Мы придерживаемся, в целом, следуюшего:
Prevention of Nephrotoxicity with Iodinated Contrast Media
A. Requirements for CREATININE testing prior to iodinated contrast media injections (for the purpose of reducing the chance of contrast-induced renal failure):
1. Patients > 50 years of age are to have a recent (within 30 days) serum creatinine prior to contrast injection.
2. Patients < 50 years of age do not require labs, UNLESS the patient has one or more of the following:
· An underlying medical condition that impairs the renal system
· Cancer
· Recently (within 30 days) had chemotherapy
· History of renal disease.
· Diabetes mellitus
· Receiving treatment with potentially nephrotoxic drugs
3. When clinical findings or history raise doubt about the patient’s current renal function, a STAT creatinine should be done prior to injecting contrast media.
B. If the serum creatinine is > 1.5 mg/dl, the referring clinician should be called and advised about alternative imaging approaches, such as MRI or a non-contrast CT. If the creatinine is > 1.5 but < 2.0 mg/dl, and the referring physician and radiologist have determined that a contrast-enhanced imaging study must be done to obtain critical medical information, the contrast may be given with the following precautions:
1. Patient should be pretreated with Mucomyst (N-acetylcysteine), either:
a. Orally, 600 mg twice daily on the day before and the day of the contrast imaging study, or
b. Intravenously, 150 mg/kg over 30 minutes before contrast administration, followed by 50 mg/kg over 4 hours.
2. Bicarbonate 150 mEq in 1000 cc D5W, 3 cc/kg bolus, then 1 cc/kg/hr x 6 hours.
3. Adequate patient hydration must be maintained.
C. Adequate patient hydration is important to minimize the risk of nephrotoxicity. Unless monitored by anesthesia, no patient receiving radiographic contrast should have NPO orders. If iodinated agents are used, the imaging study should be scheduled before the patient’s dialysis on the same day, or dialysis can be done within 24 hours after contrast injection.
Prevention of Allergic-Type Contrast Reactions
A. For patients receiving iodinated contrast media, obtain a complete history of allergies to medications and food, as well as previous reactions.
1. The patient is to fill in the attached questionnaire.
2. The technologist is to review the questionnaire with the patient prior to injection.
3. The questionnaire is part of the patient’s medical record. The Technologist is to complete the information regarding type and volume of contrast and reactions, then sign questionnaire, post injection
4. Non-Ionic contrast media is the preferred contrast for intravenous contrast injection.
For patients receiving gadolinium contrast media, ask about any prior reactions to dyes or contrast used in X-ray, CT, or MRI.
B. For patients receiving iodinated contrast media, pre-treatment to prevent or lessen reactions should be given under the following guidelines:
1. Patients with history of
· Prior mild contrast reaction
· Moderate or severe reaction to foods or medications. Moderate or severe reactions include any reaction more severe than itching and/or hives.
· Asthmatics, actively using inhalers or medications
Note: if an asthmatic patient is under the care of a pulmonary physician, check with their physician prior to prescribing steroids.
2. If a patient arrives without being pre-treated, it is preferable to reschedule the exam to allow steroid treatment. Alternative options are at the discretion of the Radiologist. If there is a history of moderate to severe contrast reaction, another radiological procedure (MRI, non-contrast CT, US or Nuclear Medicine) should be considered as an alternative
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