A comparison of the use of traditional hand injection versus automated contrast injectors during cardiac catheterization.

OBJECTIVE To compare the incidence of contrast-induced nephropathy (CIN) and vascular complications in patients undergoing cardiac catheterization using traditional manual contrast injection techniques with those in which an automated contrast injector device was used. BACKGROUND It has been suggested that use of automated contrast injectors in coronary interventions could reduce complications by reducing contrast volume usage and allowing the use of smaller sheaths. METHODS This was a retrospective cohort study with review of patient's electronic medical charts and the Heartbase registry. Complete data were available for 13107 patients between 1999 and 2009. Of those patients, 5137 procedures were performed with traditional manual contrast injection and 7970 procedures used automated contrast injection. The CIN event rate and vascular complication rates were compared between patients who underwent catheterization using these differing techniques. RESULTS Overall, the incidence of CIN was comparable in traditional and automated contrast injector assisted catheterizations (9.07% vs 8.73%; P=.5). However, for the subgroup of patients that had a diagnostic cardiac catheterization and went on to have an ad hoc angioplasty, incidence of CIN was much lower in the automated contrast injector group (7.04% vs 5.50%; P=.007). The incidence of vascular complications was lower in the automated contrast injector group vs the traditional method (2.85% vs 2.17%; P=.02), irrespective of an ad hoc angioplasty. CONCLUSION Use of automated contrast injectors resulted in a significant decrease in vascular complications across all cardiac catheterizations. Additionally, there was a significant decrease in CIN when the automated contrast injector was used for catheterizations that included a percutaneous coronary intervention.