title: Effects of viscosity on power and hand injection of iso-osmolar iodinated contrast media through thin catheters.
abstract: BACKGROUND
  It can be challenging to achieve adequate vessel opacification during percutaneous coronary interventions when using thin catheters, hand injection, and iso-osmolar contrast media (CM) such as iodixanol (Visipaque™).
  
  
  OBJECTIVE
  To explore these limitations and the possibility to overcome them with iosimenol, a novel CM.
  
  
  METHODS
  Three X-ray contrast media with different concentrations were used in this study. A series of in vitro experiments established the relationship between injection pressure and flow rate in angiography catheters under various conditions. The experiments were conducted with power and hand injections and included a double-blind evaluation of user perception.
  
  
  RESULTS
  By using hand injection, it was generally not possible to reach a maximum injection pressure exceeding 50 psi. The time within which volunteers were able to complete the injections, the area under the pressure-time curve (AUC), and assessment of ease of injection all were in favor of iosimenol compared with iodixanol, especially when using the 4F thin catheter. Within the pressure ranges tested, the power injections demonstrated that the amount of iodine delivered at a fixed pressure was strongly related to viscosity but unrelated to iodine concentration.
  
  
  CONCLUSIONS
  There are substantial limitations to the amount of iodine that can be delivered through thin catheters by hand injection when iso-osmolar CM with high viscosity is used. The only viable solution, besides increasing the injection pressure, is to use a CM with lower viscosity, since the cost of increasing the concentration, in terms of increased viscosity and consequent reduction in flow, is too high. Iosimenol, an iso-osmolar CM with lower viscosity than iodixanol might therefore be a better alternative when thinner catheters are preferred, especially when the radial artery is used as the access site.
authors.affiliation: Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA james.zhang@otsuka-us.com.
authors.forename: James J
authors.initials: JJ
authors.lastname: Zhang
authors.affiliation: Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Hogstrom
authors.affiliation: Interpharma Praha a.s., Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Malinak
authors.affiliation: Otsuka International Asia Arab Division, Otsuka Pharmaceutical Co., Ltd., Osaka, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ikei
mesh_terms: D001549:Benzamides / Q000008:administration & dosage*; D057785:Catheters; D003287:Contrast Media / Q000008:administration & dosage*; D066298:In Vitro Techniques; D007275:Injections, Intravenous / Q000295:instrumentation; D007472:Iohexol / Q000008:administration & dosage*; D009994:Osmolar Concentration; D062645:Percutaneous Coronary Intervention; D011312:Pressure; D011412:Propanolamines / Q000008:administration & dosage*; D012212:Rheology; D013594:Syringes; D014283:Triiodobenzoic Acids / Q000008:administration & dosage*; D014783:Viscosity
chemical_list: D001549:Benzamides; D003287:Contrast Media; D011412:Propanolamines; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol; C450045:iosmin
keywords: Percutaneous coronary intervention; angiography catheters; iodixanol; iosimenol; iso-osmolar contrast media; viscosity