Contrast Corner
Intravenous Contrast Agent Guideline
The following is intended to serve as a guideline for performing diagnostic studies that require contrast medium. It is realized, however, that each individual case presents a unique situation. There will be times when the benefit of information gained from contrast administration will supersede the potential risk of reaction or renal toxicity. The following guidelines may not apply in these cases or in life threatening emergencies.
1) A current creatinine level must be available for all inpatients and for outpatients over 65 years of age prior to administration of intravenous contrast. We interpret “current” as within one month for an outpatient, and one week for an inpatient.
2) Patients with an elevated creatinine should receive intravenous contrast only if absolutely necessary. The following table provides a guideline for the use of contrast by type relative to the patients creatinine in mg/dL or eGFR in %:
UW Guidelines for Contrast Selection
| Diabetic | ||
|---|---|---|
| Creatinine | eGFR | |
| Iohexol | ≤ 1.4 | > 45 |
| Iodixanol | ≤ 2.0 | 45-30 |
| No Contrast | > 2.0 | < 30 |
| Non-Diabetic | ||
|---|---|---|
| Creatinine | eGFR | |
| Iohexol | < 1.8 | > 30 |
| Iodixanol | 1.8 - 3.0 | 30-15 |
| No Contrast | > 3.0 | < 15 |
3) For an acutely traumatized patient for whom there is insufficient time to obtain a creatinine level, it is understood that the benefit of making an emergent diagnosis of a life threatening injury outweighs the risk of contrast nephrotoxicity.
4) Patients who have chronic renal failure and are on chronic dialysis may receive contrast, preferably but not necessarily just prior to a dialysis session. Patients who have been recently started on dialysis for hopefully transient renal failure must have their contrast enhanced scan just prior to a dialysis session.
5) Patients with multiple myeloma, sickle cell disease, homocystinuria or active gout should receive intravenous contrast only if absolutely necessary. The patient should be well hydrated with intravenous fluids.
6) Patients who report a contrast sensitivity may be premedicated according to protocol at the discretion of the radiologist. Resuscitation equipment and drugs should be readily available.
7) Patients who report “passing out” or who needed resuscitation after past contrast injections, should have iodinated contrast only if alternative testing will not provide a satisfactory result. Same should apply to patients with allergic asthma or multiple severe allergies.
8) Patients who exhibit anxiety prior to injection have a much greater incidence of allergic reaction. They may be premedicated with:
Midazolam, 2 mg IV titrated up to a maximum of 5 mg.
Contraindication-glaucoma.
