Abstract:
The fluid management system according to the invention is adapted to automatically supply fluid for injection into a patient. The fluid management system comprises a fluid management device, a fluid transfer system and a fluid injector. The fluid management device serves to store and administrate multi dose containers. The fluid transfer system connects the outlet of the containers stored within the fluid management device to the injector and the injector withdraws the fluid via fluid transfer system from the containers and injects the fluid to an administration device at the patient. The fluid management device comprises at least one rotating carousel with the axis of rotation being vertically, at least two container holders attached to the rotating carousel, said container holders being adapted to position a container vertically with the open end of the neck facing downwards and a spike holder mounted below the rotating carousel and oriented such that the spike holder would axially align a spike connected to the spike holder with the axis of the container that is to be spiked and loaded into the container holder.

Description:
[0001]    This application is a U.S. National Phase of International Patent Application No. PCT/EP2010/068097, entitled “Fluid Management System”, filed Nov. 24, 2010, which claims priority to European Patent Application No. 09177313.5, filed Nov. 27, 2009, the disclosures of which are incorporated herein by reference in their entirety. 
     
    
       [0002]    The present disclosure relates generally to a fluid management system (FMS) and method for the administration of fluid to a patient from multiple dose containers. The FMS presented in this disclosure is adapted to automatically supply fluid for injection into a patient. 
       BACKGROUND 
       [0003]    In many medical environments, a medical fluid is injected into a patient during diagnosis or treatment. One example is the injection of contrast media into a patient to improve imaging by a diagnostic imaging procedure such as computed tomography (CT), angiographic, magnetic resonance (MR) or ultrasound imaging using a powered fluid injection system. 
         [0004]    Various manual and automated injection systems used for performing the above-referenced procedures are known in the art. In the system as disclosed in WO 2004/091688 A2 or WO 2007/033103 A1 the containers from which the fluid for injection is withdrawn have to be prepared for use manually, i.e. manually spiked and manually mounted in withdrawal position after spiking 
         [0005]    A typical procedure how contrast media is prepared, handled, and administered from a multi dose container is described in the following: 
         [0006]    The multi dose containers with contrast media are pre-warmed before use via a heater normally positioned near to the diagnostic imaging instrument. Temperature of the heater is set to 37 degrees Celsius the regular body temperature. A container with contrast media is then removed from the heater by a technician. The plastic safety cap is removed from the end of the multi dose containers to expose the rubber seal. A vented spike is connected to the contrast media injector and then manually driven into the rubber seal on the multi dose container by the technician in order to feed the injector line. Due to contamination reasons the spike has to be replaced approximately every 6-8 hours. The multi dose container is then placed in a container holder suspended from an IV pole in a vertical orientation with the container neck end facing downwards. The previously described steps are then repeated for one container of saline. The technician then draws the required contrast media and saline from the multi dose containers into the injector reservoirs via the injector user interface. Protective packaging from a new patient connection tube with cannula connection is removed. A cap used to plug the connector of the injector patient supply line is manually removed. The patient connection tube and patient supply line are connected via cannula connection. Air is then expelled from the tubes by the technician manually activating the injector which then pumps both saline and contrast media into a bin. The technician examines the tubes by eye to ascertain when the lines are purged and subsequently ceases the injector pump. The packaging from a new cannula connector is then removed and the connector attached to the end of the patient tube. 
         [0007]    The manual procedure described above is costly and not very efficient, such that it is an object of the present disclosure to achieve a higher degree of automation. The multiple drug injection apparatus disclosed in WO 2008/076631 A2 shows a somewhat higher degree of automation. 
         [0008]    However a mere automation poses additional problems. With a multi-dose-container it is always an issue that the container is used beyond the recommended in-use time or that the containers, which had been de-spiked before, are re-used. 
         [0009]    Therefore it is desirable to have a fluid management system that is safe and efficacious to use. In particular, it is desirable to have a system accurately and precisely control the fluid containers and the withdrawal of fluid. It is also essential that the fluid supply remains contamination-free during the whole in-use time of a container. 
         [0010]    In addition, it is desirable to have a fluid management system that is capable of using a variety of fluids, such as contrast media, saline, flushing fluids and of container sizes. 
       SUMMARY 
       [0011]    In view of the foregoing, it is an object of the present disclosure to provide a fluid management system (FMS) that addresses the obstacles and disadvantages associated with conventional fluid injection practices. 
