UT Southwestern Medical Center, Parkland Health, Dallas, Texas; Parkland Health, Dallas, Texas. Electronic address: https://twitter.com/ericwpepin.
Parkland Health, Dallas, Texas.
J Am Coll Radiol. 2024 Jan;21(1):175-181. doi: 10.1016/j.jacr.2023.06.032. Epub 2023 Aug 3.
Iodinated contrast medium (ICM) is available in single- and multiuse vials of varying sizes, but CT departments often preferentially stock only a single or a limited number of vial sizes. The aims of this study were to assess actual ICM waste at a large safety-net hospital and to compare with estimated waste if single-use vials in a variety of vial sizes or multiuse vials were used.
ICM administrations were retrospectively reviewed for all CT examinations performed in 2021 in a department that stocked only 100-mL ICM vials. Administered ICM dose, opened ICM volume and number of vials, and wasted ICM were compared with hypothetical models using optimally sized single-use vials and multiuse vials. Contrast use was also compared by patient class.
In total, 40,393 ICM administrations over 49,670 CT examinations among 26,028 patients were reviewed, totaling 4,168,335 mL of contrast media. The mean dose was 103 mL, with mode of 100 mL. Exclusive use of 100-mL vials resulted in 1,006,165 mL waste (mean waste, 26 mL/administration). Optimally sized single-use vials resulted in 436,515 mL waste (mean waste, 11 mL/administration). Multiuse vials resulted in 537,074 mL waste (mean waste, 13 mL/administration). The distribution of optimal single-use vial size differed significantly by patient class (P < .001), with inpatient examinations more amenable to the use of smaller single-use vials.
Optimizing ICM inventory can reduce contrast waste by 50% to 59%. Regular monitoring of contrast use may help optimize inventory selection across care settings. This retrospective review supports scrutiny of ICM inventory management to reduce waste, save costs, and mitigate the impacts of supply-chain disruptions.
碘造影剂(ICM)有单剂量和多剂量的不同规格小瓶可供选择,但 CT 部门通常只优先储备单一或有限数量的小瓶规格。本研究的目的是评估大型社区医院的实际 ICM 浪费情况,并与如果使用各种规格的单剂量小瓶或多剂量小瓶的估计浪费进行比较。
回顾性审查了 2021 年在仅储备 100 毫升 ICM 小瓶的部门进行的所有 CT 检查的 ICM 给药情况。比较了实际给药剂量、开启的 ICM 体积和小瓶数量以及浪费的 ICM 与使用最佳尺寸的单剂量小瓶和多剂量小瓶的假设模型。还按患者类别比较了造影剂的使用情况。
共审查了 26028 名患者的 49670 次 CT 检查中的 40393 次 ICM 给药,总计 4168335 毫升造影剂。平均剂量为 103 毫升,模式剂量为 100 毫升。仅使用 100 毫升小瓶会导致 1006165 毫升的浪费(平均每剂浪费 26 毫升)。最佳尺寸的单剂量小瓶导致 436515 毫升的浪费(平均每剂浪费 11 毫升)。多剂量小瓶导致 537074 毫升的浪费(平均每剂浪费 13 毫升)。最优单剂量小瓶的尺寸分布因患者类别而显著不同(P<0.001),住院检查更适合使用较小的单剂量小瓶。
优化 ICM 库存可以将造影剂浪费减少 50%至 59%。定期监测造影剂的使用情况可能有助于在不同的护理环境中优化库存选择。这项回顾性研究支持对 ICM 库存管理进行审查,以减少浪费、节省成本并减轻供应链中断的影响。