A Word About Air Detection Devices

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A Word About Air Detection Devices

PA PSRS Patient Saf Advis 2004 Dec;1(4):16.

Air detection devices, used in conjunction with other risk reduction measures, may reduce the risk of air embolism associated with contrast media injectors. However, these systems are not foolproof,¹ and they cannot be relied upon solely to prevent this complication.²

Such devices include:

An oval marker that appears to be a circular dot when observed through fluid present in the syringe. This may allow the technologist to see more readily whether the syringe contains such liquids as contrast or saline.^3,4
An optional air detection device that identifies empty syringes and an air bolus.^5,6
A tilt sensor lockout mechanism that prevents injection unless the injector head is tilted downward. This reduces the risk of air bubbles reaching the syringe tip.^5,6
Transparent syringes that allow air bubbles to be more easily seen, so that air can be purged before injecton.⁷
Prefilled syringes that are air-free, thus avoiding the risk of introducing air into syringes filled on-site.⁶
Ultrasound technology that stops the injection if air is detected in the system.⁶

The following problems, however, can prevent such systems from working effectively:²

If the liquid in the syringe becomes opacified (such as when intermingled with blood), the technologist will be unable to see a liquid-detecting dot.
Contrast procedures are performed in the dark or with reduced lighting. If a light source (such as a flashlight) is not available, the technologist may not be able to see bubbles in a transparent syringe or tubing.
The other mechanisms address air detection in the syringe but may not identify air entering the vascular system in other ways during contrast injection. Multiple port lines, stopcocks, transducer lines, contrast conservation systems, and flush lines also may be portals of air entry.

Reduction of air emboli associated with contrast injection involves implementation of a multi-pronged approach involving not only equipment (such as air detection devices), but also training, competency assessment, procedures, manufacturer operating instructions, protocols, drills, and reporting.

Notes

Gallauresi BA. Safeguarding contrast media injections. Nursing 2001 Jan; 31(1):24.
Hansel, B (ECRI). Conversation with: J. Johnston. 2004 Oct 1.
Pham KL, Cohen AJ. Iatrogenic venous air embolism during contrast enhanced computed tomography: a report to two cases. Emerg Radiol (2003) 10:147-151.
Medrad Special Features Fluid Dots. 2003 [cited 2004 Sep 29] Available from Internet: http://www.medrad.com/systems-and-products/syringes-and-disposables/
special_features.html.
Massat MB, ed. Technology overview: contrast media injectors-growth of MRI and CT procedure drives market demand for power injectors. Reilly Communications Group. 2003 March/April. [cited 2004 Sep 29]. Available from Internet: http://www.reillycomm.com/ it_archive/it_to0303_2.htm.
ECRI. Healthcare Product Comparison System. Technology overview: injectors, contrast media, angiography; computed tomography; magnetic resonance imaging. 2002 Oct.
ECRI. Healthcare Product Comparison System. Comparison chart. Products for injectors, contrast media, angiography; computed tomography; magnetic resonance imaging. 2002.

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Notes

	THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS
	The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web site at www.patientsafetyauthority.org .
	ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for more than 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology.
	The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.