         [0012]    The FMS according to the present disclosure is adapted to automatically supply fluid for injection into a patient. The FMS according to the disclosure comprises a fluid management device (FMD), a fluid transfer system (FTS) and an injector. 
         [0013]    The FMD serves to store and administrate fluid from multi dose containers, although it is also possible to store and administrate fluid from single dose containers. The term “container” shall be understood to include also at least a bottle, a pouch, a bag, a cartridge or carpule. The FTS connects the outlet of the containers stored within the FMD to the injector and the injector withdraws the fluid via FTS from the containers and injects the fluid to an administration device at the patient. The injector comprises at least one pump and is programmed to inject a predetermined amount of fluid with predetermined flow rate. 
         [0014]    The FMD comprises at least a rotating carousel with the axis of rotation being vertical, at least two container holders attached to the rotating carousel, said container holders being adapted to position a container vertically with the open end of the neck facing downwards and a spike holder mounted below the rotating carousel and oriented such that the spike holder would axially align a spike connected to the spike holder with the axis of the container loaded into the container holder and being in spiking position. 
         [0015]    In one embodiment the FMD comprises two rotating carousels. In another embodiment the FMD comprises further one or more, preferably two, container holders not being attached to the rotating carousel. 
         [0016]    Preferably each rotating carousel is mounted in a separate chamber and each container holder not being attached to the rotating carousel is also mounted in a separate chamber. In one embodiment the FMD has a chassis framework to which the one or more chambers are mounted. 
         [0017]    Preferably the rotating carousel has a carousel drive shaft positioned at the axis of rotation. 
         [0018]    A plate may be attached to the drive shaft to which the container holders are mounted vertically. 
         [0019]    In one embodiment up to ten container holders may be attached to the rotating carousel, preferably five container holders are attached to the rotating carousel. All container holders attached to the same rotating carousel may be adapted to hold containers of equal size. Alternatively some container holders may be adapted to hold containers of different size than other container holders. Preferably one container holder is adapted to hold a container that is smaller in size than the other containers. 
         [0020]    Preferably the container holders are equally spaced on a circle around the axis of rotation. 
         [0021]    At least one chamber, preferably the chambers with the rotating carousel, may be temperature-controlled. 
         [0022]    Preferably each chamber can be accessed by an individual hinged lid or door. Such lid or door may be transparent or include a window for visual inspection of each chamber&#39;s content 
         [0023]    The FMD may further comprise for each rotating carousel a carousel drive system having a motor, and means to transmit rotation from the motor axis to the shaft of the rotating carousel. Preferably the FMD further comprises means to disengage the shaft of the rotating carousel from the motor axis in case the lid or door of the chamber housing said rotating carousel is being opened. 
         [0024]    Each spike holder may be moveably mounted to a linear slide allowing the spike holder to slide in vertical direction. The FMD may further comprise for each spike holder an automated spiking system having a motor and means to move the spike holder mounted in the linear slide. 
         [0025]    The FMD may further comprise a central electronic control system (CECS) to control the carousel drive system and the automated spiking system. Further the CECS may be in communication with and adapted to monitor/control
       a. information output device such as a display   b. user input device like touch screen or keyboard   c. temperature in temperature-controlled chambers   d. fluid level sensors   e. position control sensors for spike   f. position control sensors for rotating carousel   g. valves in FTS tubing   h. 2-way data transfer system for communication with the CM injector and/or a computer network   i. 1-way data transfer system such as a reader for reading data from data storages on containers or fluid transfer systems (FTSs)   j. data storage       
 
         [0036]    The fluid transfer system comprises a first transfer tubing with at least two first ends, each of the first ends connected to a spike, and at least two second ends, each second end corresponding to a first end; a manifold having at least two input openings and one output opening, the second ends of the transfer tubing being connected to the input openings of the manifold; a second transfer tubing being connected to the output opening of the manifold with its first end; and a valve mounted between each first end and second end of the first transfer tubing. By means of the valves fluid can be extracted selectively from one of the spiked containers. 
         [0037]    The second end of the second transfer tubing may be adapted to be connected to an injector 
         [0038]    The fluid transfer system may further comprise data storage means for storing a unique identifier of the fluid transfer system. In reading the unique identifier the CECS can log the use of a specific fluid transfer system and alert the user via information output device if the maximum in-use time for a spike has been reached. 
