Impact of ACIST CVi Contrast Delivery System on Iodinated Contrast Media Administration and Waste

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00150. Epub May 24, 2024.

The COVID-19 pandemic led to disruptions in iodinated contrast media (ICM) production and produced a global product shortage in the spring of 2022. The ACIST CVi system is an automated contrast injector system approved by the FDA for multi-patient dosing of ICM from a single container. A transition from the traditional manifold system for contrast injection to the ACIST CVi automated injector system in our cardiac angiographic labs during the COVID-19 pandemic led to reductions in contrast waste and cost while limiting patient exposure to ICM.

Contrast-enhanced cardiac angiography plays a vital role in the diagnosis and management of various cardiac conditions. Traditional manifold-based contrast injection systems have long been employed for cardiac angiography. However, any unused iodinated contrast material (ICM) cannot be safely administered to another patient and must be discarded.  The ACIST CVi system (ACIST Medical) is an automated contrast injector approved by FDA for multi-patient dosing of ICM from a single container, offering potential reductions in both patient exposure to ICM and ICM waste.  Although ACIST devices have been commercially available in the United States since 1998, relatively few data have been published on the magnitude of waste reduction or the financial impact of implementing the system.  Driven by a recent global shortage of ICM due to the SARS-CoV-2 pandemic, we recently transitioned from the traditional manifold system to the ACIST CVi automated system. We report the impact of this transition on ICM administered per case, ICM waste, and ICM-related operating costs.

The ACIST CVi system was implemented in all (4) cardiac angiographic suites on June 7, 2022. We determined baseline ICM usage with the manifold system using data from procedure reports for all cardiac catheterization procedures (n = 1789) performed between January 1, 2022 and June 6, 2022; these reports recorded ICM administered and unused ICM that was discarded. We then extracted the same data for all cardiac catheterizations from June 7, 2022 to March 24, 2023 (n = 3138). We compared total ICM used per case, ICM administered to the patient per case, and ICM discarded per case. To assess ICM-associated costs, we obtained data on total ICM-related expenditures related to our cost center during the first quarter of 2022 (all manifold system) and the first quarter of 2023 (all ACIST CVi system). There were similar proportions of percutaneous coronary intervention cases compared to diagnostic cases before and after the ACIST CVi system was implemented (within 7% per month).

This study was reviewed by the ChristianaCare Health Services IRB and determined to be exempt.

Use of the ACIST CVi system was associated with reductions in total ICM used per case (178 mL vs 93 mL, -48%), total ICM administered to patients per case (109 mL vs 82 mL, -25%), and total ICM wasted per case (70 mL vs 11 mL, -84%) (Table). These changes resulted in less spending for ICM:  in quarter 1 of 2022, ICM related to cardiac catheterization expenditure was $81,254 USD with a per case cost of $77 USD per case, while in quarter 1 of 2023 this cost was $40,614 with a per case cost of $45 USD per case (Table).

Our observations add to the limited data available on ICM utilization associated with the ACIST injector systems.  Prior studies have focused on the volume of ICM received by patients rather than ICM waste.1-5 A meta-analysis based on 10 separate reports conducted in 2014 concluded that the ACIST automated system does reduce patient ICM exposure.1 However, prior studies have not quantified the impact of system utilization on ICM waste.  The pandemic-related disruptions in ICM production produced a global product shortage in the spring of 2022.  A systematic review of proposed responses to the crisis did not include consideration of automated injector systems to lower ICM waste.6 Our study of 4927 total cardiac catheterization procedures affirms that the ACIST CVI system lowers patient exposure to ICM and quantifies its impact on ICM waste.  Furthermore, although US inflation rose approximately 4% between 2022 and 2023 and shortages led to increases in market prices for ICM, we observed reductions in per-case expenses for ICM.7 The savings were driven by modest reductions in ICM administered to patients and large reductions in ICM waste.

Limitations. Limitations of this assessment include the modestly sized measurement period and patient sample.  A full operating cost analysis would require accounting of ACIST CVi disposable components and greater detail of case mix.

The ACIST CVi injector system reduces waste effectively while limiting patient exposure to ICM. 

From the Section of Cardiology, Center for Heart and Vascular Health, ChristianaCare Health System, Newark, Delaware, USA.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Neil J. Wimmer, MD MSc, 8755 Ogletown Stanton Rd, Newark, DE 19718, USA. Email: neil.j.wimmer@christianacare.org