|
|
|
Patient Care
For Physicians
Intravenous Contrast Media Guidelines and Policies - for Adults
based on ACR recommendations
Nonionic contrast is used for all patients
High risk groups
Previous reaction to contrast media
Renal Failure (azotemia)
Diabetes mellitus
Serious allergies and/or asthma
Significant cardiovascular disease
Metformin (Glucophage)*
Prior CM admin e.g. cardiac cath or PE study within 24-48 hours
Nephrotoxic drugs
Pheochromocytoma, mastocytosis
Sickle cell disease
Misc: Pregnancy, thyroid disease
*For Diabetic Patients on Glucophage (Metformin) or Glucovance (Metformin and glyburide)
- Stop medication prior to IV contrast injection.
- Withhold medication for 48hrs after contrast administration.
- Inform patient and referring M.D. to confirm normal renal function e.g., serum creatinine, before re-starting medication again.
Pre-medication strategies, oral steroids are best!
Routine:
- Methylprednisolone (Medrol)32mg - 12 and 2hrs prior, p.o.
An antihistamine can be added: H1 blocker-diphenhydramine (Benadryl) oral, 50mg 1-2hrs prior p.o. or systemic: 25/50mg IV/IM
- Alternate regimen: Prednisone 50mg 12,6,1 hr prior, p.o.
Antihistamine regimen can be added as above
Urgent/Emergent Study
- Hydrocortisone (Solu-Cortef) 200-400mg IV 2-4hrs IV
- If time allows; Prednisone 50mg, 2-4hrs prior, p.o.
- If previous reaction was cutaneous only, may use H1 blocker - Benadryl IM/IV, 25-50mg
|