         [0039]    The base of the spike includes seating and attachment means to connect the spike to corresponding seating and attachment means at the spike holder of the FMD. The top of the spike is adapted to enter into a container septum. To allow fluid to be easily withdrawn through the spike a vented spike is preferred. The spike may be covered by a sheath prior use to avoid contamination. 
         [0040]    The present disclosure is further directed to a method for automatic supply of fluid for injection into a patient comprising
       providing a fluid management device adapted to house at least one container with fluid in a vertical position with the open end of the neck facing downwards and having a spike holder mounted and oriented such that the spike holder would axially align a spike connected to the spike holder with the axis of the container loaded in the container holder and being in spiking position;   providing a fluid transfer system having a transfer tubing with a first end connected to a spike and a second end adapted to be connected to an injector;   loading at least one container with the open end of the neck facing downwards into the fluid management device, said open end of the neck being covered by a septum;   attaching the spike to the spike holder and the second end of the transfer tubing to an injector;   moving the spike into the septum;   withdrawing fluid from the container.       
 
         [0047]    The method further comprises withdrawing the spike from the septum of the container. The withdrawal of the spike from the septum may occur in response to a signal that was triggered because either the container is empty or the maximum in-use time for the container has been reached or the maximum in-use time for the spike has been reached. Such maximum in-use times are logged by a timer connected to the central electronic control system (CECS) of the fluid management device. The fluid level/volume of the spiked container can be monitored by the CECS via according fluid level/volume sensors. 
         [0048]    In another embodiment at least two containers are loaded into the fluid management device. The fluid management device further has means to position subsequently each of the containers in axial alignment with the spike holder. The method further comprises moving a second container in a position where it is in axial alignment with the spike holder and moving the spike into the septum of the second container and withdrawal of fluid from the second container. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0049]    The features of the described embodiments are specifically set forth in the appended claims. However, embodiments relating to both structure and method of operation are best understood by referring to the following description and accompanying drawings, in which similar parts are identified by like reference numerals. 
           [0050]      FIG. 1  is a first perspective view of a fluid management device 
           [0051]      FIG. 2  is a second perspective view of a fluid management device 
           [0052]      FIG. 3  is a front view of the inside of the fluid management device 
           [0053]      FIG. 4  is a perspective view of the inside of the fluid management device 
           [0054]      FIG. 5  is a perspective view of the spike 
           [0055]      FIG. 6  is a perspective view of the spike with sheath 
           [0056]      FIG. 7  is a perspective view of the spike holder 
           [0057]      FIG. 8  is a top view of the spike holder 
           [0058]      FIG. 9  is a perspective view of a spiked container and the spiking system 
           [0059]      FIG. 10  is a first view of a spiked container and the spiking system 
           [0060]      FIG. 11  is a first top view of a fluid management device 
           [0061]      FIG. 12  is a second top view of a fluid management device 
           [0062]      FIG. 13  is a perspective view of the rotating carousel 
           [0063]      FIG. 14  is a perspective view of the rotating carousel with containers attached 
           [0064]      FIG. 15  is first perspective view of a second embodiment of the fluid management device 
           [0065]      FIG. 16  is second perspective view of a second embodiment of the fluid management device 
       
    
    
     DETAILED DESCRIPTION 
       [0066]    The FMS according to the first exemplary embodiment described herein is adapted to automatically supply pre-heated contrast media (CM) and non-heated saline to a CM injector for injection into a patient from a container filled with CM (CM container) or a container filled with saline (Saline container). 
         [0067]    According to this embodiment the fluid management device (FMD)  100  shown in  FIGS. 1 to 4  consists of four separate chambers  20   a,    20   b,    21   a,    21   b.  The chambers  20   a  and  20   b  are temperature-controlled and designated to house CM containers  22 . The chambers  20   a  and  20   b  are positioned vertically on top of one another and are mounted to a chassis framework  14 . The chambers  21   a  and  21   b  are non-temperature-controlled and designated to house Saline containers. The chambers  21   a  and  21   b  are also mounted vertically on top of each other and attached to the chassis framework  14 , adjacent to the two temperature-controlled chambers  20   a,    20   b.  The FMD  100  is encased in plastic mouldings to shield the internal components from the ambient environment. Access to each chamber  20   a,    20   b,    21   a,    21   b  is provided by an individual hinged door  24   a,    24   b,    25   a,    25   b  with transparent viewing window for visual inspection of each chamber&#39;s contents. 
