Administration of intravenous contrast

Radiology Department Staff is responsible to ensure that this policy and procedure is
followed during procedure and when storing radiological supplies in the department.
Radiology department Head is responsible for ensure that all staff is aware of this policy and
procedure, ensure that strict monitoring of compliance to this policy and procedure is
followed, ensure appropriate actions are undertaken in case of contrast reactions and
extravasation of contrast, and to provide guidelines for the proper storage of radiological
supplies.
* Provide questionnaire for the patent to check history of allergy, chronic illness, any implants, If
the patient is “claustrophic”, and consent for injection if any contrast will be administrated
{collect signature of the patient}.

Medications which may increase the risk of iodinated contrast, induced renal failure such as: -
{Metform} for diabetes, the advice to stop from the day of procedure for two days and to
repeat creatinine test after 2 days. {ibuprofen, naproxen, ketorolac, fenoprofen, indomethacin,
celecoxib, nephrotoxic antimicrobials, gentamicin, tobramycin, amikacin, amphotericin B,
cidofovir) If contraindications are identified, the radiologist will be contacted to determine the
appropriate preparation or to cancel the procedure.

*The radiologist reviews all requests for radiology procedures with intravenous contrast to
determine or modify the appropriate protocol based on the clinical indications, contact patient
by phone or mail with questionnaire for allergy or any medical conditions.

*Ensure appropriate premedication in patients with known with suspected allergic reactions for
any medications, oral administration of steroids is preferable in advance to IV administration, to
be given at least 6 hours prior to the injection of contrast media in order to reduce the
frequency of urticaria, angioedema, and respiratory symptoms, you may consider giving
hydrocortisone IV stat prior to contrast administration and 4 hours later to cover delayed
reaction.

* The patient should be fasting 6-8 hours.

*Checking vitals and doing cannulation if everything in normal range.

*Type of contrast and dose information is recorded by the technologist with dose calculation
{Dose: 1- 2 mL/kg maximum dose 150 ml}, the lowest possible dose is should use.

* The first step in the treatment of adverse reactions that arise during IV administration is to
immediately discontinue the injection. monitor the patient's cardiac rhythm, blood pressure,
and oxygen saturation, mild reactions are self-limiting and do not require treatment. however,
the patient should be closely monitored until the symptoms resolve, within the radiology
department. moderate and more severe reactions may necessitate support from an emergency
response team and further monitoring, ensure that sufficient staff capable of handling the
severe contrast reaction; including {intubation and administration of life support drugs} .

* The patients must have a recent serum creatinine test within 90 days prior to the exam
{simply asking patients if they have a problem with their kidneys is not considered an effective
screening tool}. If the creatinine is high, the radiologist will calculate the creatinine clearance
and decide whether to proceed or not. The nephrologist should be consulted to take decision
for arrangement of early postprocedural dialysis session.

*Special precautions have to be done in case of: - Age > 50 years old, History of renal disease
including {Dialysis, Kidney Transplant, Single kidney, Kidney Surgery, History of known cancer
involving kidneys or chemotherapy, history of hypertension requiring medical therapy, history of
diabetes mellitus}.

* Patient with no adverse effects is taken to the treatment room, check vital signs and remove
cannula.
*Instructions for drinking water at least 2-3litres within 24 hours after the examination

*The conduct of contrast media extravasation will might include: -

 discontinue the contrast infusion and notify the radiologist immediately

 complete the acquisition of images of the CT series
 apply an ice pack to the affected area and elevate the affected extremity to reduce
swelling
 keep the patient under observation for at least two hours
 make contact with the doctor requesting the examination
 it is suggested to follow up the patient in the next few days until the resolution of local
oedema; this can be accomplished with a phone call to evaluate the regression of the
signs and symptoms.

*Emergent contrast administration in life-threatening situations. In cases of life-threatening

emergency requiring administration of IV contrast and where the ordering provider cannot wait
for the premedication by the protocol, it is requiring administration of steroids 4 hours and 1
hour prior to the procedure and the alternative test is not acceptable, the ordering physician
must add a note in the medical record of the patient prior to the contrast administration which
clearly states the following: - *Indication of the urgent study, reason why the alternative exam
(if offered by the radiologist) is not acceptable, ensure that sufficient staff capable of handling
the severe contrast reaction; including intubation and administration of life support drugs will
be available during and after the procedure, instructions as drinking water at least 2-3litres
within 24 hours after the examination.

MRI GADOLINIUM BASED CONTRAST AGENTS: - dose: 0.2 mL/kg with maximum dose 20 mL ,
the same approach for iodinated IV contrast for contrast reactions

Storage: -

*To store radiology products in standardized and appropriate conditions as stated in the
product manufacturers recommendations.

*Ensure maintain adequate supplies in radiology department for 30 days of routine work. the
list of all supplies in radiology department is updated and made available to the staff on a
regular basis either by hard or in electronic format, when the stock level goes below 50-30%,
request is sent to the store.