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

VIALMIX® activation device.
VIALMIX® RFID activation device.

DEFINITY® is the only ultrasound enhancing agent that uses mechanical activation, which contributes to its consistent image quality1-4

DEFINITY® may be used for up to 12 hours after activation with VIALMIX® or VIALMIX® RFID. If an activated vial is not used within 5 minutes, resuspend by hand agitation for 10 seconds prior to use.1

VIALMIX®
User Guide

VIALMIX® RFID
User Guide

DEFINITY® can be reactivated, allowing up to 48 hours of use from the initial activation5

DEFINITY Activation/Reactivation Timeline DEFINITY Activation/Reactivation Timeline

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


  • An efficient administration technique that combines DEFINITY® and preservative-free saline in the same syringe1
  • A continuous administration of DEFINITY® for exams performed over an extended period1
  • A straight bolus injection for rapid DEFINITY® enhancement in small doses1

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.*

  1. Remove cover from the PINSYNC® package
  2. 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
  3. Remove the package without touching the exposed end of the vial adapter as this will cause contamination
  4. 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
  5. Invert vial and slowly withdraw 1.3 mL activated DEFINITY®
  6. Hold vial adapter by the skirt; remove syringe from PINSYNC® with a counterclockwise twisting motion
  7. Gently agitate the syringe by hand to evenly distribute microbubbles
  8. Administer 1 to 2 mL slowly with subsequent injections as needed

*Please refer to the PINSYNC® Instructions for Use (IFU).


For more details on the diluted bolus method, watch this instructional video.

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.

  1. Vent the vial by placing needle tip in the activated DEFINITY® vial
  2. 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
  3. Invert vial and slowly withdraw 1.3 mL activated DEFINITY® from the middle of the liquid without injecting air into the vial
  4. Gently agitate the syringe by hand to evenly distribute microbubbles
  5. 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.*

  1. Remove cover from the PINSYNC® package
  2. 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
  3. Remove the package without touching the exposed end of the vial adapter as this will cause contamination
  4. Attach the 3 mL syringe to the vial adapter with a clockwise twisting motion. Do not inject air into the DEFINITY® vial
  5. Invert vial and slowly withdraw 1.3 mL activated DEFINITY®
  6. Hold vial adapter by the skirt; remove syringe from PINSYNC® with a counterclockwise twisting motion
  7. 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
  8. 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).

For more details on the continuous infusion
method, watch this instructional video.

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.

  1. Vent vial with a needle by placing needle tip in the activated DEFINITY® vial
  2. Attach an 18- or 20-gauge unfiltered needle to the 3 mL syringe and place the needle in the vial
  3. Invert vial and slowly withdraw 1.3 mL activated DEFINITY® from the middle of the liquid without injecting air into the vial
  4. Add 1.3 mL activated DEFINITY® into the 50 mL bag of preservative-free saline
  5. 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.*

  1. Remove cover from the PINSYNC® package
  2. 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
  3. Remove the package without touching the exposed end of the vial adapter as this will cause contamination
  4. Attach the 3 mL or tuberculin syringe to the vial adapter with a clockwise twist and without injecting air into the DEFINITY® vial
  5. Invert vial and slowly withdraw 10 µL/kg activated DEFINITY®
  6. Hold vial adapter by the skirt; remove syringe from PINSYNC® with a counterclockwise twisting motion
  7. 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).

For more details on the bolus method,
watch this instructional video.

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.

  1. Vent vial with a needle by placing needle tip in the activated DEFINITY® vial
  2. Attach an 18- or 20-gauge unfiltered needle to the 3 mL or tuberculin syringe and place needle in the vial
  3. Invert vial and slowly withdraw 10 µL/kg activated DEFINITY® from the middle of the liquid without injecting air into the vial
  4. 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

Learn About DEFINITY® Safety

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.

Image Optimization Guide

Image Optimization Guide


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:

  1. DEFINITY® [package insert]. N. Billerica, MA: Lantheus Medical Imaging, Inc.

  2. VialMix® User's Guide. N. Billerica, MA: Lantheus Medical Imaging, Inc.

  3. Optison™ [package insert]. Marlborough, MA: GE Healthcare Inc.

  4. Lumason® [package insert]. Monroe Township, NJ: Bracco Diagnostics Inc.

  5. Data on File, N. Billerica, MA: Lantheus Medical Imaging, Inc.

  6. 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.

  7. 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.

  8. Armstrong WF, Ryan T. Feigenbaum's Echocardiography. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:9-38.