         [0068]    The central electronic control system (CECS) (not shown) is located in the midsection of the FMD  100  between the two vertically mounted temperature-controlled chambers  20   a,    20   b  and attached to the chassis framework  14 . 
         [0069]    A rotating carousel shown in detail in  FIGS. 13 and 14  is secured within each temperature-controlled chamber  20   a,    20   b  with the carousel drive shaft  27  positioned vertically. The carousel drive shaft  27  is mounted axially to a bearing, said bearing being securely mounted to the chassis framework  14 . A carousel drive system is mounted and positioned in such a fashion as to be able to rotate the rotating carousel via the central electronic control system (CECS). The carousel drive system comprises of a motor, reduction gearbox, and supplementary running gear (spur gears, belts, etc), of which the main gear  2 , the motor gear  3  and idler gear  4  can be seen best in  FIGS. 4 ,  11  and  12 . 
         [0070]    Within each temperature-controlled chamber  20   a,    20   b  are container holders for each of five CM containers  22  (shown in detail in  FIGS. 13 and 14 ), in order to position, orientate, and secure them such that they can be correctly axially aligned with the spike holder  10  of the automated spiking system. Each CM container holder is equally spaced from the adjacent CM container holder on a circle around the carousel drive shaft  27  and vertically mounted to a plate  7  with said plate  7  being attached to the carousel drive shaft  27 . Each container holder comprises of two clips  28  and a wire container rack  8   
         [0071]    Within each non-temperature-controlled chamber  21   a,    21   b  is a container holder in order to position, orientate, and secure the Saline container  23  such that it can be correctly axially aligned with the spike holder  10  of the automated spiking system (see for example  FIG. 4 ). The container holder is vertically mounted to a plate  18  with said plate  18  being attached to the chassis framework  14 . Each container holder comprises of two clips  28  and a wire container rack  8   
         [0072]    The automated spiking system as shown in more detail in  FIGS. 9 and 10  comprises a spike holder  10 , a linear slide  9  for the spike holder  10  and a spike drive system  12  including a motor, reduction gearbox, lead screw. The linear slide  9  with the spike holder  10  is mounted vertically to the chassis framework  14  below each of the four chambers  20   a,    20   b  and  21   a,    21   b.  Said automated spiking system is positioned and orientated such that the spike holder  10  is adapted to axially align a spike  11  with the axis of the container  22 ,  23  that is to be spiked. 
         [0073]    A bail  31  is mounted to the chassis framework  14  to enable the FMD  100  to be mounted to a ceiling attachment arm  1 . 
         [0074]    The fluid transfer system (FTS) as shown in  FIGS. 1 and 4  includes a spike  11  for each chamber adapted to be slotted in the spike holder  10  below the chamber. The spike  11  shown in  FIGS. 5 and 6  has a base  41  and a top  42 . The spike  11  is a vented spike. The base  41  has two guide notches  45  on opposite sides which are adapted to hold to corresponding slide rails  55  of the spike holder  10  (see  FIGS. 7 and 8 ). The hole  44  in the base is adapted to mount pin  54  of the spike holder  10 , when the spike  11  is slotted in the spike holder  10 . The spike  11  preferably has a sheath  43  to avoid contamination prior use. The FTS further comprises tubing  15 ,  16  connected to each spike  11  and adapted to transfer the fluid from the spiked container to the CM injector (see  FIGS. 1 and 4 ). A Y-connector  17  is mounted between the tubing  15  of spike  11  of the top temperature-controlled chamber  20   a  and tubing  16  of spike  11  of the bottom temperature-controlled chamber  20   b.  A Y-connector  17  is mounted between the tubing  15  of spike  11  of the top non-temperature-controlled chamber  21   a  and tubing  16  of spike  11  of the bottom non-temperature-controlled chamber  21   b.  Tubing  18  connects the output end of the Y-connector  17  with the connector plug of the CM injector. Valves (not shown) are mounted between each spike  11  and the Y-connector  17  to control the fluid from the respective spiked container to the Y-connector. By means of the valve fluid can be extracted selectively by the CM injector from the spiked top or bottom container filled with CM or saline. 
