needle method.1 Click below for instructions on
dosing by your specific method.
DEFINITY® Dosing Videos
DILUTED BOLUS
CONTINUOUS INFUSION
BOLUS
Step 1 — Choose Administration Method
Step 2 — Choose Withdrawal Technique
Diluted Bolus
DEFINITY® is the only ultrasound enhancing agent approved for use in a diluted form.1,3,4 Diluted bolus is the most common DEFINITY® administration option. This method simplifies administration by combining activated DEFINITY® and preservative-free saline in the same syringe.
How to Prepare DEFINITY® for Diluted Bolus
Diluted Bolus Dosing With PINSYNC® (Vented Vial Adapter 13 mm)
PINSYNC® (Vented Vial Adapter 13 mm) enables the safe, simple, and efficient transfer of activated DEFINITY® from vial to syringe.
Supplies
- PINSYNC®*
- 10 mL syringe filled with 8.7 mL preservative-free saline
Instructions
WARNING: Do not remove PINSYNC® from the package and do not use the adapter if the package is damaged or if the adapter comes out of the package.*
- Remove cover from the PINSYNC® package
- Place the activated DEFINITY® vial on a flat surface, hold the PINSYNC® package, and push the PINSYNC® vial adapter straight down onto the DEFINITY® vial top until it snaps securely into place
- Remove the package without touching the exposed end of the vial adapter as this will cause contamination
- Attach the 10 mL syringe filled with 8.7 mL preservative-free saline to the vial adapter with a clockwise twisting motion. Do not inject air into the DEFINITY® vial
- Invert vial and slowly withdraw 1.3 mL activated DEFINITY®
- Hold vial adapter by the skirt; remove syringe from PINSYNC® with a counterclockwise twisting motion
- Gently agitate the syringe by hand to evenly distribute microbubbles
- Administer 1 to 2 mL slowly with subsequent injections as needed
*Please refer to the PINSYNC® Instructions for Use (IFU).
Diluted Bolus
DEFINITY® is the only ultrasound enhancing agent approved for use in a diluted form.1,3,4 Diluted bolus is the most common DEFINITY® administration option. This method simplifies administration by combining activated DEFINITY® and preservative-free saline in the same syringe.
How to Prepare DEFINITY® for Diluted Bolus
Diluted Bolus Dosing With Needle Method
DEFINITY® can be administered using the traditional needle method.
Supplies
- 18- or 20-gauge needles
- 10 mL syringe filled with 8.7 mL preservative-free saline
Instructions
When using a needle method, it is important to vent the vial. This avoids negative pressure in the vial which prevents microbubble disruption and allows for easier withdrawal.
- Vent the vial by placing needle tip in the activated DEFINITY® vial
- Attach an 18- or 20-gauge unfiltered needle to the 10 mL syringe filled with 8.7 mL preservative-free saline and place the needle in the vial
- Invert vial and slowly withdraw 1.3 mL activated DEFINITY® from the middle of the liquid without injecting air into the vial
- Gently agitate the syringe by hand to evenly distribute microbubbles
- Administer 1 to 2 mL slowly with subsequent injections as needed
For more details on the diluted bolus method, watch this instructional video.
Continuous Infusion
The DEFINITY® continuous infusion administration method combines 1.3 mL activated DEFINITY® in a 50 mL bag of preservative-free saline offering consistent image enhancement well suited for exams performed over an extended period.1 DEFINITY® is the only ultrasound enhancing agent approved for use in a diluted form.1,3,4
How to Prepare DEFINITY® for Continuous Infusion*
Continuous Infusion Dosing With PINSYNC® (Vented Vial Adapter 13 mm)
PINSYNC® (Vented Vial Adapter 13 mm) enables the safe, simple, and efficient transfer of activated DEFINITY® from vial to syringe.
Supplies
- PINSYNC®*
- 50 mL bag of preservative-free saline
- 3 mL syringe
Instructions
WARNING: Do not remove PINSYNC® from the package and do not use the adapter if the package is damaged or if the adapter comes out of the package.*
- Remove cover from the PINSYNC® package
- Place the activated DEFINITY® vial on a flat surface, hold the PINSYNC® package, and push the PINSYNC® vial adapter straight down onto the DEFINITY® vial top until it snaps securely into place
- Remove the package without touching the exposed end of the vial adapter as this will cause contamination
- Attach the 3 mL syringe to the vial adapter with a clockwise twisting motion. Do not inject air into the DEFINITY® vial
- Invert vial and slowly withdraw 1.3 mL activated DEFINITY®
- Hold vial adapter by the skirt; remove syringe from PINSYNC® with a counterclockwise twisting motion
- Attach an 18- or 20-gauge unfiltered needle to the syringe and slowly add 1.3 mL activated DEFINITY® into the 50 mL bag of preservative-free saline
- Gently agitate the syringe by hand to evenly distribute microbubbles
Titrate drip rate at 4 mL/minute or a maximum of 10 mL/minute. Adjust flow rate for optimal image enhancement.1
*Please refer to the PINSYNC® Instructions for Use (IFU).
