PROTOCO₂L^TM

An ACRIN CT-Colonography Trial Standard¹

Virtual Colonoscopy, or CT Colonography, is becoming increasingly accepted as a screening method for colorectal cancer. The American Cancer Society has included Virtual Colonoscopy in its Guideline on Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps as an acceptable option for Colorectal Cancer Screening.²

Optimal colonic distention is a critical requirement for obtaining an optimal Virtual Colonoscopy study.³

Advantages to Automated Insufflation with Carbon Dioxide

Patient Comfort: Carbon dioxide is more rapidly resorbed than room air and may improve patient comfort after completion of the examination.³

Consistent Distension: Automated insufflation to a constant pressure takes the guesswork out of determining if the patient is adequately distended.
Productivity: Automated insufflation may decrease the demands on staff time.³

PROTOCO₂L^TM INSUFFLATION SYSTEM

• Automated insufflation helps improve productivity by freeing up practitioner³
   
• Regulated pressure avoids spikes and minimizes patient discomfort that can occur with hand insufflation⁵
   
• Over-pressure alarms and safety shutdown features help assure patient safety
   
• Pressure can be adjusted for different patient requirements or during a procedure
   
• No special utilities required: PROTOCO₂L^TM uses standard medical grade (USP) D or E size carbon dioxide cylinders and connects to standard hospital electrical receptacle
   
• PROTOCO₂L^TM displays instantaneous gas pressure, records the total volume delivered during the procedure, and alerts the operator when the CO₂ cylinder is low
   
• Accessory cart features storage for CO₂ cylinders and holder for administration set

PROTOCO₂L^TM ADMINISTRATION SET

• Simple connection and removal from PROTOCO₂L^TM Insufflator
   
• In-line fluid trap captures colon effluent and removes it from the "path" of the carbon dioxide for proper insufflation
   
• Hydrophobic filter helps protect the PROTOCO₂L^TM Insufflator from cross-contamination

COMFORT AND SAFETY

Rapid absorption of CO₂ results in improved comfort after the procedure, as compared with room air insufflation.^{3, 4, 5}

Automated low-pressure insufflation may reduce colonic spasm as compared with manual methods, particularly in segments with advanced diverticular disease.⁵

Helps ensure patient safety through redundant pressure relief valves and automatic flow stop features, which protect against over-insufflation.

A choice of tips for rectal administration allows the practitioner to select the most comfortable tip for the patient.

In our experience, we have found that automated CO₂ delivery is not only safe but also results in improved colonic distention compared with manual techniques and also that use of CO₂ compared with room air results in less post procedural discomfort." ⁶

– Pickhardt PJ. Radiology 2006; 239 (2):313-316.

A study on minimizing post-colonoscopy abdominal pain showed that 1 hour after colonoscopy, a majority of patients insufflated with room air had significant residual gas in the colon. The study showed that 94% of patients insufflated with carbon dioxide had only trace to minimal residual gas.⁷

CONSISTENCY

Regulated pressure gradually distends the colon, and maintains that pressure for the duration of the study.

Automated insufflation with CO₂ results in more consistent distention and less variability from technologist to technologist.⁸

Improved distention, as compared to manual room air insufflation, has been shown in two clinical trials.^{4, 8}

Volume display allows the monitoring and recording of the volume of CO₂ used, unlike room air insufflation, where the amount of air introduced is not evident.

We found significantly better luminal distention overall using automated administration than using the manual method." ⁴ 

– Burling D, et al. AJR 2006; 186:96-103.

PRODUCTIVITY

Automated operation helps reduce staff time during insufflation process.³

Replaces gas lost during the procedure automatically.
Visual displays allow quick reference of pressure and volume, and alerts the operator when the CO₂ cylinder is low.

Adjustable pressure up to 25 mmHg allows for user control when desired.

The CT technologists at my institution unanimously prefer the automated CO2 technique over manual methods. They cite a more clearcut point to begin scanning, a diminished need for coaching patients, and decreased operator dependence." ⁵

– Pickhardt P.J. AJR 2007; 189:290-298.