         [0075]    A central electronic control system (CECS) with proprietary software is used to communicate with sensors and control units of the FMD as further described below. The CECS may also be connected to a user-device interface for output of information to a user or for receiving input from a user. Especially the CECS is adapted to communicate and subsequently drive the rotating carousel and the automated spiking system of all chambers. The CECS may also allow for data storage, 1-way data transfer between data storage means on approved containers and approved FTSs and 2-way data transfer with an approved CM injector. 
         [0076]    Preheating of the CM containers to approximately 37 degrees Celsius within each temperature-controlled chamber of the FMD is achieved through forced convection and an internal temperature control system i.e. ambient temperature of each temperature-controlled chamber is autonomously controlled. This feature negates the user having to warm a CM container before injection of the CM into the patient. In a preferred embodiment the temperature control mechanism is adapted to automatically switch on for advanced start-up before treatments begin at the start of the day. 
         [0077]    Storage of up to five CM containers in each of the temperature-controlled chambers enables the FMD to service patients up to approximately 1 full day of treatment. The CM containers (and also the Saline containers) may have various sizes. The container holders are adapted to the size of the containers to be used therewith. Preferably 4 CM containers filled with 500 ml CM and 1 container filled with 100 ml CM are mounted within each temperature-controlled chamber. Access to one smaller sized CM container negates unnecessary wastage of CM fluid at the end the working day or between pauses in treatment of longer than the recommended in-use time for the CM containers. After spiking the CM container the CM fluid stored therein has a limited useful life, which leads to a recommended in-use time which is typically approximately 10 hours for established CMs. Therefore, if a new 500 ml CM container were used for the final treatment of the day the remaining fluid would have to be scrapped before the next morning. The ability to more efficiently control wastage of CM fluid is expedient. Storage of a Saline container filled with 500 ml saline in each of the non-temperature-controlled chambers allows up to approximately half a day of treatment supply. 
         [0078]    The storage of multiple containers filled with CM or saline negates the user having to constantly replenish a fluid supply to the CM injector throughout the day. 
         [0079]    In order for the FMD to supply CM and saline fluids to the CM injector, spike  11  of the FTS is inserted into the septum of the respective container. To achieve this, the user must fit the spike  11  of an FTS to the spike holder  10  on the FMD  100  via a seating and attachment feature (guide notch  45 , slide rail  55 , pin  54 , hole  44 ). The spike holder  10  is designed such that good axial alignment of the spike  11  with respect to the container septum is achieved. Once the FMS is initialized, the containers are replenished in the chambers, and the temperature-controlled chambers are up to temperature, the central electronic control system (CECS) communicates with the automated spiking system  12  to drive the spike holder  10  with spike  11  vertically upwards, such that the spike enters through an entry point into the relevant chamber and up into the container septum. As this occurs, the silicone rubber bellowed sheath  43  is crushed to allow the spike top  42  full entry into the container septum. Using position control sensors, the CECS drives the spike  11  into the container septum a prescribed distance. Once this prescribed distance has been reached the CECS deactivates the automated spiking system  12  to maintain the spike holder  10  at a set vertical location with respect to the container septum. 
         [0080]    The fluid level or fluid volume within each of the spiked containers is monitored via sensors with feedback to the CECS. Once a container is emptied to a prescribed level termed “Empty”, the CECS communicates with the automated spiking system  12  in order to drive the spike holder  10  vertically downward, thereby de-spiking the relevant container. This location of the container holder  8  is then marked “Empty” by the CECS. By logging the empty/full-status of the containers, the CECS can signal to the user via user-device interface, for example when the last container in a CM chamber is being spiked or when all containers in a chamber are empty. 
         [0081]    The FMD also incorporates a push button which allows the user to over-ride the automated spiking feature in order to stop the system from spiking another container. Furthermore, it allows for a function that permits the user to manually select a small CM container for end of day treatments in order to minimise CM fluid wastage. 
         [0082]    Automation of the rotation of the rotating carousel within each temperature-controlled chamber is used to index new CM containers so that they can be accessed and spiked. The CECS is used to drive a geared motor which in turn rotates (indexes) the rotating carousel to the desired location. Angular position of the rotating carousel is monitored via position sensors and CECS. Therefore, at any given time, the CECS recognizes the location of each CM container. It can therefore determine by what angle the rotating carousel should be rotated in order to spike a specific CM container. 
