Scope
IV Iodinated Contrast For CT | Gadolinium Based Contrast For MRI | Radiopharmaceuticals For Nuclear Medicine | Oral And Rectal Contrast Agents
Goals
Prevent Adverse Reactions | Minimize Renal Injury | Ensure Proper Documentation | Provide Clear Patient Instructions
Key Stakeholders
Referring Clinician | Radiologist | Technologist | Nursing Staff | Pharmacy
Prior Contrast Reaction | Asthma | Atopy
Ask About Prior Contrast Reaction | Document Severity And Treatment Required | Note History Of Asthma Or Multiple Drug Allergies
eGFR Creatinine
Obtain Recent Serum Creatinine Or eGFR For Patients At Risk | Use Institution Thresholds For Gadolinium And Iodinated Contrast | Consider Alternatives If Renal Function Is Severely Impaired
Metformin And Nephrotoxic Drugs
Identify Metformin Use And Follow Local Guidelines For Withholding | Review Nephrotoxic Medications And Coordinate With Prescribing Clinician
Risk Assessment And Counseling
Screen For Pregnancy Prior To Ionizing Radiation And Gadolinium Use | Discuss Risks And Benefits | Provide Breastfeeding Guidance Based On Agent And Local Policy
Documented Discussion
Obtain Consent When Required | Explain Purpose Risks Alternatives And Post Procedure Instructions | Document Consent In Medical Record
Oral Prednisone Regimen
Typical Regimen For Iodinated Contrast Allergy Prophylaxis | Example Schedule 13 Hours 7 Hours And 1 Hour Before Exam | Use Institutional Protocols And Adjust For Urgent Studies
Short Course For Urgent Exams
Rapid Regimen For Urgent Imaging | Use IV Steroids And Antihistamines Per Local Policy | Consult Radiology Or Allergy For Complex Cases
H1 And H2 Blockers
Administer H1 Antagonist Such As Diphenhydramine For Moderate Reactions Or As Part Of Premedication | Consider H2 Blocker For Additional Coverage Per Protocol
Record Medication Timing And Dose
Document Premedication In Chart And On Imaging Order | Confirm Patient Received Medications Prior To Contrast Administration
Catheter Size And Location
Use Appropriate IV Catheter Size For Power Injectors | Verify Patency With Saline Flush | Avoid Small Peripheral Veins For High Flow Injection Rates
Rate Volume And Concentration
Follow Protocol Specific Rates And Volumes For Study Type | Adjust For Patient Size And Renal Function | Document Agent Name Lot Number And Volume Administered
Pressure Limits And Monitoring
Set Pressure Limits Based On Catheter And Vein | Monitor For Pain Swelling Or Resistance During Injection | Stop Injection Immediately If Extravasation Suspected
Timing And Patient Instructions
Provide Clear Instructions For Oral Contrast Timing And Fasting | Use Water Soluble Contrast For Suspected Perforation | Document Type And Volume Given
Stop Injection Elevate And Assess
Stop Injection Immediately | Leave Catheter In Place To Aspirate Residual Contrast If Possible | Elevate Limb And Apply Cold Or Warm Compress Per Institutional Policy
Estimate Volume And Inspect Skin
Estimate Extravasated Volume | Inspect For Blistering Skin Changes And Neurovascular Compromise | Document Event Time Agent And Actions Taken
Surgical Consultation And Wound Care
Arrange Surgical Or Plastic Surgery Consultation For Large Volume Or Severe Injury | Provide Patient Instructions For Signs Of Infection Or Compartment Syndrome | Schedule Follow Up And Document Outcome
Oral And IV Hydration
Use IV Hydration For High Risk Patients Per Institutional Protocol | Oral Hydration May Be Adequate For Low Risk Patients | Tailor Volume And Duration To Renal Function
Low Dose And Alternative Modalities
Use Lowest Effective Contrast Volume And Concentration | Consider Noncontrast Imaging Or Alternative Modalities When Appropriate | Use Split Bolus Or Dual Energy Techniques To Reduce Dose
NAC And Other Agents
Follow Local Guidelines For Use Of N Acetylcysteine Or Other Renal Protective Agents | Evidence Varies So Consult Institutional Policy
Agent Lot Number Volume And Route
Record Agent Name Lot Number Expiration Volume Route Injection Rate And Site | Note Any Reactions And Interventions Performed
Severity Grading And Follow Up
Classify Reaction As Mild Moderate Or Severe | Document Treatment Given And Patient Response | Notify Radiologist And Risk Management If Required
Post Procedure Guidance
Provide Written Instructions For Hydration Monitoring For Signs Of Reaction And When To Seek Care | Include Contact Information For Urgent Concerns
Extravasation
Leakage Of Contrast From Vessel Into Surrounding Tissue | Requires Immediate Assessment
eGFR
Estimated Glomerular Filtration Rate | Used To Assess Renal Function And Contrast Risk
Premedication
Steroid And Antihistamine Regimens Given To Reduce Risk Of Allergic Reaction
Power Injector
Device For Controlled High Flow Contrast Injection | Requires Appropriate IV Access
Nephrogenic Systemic Fibrosis NSF
Rare Fibrosing Condition Associated With Gadolinium In Severe Renal Failure | Use Caution And Follow Guidelines