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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: 2008 International PHA Conference and Scientific Sessions

Release Date: 06.20.2008

Presentation Type: Abstracts

Bair N., Banjac S., Minai O., Dweik R. 

Pulmonary Vascular Program, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA

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 many times require greater than one hour for completion.  Many centers utilize a technique involving several additional extension lines while the pump is maintained outside of the scanning area. Here, we describe our experience at the Cleveland Clinic with the MEDRAD Continuum MR Compatible Infusion System (MEDRAD, Pa.) that utilizes an MRI-safe pump and eliminates the cumbersome and potentially dangerous need to add multiple extension lines.

METHODSPatients are scheduled on an outpatient or inpatient basis for the MRI scan.  The Cleveland Clinic Pulmonary Hypertension Advanced Practice Nurses assist in arranging for the scan to insure the proper scanning area is chosen.  An additional cassette is prepared prior to the scan.  For an outpatient procedure, the extra cassette is prepared by the patient.  For hospitalized individuals, the hospital IV pharmacy provides the extra 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 then connected to the MEDRAD pump administration set.  The tubing is inserted into the pump and settings are adjusted to infuse the medication 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.

RESULTSIn a retrospective chart review, we identified 7 patients receiving IV prostacyclins who also underwent MRI scanning over the past year (April, 2007 through February, 2008).  The group included 2 males and 5 females with a mean age of 48+13 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 56+6 mm HG and the average cardiac index on the initial right heart catheterization was 1.98+0.5 l/min/m2.  Three patients were receiving IV treprostinil with an average dose 95+40 ng/kg/min and 4 patients were receiving epoprostenol at an average dose of 38+20 ng/kg/min.  The types of MRIs performed included brachial plexus, spine (cervical and lumbar), ankle, brain, abdomen, and chest.  All procedures were completed without complications. No adverse events were reported.

CONCLUSION: MEDRAD Continuum MR Compatible Infusion System offers safe and convenient method for prostacyclin infusion during MRI imaging.