         [0083]    Upon the user opening the door of a temperature-controlled chamber, a sensor is triggered with feedback to the CECS. The CECS then disengages (mechanically, electrically, electronically, or otherwise) the carousel drive system such that the rotating carousel can no longer be automatically rotated. This then allows the user to “Free-Wheel” the rotating carousel, providing a means for the user to easily rotate the rotating carousel to access each individual CM container in the quickest manner possible. 
         [0084]    In one embodiment as shown in  FIGS. 11 ,  12  and  13  the rotation from the motor is transmitted via motor gear  2 , and idler gear  4  to main gear  2 . The idler gear  4  is mounted to the first end of an attachment  61  which is pivoted, the second end of the attachment being movably connected to a an idler pin  6 . The idler pin  6  being connected to the door of a temperature-controlled chamber. Upon opening the door of a temperature-controlled chamber as shown in  FIG. 12 , the idler pin  6  moves with the door and rotates the attachment  61  such that the idler gear  4  disengages from the motor gear  3  and the main gear  2 . 
         [0085]    Containers adapted to be used with the FMD, so-called approved containers, have an RFID tag (or other data storage means) attached to them. This allows the CECS to recognise at what time and in what location a container is replenished via interrogation with an RFID reader (or reader corresponding to the other data storage means) connected to the CECS. It also allows the CECS to ascertain if a non-approved container is placed in one of the container holders through interrogation of the RFID tag. If no RFID tag is present on the container, the CECS will recognise this upon trying to interrogate the container as no communication will be achieved. Should this be the case, the CECS will action a visual and/or audible error feedback to the user and then lock the relevant container location out from use so that it cannot be spiked. This is an important safety feature to ensure that only the correct fluids and approved containers are stored within the FMD for supply to the CM injector. 
         [0086]    Likewise, an RFID tag is also attached to each FTS. The CECS is then able to interrogate each FTS presented to ensure it is approved for use. 
         [0087]    Further once a spike of an FTS is spiked into a container septum the CECS logs the FTS as used and begins a countdown of a prescribed time which is the recommended in-use time for a spike. After the recommended in-use time for the spike, i.e. 24 hours, has elapsed the CECS then actions an error feedback via either visual or audible means to alert the user that the FTS must be replaced before further use of the FMS can occur. 
         [0088]    Data stored on the RFID tag of each container such as the manufacturing date, fluid formulation, etc. is able to be interrogated and stored via the RFID reader and the CECS. This data can then be transferred to the CM injector or saved onto mobile storage means (i.e. USB stick). This feature improves traceability. 
         [0089]    Once a CM container has been spiked, a countdown timer is activated via the CECS and the respective CM container is logged by the CECS as having been spiked. After the recommended in-use time for the CM container has elapsed, and assuming the respective CM container is not yet defined as “Empty”, the CECS locks the respective CM out and communicates with the automated spiking system to de-spike said CM container. As the unique code stored on the RFID tag of the CM container is logged in the CECS as used, and/or has elapsed past the defined useful life when spiked, the user is then prevented from both re-using the CM container and from replenishing that CM container within either temperature-controlled chamber at a later date. 
         [0090]    In one embodiment information relevant to the CM injector (fluid supply levels/volume remaining, temperature) are displayed on the main user interface screen of the CM injector. This is achieved via direct data transfer between the FMD and CM injector. Information such as the temperature, which containers are empty/over the recommended in-use time, etc for each temperature-controlled chamber is intended to be displayed via LED&#39;s or display screen on the FMD. This feature allows the user to directly monitor fluid levels within the FMD with respect to the relevant chamber. A viewing window is also positioned on each of the chamber doors as a secondary means for the user to visually check fluid levels and for which containers require replenishment. The chamber doors allow the user access to replenish fluid supplies, provided a container within the chamber is not spiked at the time. Once a door on a temperature-controlled chamber is opened the carousel drive system is disengaged to prevent the rotating carousel from being automatically driven whilst the user replenishes supplies. The disengagement of the carousel drive system also allows the rotating carousel to free-wheel such that the user can easily rotate the rotating carousel to access each individual container in the quickest manner. Upon closing the door of the temperature-controlled chamber the carousel drive system is re-engaged in order to automatically drive the rotating carousel for use. 
