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Maintenance of Intravenous Prostacyclin Infusions During Magnetic Resonance Imaging Scan

Nancy Blair

Svetlana Banjac

Omar Minai

Raed Dweik


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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Nancy Bair, CNS; Svetlana Banjac, NP-C; Omar Minai, MD; Raed Dweik, MD
Cleveland Clinic, Cleveland, OH

PURPOSEThe purpose of this abstract is to present our experience with an MRI-safe pump and IV prostacyclins.

BACKGROUNDMagnetic resonance imaging (MRI) scanners are used as a noninvasive method to provide information on anatomical and functional features of Pulmonary Arterial Hypertension (PAH) and many other conditions. Patients with continuous intravenous infusions of prostacyclin create a dilemma for the healthcare team, because none of the pumps routinely used for infusion of these medications are compatible with the MRI scanners. The prostacyclin infusion cannot be safely interrupted to allow for the scan, which often requires greater than one hour for completion. Many centers utilize a technique involving additional extension lines while the pump is maintained outside of the scanning area. We describe our experience at the Cleveland Clinic with the MEDRAD Continuum MR Compatible Infusion System (MEDRAD, Pa.), which utilizes an MRI-safe pump and eliminates the potentially dangerous need for multiple extension lines.

METHODOLOGYThe Cleveland Clinic Pulmonary Hypertension Advanced Practice Nurses arrange for the scan to ensure the proper scanning area is chosen. For an outpatient procedure, an additional cassette is prepared by the patient. For hospitalized individuals, the hospital IV pharmacy provides the additional cassette. When the patient arrives to the MRI area, the calculations are done to allow for an hourly infusion rate. The Radiology nurse withdraws the needed amount of prostacyclin into a 60cc syringe which is connected to the MEDRAD pump administration set. The tubing is inserted into the pump and infusion of the medication continues at the same dose of prostacyclin throughout the procedure. The patient's CADD tubing and pump are disconnected, and the MEDRAD pump and tubing are connected to the patient's intravenous catheter. When the scan is complete, the patient is reconnected to their original CADD pump and tubing.

FINDINGSIn a retrospective chart review, we identified 7 patients receiving IV prostacyclins who had MRI scanning over the past year (April, 2007 through February, 2008). The group included 2 males with a mean age of 39 years and 5 females with a mean age of 52 years. PAH classifications included 4 patients with idiopathic PAH and 3 patients with associated causes of PAH including liver disease, connective tissue disease, and congenital heart disease. The average mean pulmonary arterial pressure on the initial right heart catheterization was 55.5 mm HG, and the average cardiac index on the initial right heart catheterization was 1.98 l/min/m2. Three patients were receiving IV treprostinil with an average dose 94.6 ng/kg/min and 4 patients were receiving epoprostenol at an average dose of 38.3 ng/kg/min. The types of MRIs performed included brachial-plexus, spine (cervical and lumbar), ankle, brain, abdominal, and chest. Contrast or non-contrast mediums were utilized as necessary. All procedures were completed without complications. No adverse events were reported.

IMPLICATIONSMEDRAD Continuum MR Compatible Infusion System offers a safe and convenient method for prostacyclin infusion during MRI imaging.