Put simply, Mount Auburn Hospital, Cambridge, Mass, uses large polymer bottles of nonionic contrast because they are convenient and cost effective. Once opened and placed in an injector, they can be used for multiple cases. We consider a product or method to be convenient when it meets at least one of five criteria: it decreases the number of steps involved in a process, it is easy to use or perform, it improves work flow, it increases the speed of work overall, or it is cost effective. Many imaging providers seem to have come to the conclusion that using polymer contrast bottles is a convenience issue because bottles meet all five criteria. Convenience can typically be expected to make employees happy, which results in better workflow and staff retention.
One concern that staff members may express when a new product is introduced is that it may be inconvenient to use (especially if accreditation, regulatory compliance, and safety are among the reasons to adopt the new product). For example, many intravenous-access sets and blood-drawing kits introduced for the safety of radiology staff have not been embraced by the technologists because they are inconvenient (slower or more difficult to use).
This concern does not apply to polymer contrast bottles because the packaging actually decreases the number of steps needed to use the contrast. Since these bottles were implemented in our department, we are no longer ordering multiple sizes of bottles or multiple concentrations. Now, we order contrast in only one size and we are able to use just the amount of contrast needed for each case. With the high volume of studies performed in our CT department, we go through numerous bottles per hour. But we do not need to discard any of the product after an examination, and we are no longer constantly changing the syringes or opening and closing bottles of contrast. We hang one bottle early in the morning and we can draw off the contrast needed for multiple examinations from this.
The ability to work from one bottle really improves the turnaround time for use of the room, especially since our department has a CT patient booked every 15 minutes. It is very important to get patients into the room, scan them, and get them back out again. Naturally, there are certain components of workflow that we can control and others that we cannot change. When we have a geriatric or pediatric patient, we really cannot control whether or not we can place that patient on the table within 2 minutes. Therefore, areas should be identified where we can shave off valuable seconds during the examination process. By the end of a 12-hour shift during which we have scanned 40 to 60 outpatients, those saved seconds with each patient have made a big difference in our workflow.
Once the bottle has been opened and spiked with a vented transfer set, we can simply swipe the edge of the access tip, connect it to the syringe, and autofill a predesignated amount of contrast. Because this very rapid action involves making only one connection and pressing only one button, the technologist can then walk away, change the linen on the table, and start to position the patient for the examination. Room turnaround is just as quick. Instead of opening and closing bottles and throwing away the used packaging, the technologist can auto-fill the contrast needed for the second, third, or fourth patients.
If we are certain of the cases needing contrast, we can prefill syringes early in the morning and use the peel-off labels on the polymer bottles to label the syringes. This allows us to track any predrawn syringe by lot number, as well as by the date and time that it was filled. This fits well with our workflow for both outpatient and inpatient imaging.
This method is more cost effective than using prefilled syringes because it was impossible to limit the amount of contrast used with the prefilled syringes. A full prefilled syringe had to be opened for each patient, no matter how much contrast was required, and any unused contrast in the syringe had to be discarded at the end of the examination. Moreover, if the contrast medium was changed from one formulation to another and the department had no prefilled syringes in stock, it was necessary to fill empty syringes with the second contrast medium. It becomes expensive to maintain just a small quantity of nonprefilled syringes in the department for this purpose. Workflow is also disrupted if a department that normally uses prefilled syringes has to switch back and forth between prefilled and self-filled syringes during the course of the work day.
Kevin F. Reynolds, RT(R), (CT), is manager, CT Division, Mount Auburn Hospital, Cambridge, Mass. This article has been adapted from Polymer Bottles: Convenient and Cost Effective, which he presented at the Polymer Bottle Safety Focus Group on September 10, 2004, in Las Vegas.