         [0091]    2-way communication between the FMS and the CM injector is achieved through a proprietary software communication platform. This enables the user to control and observe several functions of the FMD from the CM injector interface directly. Data transferral between the FMD and CM injector may be achieved through several transference means including, but not limited to, the following:
       Wired cable—USB, LAN, or otherwise   Bluetooth   Wireless Network       
 
         [0095]    One manually removable drip tray  13  is positioned beneath the rotating carousel and above the automated spiking system of each temperature-controlled chamber such that any CM fluid spillage from previously spiked CM container septums is captured within the confines of the machine. 
         [0096]    In the embodiment of the FMS described in this example, it is possible for the CECS to recognise the locations of each container within the FMD, how long they have been sitting within the FMD, whether or not they have been spiked before, and whether or not the fluid in a specific container is past its useful life. This, in principle, removes safety concerns such as the user re-spiking a used or useful-life-elapsed container. 
         [0097]    The FMS according to the second exemplary embodiment described herein is adapted to automatically supply pre-heated contrast media (CM) and pre-heated saline to a CM injector for injection into a patient from a container filled with CM (CM container) or a container filled with saline (Saline container). 
         [0098]    In  FIGS. 15 and 16  a second embodiment of a FMD is shown. The FMD  200  of this embodiment comprises two chambers  201  and  202  attached to a chassis framework. Both chambers  201 ,  202  are temperature-controlled. Each chamber  201 ,  202  houses a rotating carousel  205 ,  206 . Five container holders are mounted on each rotating carousel  205 ,  206  for holding up to five CM containers  22  and up to five Saline containers  23 . Each chamber  201 ,  202  has a lid  203 ,  204  and is adapted to be loaded from the top. Between both chambers  201 ,  202  a housing  215  for a CECS is mounted to the chassis framework together with a display  217  and a printer  220 . 
         [0099]    A vertically moveable the spike holder  210  is mounted vertically to the chassis framework below each of the two chambers  201  and  202 . Said automated spiking system is positioned and orientated such that each spike holder  210  is adapted to axially align a spike  211  with the axis of the container  22 ,  23  that is to be spiked. Tubing  218  connected to each spike  211  is adapted to transfer the fluid from the spiked container to the CM injector. 
         [0100]    The functional description of the first exemplary embodiment describedof the invention from above applies mutatis mutandis to this second exemplary embodiment of the invention. 
       ABBREVIATIONS AND REFERENCE NUMERALS 
       [0101]    FMS Fluid Management System 
         [0102]    FMD,  100  Fluid Management Device 
         [0103]    FTS Fluid Transfer System 
         [0104]    CM contrast media 
         [0105]    CECS central electronic control system 
         [0106]      1  ceiling arm attachment 
         [0107]      31  bail 
         [0108]      5  heater for temperature-controlled chamber 
         [0109]      14  chassis framework 
         [0110]      2  main gear 
         [0111]      3  motor gear 
         [0112]      4  idler gear 
         [0113]      6  idler pin 
         [0114]      61  attachment 
         [0115]      20   a,b  temperature-controlled chamber 
         [0116]      21   a,b  non-temperature-controlled chamber 
         [0117]      22  CM Container 
         [0118]      23  Saline container 
         [0119]      24   a,b  door of temperature-controlled chamber 
         [0120]      25   a,b  door of non-temperature-controlled chamber 
         [0121]      26  window 
         [0122]      27  carousel drive shaft 
         [0123]      7  plate (carousel) 
         [0124]      18  plate (saline holder) 
         [0125]      8  wire container rack 
         [0126]      28  clip 
         [0127]      13  drip tray 
         [0128]      15  tubing to top chamber spike 
         [0129]      16  tubing to lower chamber spike 
         [0130]      17  Y-connector 
         [0131]      18  tubing to CM injector 
         [0132]      9  linear slide 
         [0133]      10  spike holder 
         [0134]      11  spike 
         [0135]      12  automated spiking system 
         [0136]      43  sheath for spike 
         [0137]      41  base 
         [0138]      42  top 
         [0139]      44  hole 
         [0140]      45  guide notch 
         [0141]      54  pin 
         [0142]      55  slide rail 
         [0143]      200  FMD—second embodiment 
         [0144]      201  first temperature-controlled chamber 
         [0145]      202  second temperature-controlled chamber 
         [0146]      203  lid for first temperature-controlled chamber 
         [0147]      204  lid for second temperature-controlled chamber 
         [0148]      205 , 206  rotating carousel 
         [0149]      210  spike holder 
         [0150]      211  spike 
         [0151]      215  housing for CECS 
         [0152]      217  display 
         [0153]      220  printer