Continuous Infusion
The DEFINITY® continuous infusion administration method combines 1.3 mL activated DEFINITY® in a 50 mL bag of preservative-free saline offering consistent image enhancement well suited for exams performed over an extended period.1 DEFINITY® is the only ultrasound enhancing agent approved for use in a diluted form.1,3,4
How to Prepare DEFINITY® for Continuous Infusion1*
Continuous Infusion Dosing With Needle Method
DEFINITY® can be administered using the traditional needle method.
Supplies
- 50 mL bag of preservative-free saline
- 3 mL syringe
- 18- or 20-gauge unfiltered needles
Instructions
When using a needle method, it is important to vent the vial. This avoids negative pressure in the vial which prevents microbubble disruption and allows for easier withdrawal.
- Vent vial with a needle by placing needle tip in the activated DEFINITY® vial
- Attach an 18- or 20-gauge unfiltered needle to the 3 mL syringe and place the needle in the vial
- Invert vial and slowly withdraw 1.3 mL activated DEFINITY® from the middle of the liquid without injecting air into the vial
- Add 1.3 mL activated DEFINITY® into the 50 mL bag of preservative-free saline
- Gently squeeze bag to evenly distribute microbubbles
Titrate drip rate at 4 mL/minute or a maximum of 10 mL/minute. Adjust flow rate for optimal image enhancement.1
For more details on the continuous infusion
method, watch this instructional video.
Bolus
The DEFINITY® bolus administration method is a simple, straight bolus injection, followed by a saline flush, offering easy, rapid DEFINITY® enhancement in small doses.1
How to Prepare DEFINITY® for Bolus
Bolus Dosing With PINSYNC® (Vented Vial Adapter 13 mm)
PINSYNC® (Vented Vial Adapter 13 mm) enables the safe, simple, and efficient transfer of activated DEFINITY® from vial to syringe.
Supplies
- PINSYNC®
- 10 mL syringe filled with saline
- 3 mL or tuberculin syringe
- 3-way stopcock (optional)
Instructions
WARNING: Do not remove PINSYNC® from the package and do not use the adapter if the package is damaged or if the adapter comes out of the package.*
- Remove cover from the PINSYNC® package
- Place the activated DEFINITY® vial on a flat surface, hold the PINSYNC® package and push the PINSYNC® vial adapter straight down onto the DEFINITY® vial top until it snaps securely in place
- Remove the package without touching the exposed end of the vial adapter as this will cause contamination
- Attach the 3 mL or tuberculin syringe to the vial adapter with a clockwise twist and without injecting air into the DEFINITY® vial
- Invert vial and slowly withdraw 10 µL/kg activated DEFINITY®
- Hold vial adapter by the skirt; remove syringe from PINSYNC® with a counterclockwise twisting motion
- Administer slowly over 30 to 60 seconds. Follow with a 10 mL saline flush. Administer a subsequent injection as needed followed by saline flush
Smaller, incremental dose amounts of 0.2 to 0.3 mL are better suited for current ultrasound system technology.
Maximum allowable dose: 20 µL/kg
*Please refer to the PINSYNC® Instructions for Use (IFU).
Bolus
The DEFINITY® bolus administration method is a simple, straight bolus injection, followed by a saline flush, offering easy, rapid DEFINITY® enhancement in small doses.1
How to Prepare DEFINITY® for Bolus
Bolus Dosing With Needle Method
DEFINITY® can be administered using the traditional needle method.
Supplies
- 18- or 20-gauge unfiltered needles
- 10 mL syringe filled with saline
- 3 mL or tuberculin syringe
- 3-way stopcock (optional)
Instructions
When using a needle method, it is important to vent the vial. This avoids negative pressure in the vial which prevents microbubble disruption and allows for easier withdrawal.
