CT Contrast

CT Contrast Administration

Creatinine Guidelines for Iodinated IV Contrast

Cr Thresholds Table

Who Needs a Cr Prior to Contrast?

Cr Contrast and Hemodialysis

Contrast-Associated and -Induced Acute Kidney Injury

Guidelines for Prevention of Contrast-induced Nephropathy in Adults

“Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation” 

Hydration Protocol

Bicarbonate Protocol

Conditions that Impact Use of Iodinated CT Contrast

Patients with multiple myeloma, sickle cell disease, homocystinuria, or active gout may receive intravenous contrast but should be well hydrated.

Pheochromocytoma

Allergies

Asthma

IL-2

Diabetes, Renal Failure, Nephrectomy, Renal Transplant

Metformin

Active Gout

Multiple Myeloma

Managing Contrast Reactions (CT and MRI)

Contrast Reaction Dosage for Adult Patients

Contrast Reaction Dosage for Pediatric Patients

ACR cards

Adult

Pediatric

VIDEO: Managing Contrast Reactions Lecture – Myron Pozniak, MD

Pre-medication for Contrast Allergy

Prophylaxis Policy for Patients Allergic to IV Contrast

ACR cards

Adult

Pediatric

Other Helpful Links:

Scheduler CT/MR Screening Guidelines for Patients with Allergy

Treatment of Nonionic Radiographic Contrast Material Extravasation

CT Contrast and Breastfeeding (NEED NEW PDF)

ACR Contrast Guide 

Contrast Cards

“Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation” 

 

EXTRA COPY (Delete or put somewhere?)

  1. 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 (mg/dL) or eGFR (%):
  2. 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.
  3. Patients who have chronic renal failure and are on chronic dialysis may receive contrast. While the timing of contrast administration is not dependent upon dialysis, it is preferable that the next routine dialysis occurs within 24 hours following contrast. Contrast should be avoided in patients who are experiencing acute dialysis-dependent renal failure as there is hope that renal function will recover. However, contrast may be administered in this setting if the referring physician deems it necessary.
  4. Patients who report an allergy-like reaction to contrast may be premedicated according to protocol at the discretion of the radiologist. Resuscitation equipment and drugs should be readily available.
  5. 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.
  6. Contrast reactions could be potentiated by anxiety. Therefore, if a patient is exceedingly anxious prior to contrast injection, they may be premedicated with: Midazolam, 2 mg IV titrated up to a maximum of 5 mg (contraindication = glaucoma)

Jessica Robbins, June 2015

 

The decision to give IV contrast is often multifactorial, and the clinical scenario is often the most important piece. We want to adhere to the Cr guidelines for outpatients and non-emergent exams wherever possible. However, the Cr guidelines are simply guidelines, and if there is an emergent study that the clinical team feels needs to be done (and requires IV contrast e.g. PE protocol), these guidelines can be over ridden based on the clinical need. It is reasonable to consider an alternative test if it can be safely and expediently done, but we don’t want to delay care and sometimes CT is the best exam in an unstable patient. While we know that acute kidney injury (AKI) or eGFR<30 are the main risk factors for contrast induced AKI, the absolute risk is not clear, may be overstated, and is likely outweighed by the risk of delay in diagnosis in emergent cases. This warrants a conversation with the clinical team about the need and the urgency, but if deemed an emergency without reasonable alternative exam, it is ok to proceed. On the flip side, as we have discussed before, if a study is ordered without IV contrast (but you think it needs it and you don’t see a contraindication), a conversation with the referring team can help clarify the clinical context before making changes to the order or protocol. If you are in doubt, you can always contact the fellow or attending on call (or me if it is a CT/contrast issue) to help.