Treatment of nonionic radiographic contrast material extravasation

Details of treatment, including link to patient Health Facts for You (HFFY) sheet

Initial treatment provided by the radiology technologist includes:

  • Elevation of affected extremity above the heart
  • Removal of any tight fitting clothing above the injection site
  • Milk the extravasated contrast toward the heart by intermittent compression of affected site by manual compression or an Ace wrap

Observation performed by nursing staff includes:

  • Typical observation periods of 1-2 hours are sufficient
  • Educate patient about signs of tissue compromise, and advise to seek medical attention if needed per UW Health Facts for You (HFFY)
  • Plastic surgery consultation based on symptoms, not quantity of extravasation

Plastic surgery consultation should be considered for any of the following reasons:

  • Skin blistering
  • Redness or streaks at the injection site
  • Altered tissue perfusion (decreased capillary refill in the region or distal to the injection site)
  • Increasing pain
  • Change in sensation distal to site of extravasation

Patient given Health Facts for You (HFFY) by rad tech if responsive, or printed by nursing prior to discharge.

Bicarb Protocol

Interventional Radiology Bicarb Protocol for CIN

Indication

Radiocontrast nephropathy is a common cause of hospital acquired acute renal failure and has been associated with an increased in-hospital mortality and LOS.1-2

Various prevention strategies have been employed such as pre and post procedural hydration, vasodilators and acetylcysteine administration.

A study from JAMA printed in May of 2004 indicates that hydration with a bicarbonate solution may better prevent contrast induced nephropathy than NS hydration. Most renal failure is associated with metabolic acidosis and low urinary pH. NS may contribute to acidosis while the bicarbonate solution will buffer the pH.3

Other advantages of this prevention strategy are the low cost, lack of side effects and ability to administer in a timely manner.

Administration/Dosing

Solution: 150 mEq NaHCO3 in 1000cc D5W

  1. 1 hour prior to contrast: Initial IV bolus – 3ml/kg/hour x 1 hour
  2. After 1 hour bolus: 1ml/kg/hour during contrast exposure and 6 hours post contrast.

References

  1. Levy EM, Viscoli CM, Hurwitz RI. The effect of acute renal failure on mortality: a cohort analysis. JAMA. 1996; 275: 1489-1494.
  2. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention. Am J Med.1997; 103: 368-375.
  3. Merten GJ, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004; 291: 2328-2334.

2004/Lisa Semmann, R.N., M.S., Interventional Radiology NP