- Vent vial with a needle by placing needle tip in the activated DEFINITY® vial
- Attach an 18- or 20-gauge unfiltered needle to the 3 mL or tuberculin syringe and place needle in the vial
- Invert vial and slowly withdraw 10 µL/kg activated DEFINITY® from the middle of the liquid without injecting air into the vial
- Administer slowly over 30 to 60 seconds. Follow with a 10 mL saline flush. Administer a subsequent injection as needed followed by saline flush
Smaller, incremental dose amounts of 0.1 to 0.2 mL are better suited for current ultrasound system technology.
Maximum allowable dose: 20 µL/kg
For more details on the bolus method,
watch this instructional video.
How to Store DEFINITY®
DEFINITY® can be conveniently stored in multiple care settings.1 For greater efficiency, DEFINITY® can be dispensed using the Pyxis MedStation™ ES system.*
*Pyxis MedStation™ ES System is a trademark of Becton, Dickinson and Company.
DEFINITY® offers 2 supply options1:
- Four 2 mL vials
- Sixteen 2 mL vials
Store DEFINITY® between 36° to 46°F.1
DEFINITY® Delivers High-Quality Images
Image optimization is important when performing a DEFINITY® echo where the image always dictates the appropriate settings.6
Are You Optimizing the Use of Contrast Echocardiography? A Case‑Based Discussion
Anita M. Kelsey, MD, and Steven Walling, RDCS, explore 2 cases to illustrate the importance of teamwork, operational efficiency, and the appropriate use of DEFINITY® in achieving quality echocardiographic imaging.
Ultrasound System Control Adjustments Vary by Patient and Ultrasound System
Key Controls to Optimize Image Quality
Mechanical Index/Power: Strength of Ultrasound Beam7
Adjust power to adequately visualize cardiac anatomy
Frequency: Affects the Penetration of the Ultrasound Beam and Image Resolution8
Choose a frequency for optimal image resolution
Focus: Narrowest Area of the Ultrasound Beam With the Greatest Ultrasound Intensity8
Place focus at the mitral valve level for optimal visualization of the left ventricle
Position focus at area of interest when evaluating pathologies, regional wall motion
High frequencies provide less depth of penetration with greater image resolution.7
Low frequencies provide greater depth of penetration with lower image resolution.7
Power/Mechanical Index Can Have the Greatest Impact on Overall Image Quality
Power adjustments vary by patient and ultrasound system
Power too low
Power Optimized
Secondary Controls to Optimize Image Quality
Gain: boosts the amplification of received echoes6
When gain is set too high, the image may appear too bright
When gain is set too low, the image may appear too dark
Dynamic range/compression: adjusts the range of shades of gray displayed in 2D images6
When setting is too high, the image may appear washed out
When setting is too low, the image may appear dark
Speed of administration and system settings contribute to optimal image quality
Optimal Opacification
- An ideal administration rate enables a homogeneous fill of the left ventricular cavity
Fast Injection — Attenuation6
- Creates a high concentration of microbubbles in the apex
- Helps to evaluate apical abnormalities
Swirling6
Insufficient opacification inhibits the adequate assessment of structural abnormalities, wall motion, and left ventricular function
- Injection rate too slow or insufficient dose
- Inadequate system settings
- Poor LV function
Left ventricular function plays an important role in the rate at which DEFINITY® should be injected
- Poor LV function or low heart rate may require a more rapid speed of injection to allow DEFINITY® to completely fill the entire LV
- High heart rate may require a slower administration rate
DEFINITIONS:
LV=left ventricle; MI=mechanical index.
References:
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DEFINITY® [package insert]. N. Billerica, MA: Lantheus Medical Imaging, Inc.
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VialMix® User's Guide. N. Billerica, MA: Lantheus Medical Imaging, Inc.
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Optison™ [package insert]. Marlborough, MA: GE Healthcare Inc.
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Lumason® [package insert]. Monroe Township, NJ: Bracco Diagnostics Inc.
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Data on File, N. Billerica, MA: Lantheus Medical Imaging, Inc.
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Witt SA, McCulloch M, Sisk E, et al. Achieving a diagnostic contrast-enhanced echocardiogram: a series on contrast echocardiography, article 4. J Am Soc Echocardiogr. 2001;14(4):327-334.
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Burgess P, Moore V, Bednarz J, et al. Cardiac sonographer's communication. Performing an echocardiographic examination with a contrast agent: a series on contrast echocardiography, article 2. J Am Soc Echocardiogr. 2000;13(6):629-636.
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Armstrong WF, Ryan T. Feigenbaum's Echocardiography. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:9-38.