ContrastMediaandContrastReactions.ppt

Contrast Media and Contrast Reactions Malpractice Issues Contrast Media Iodinated Contrast: Compounds Iodinated Contrast: Properties Iodixanol Nonionic dimer, iso-osmolar Less nephrotoxic, fewer reactions? NEPHRIC study (NEJM 348:491-499, 2003) Patients with creatinine 1.5 – 3.5 mg/dL had angiography Iohexol: nephropathy in 26% Iodixanol: nephropathy in 3% Incidence of Reactions Risk Factors and Precautions Allergic Risk Renal Risk Metformin Cardiac Risk Other Risks Other Risks Acute Reactions Nausea Urticaria Laryngeal Edema Bronchospasm Hypotension with Bradycardia (Vagal Reaction) Legs elevated, Monitor vital signs O2 10L/min Ringers lactate or normal saline ATROPINE .6-1.0mg IV slow, repeat to .04mg/kg Hypotension with Tachycardia Severe Hypertension Monitor ECG, O2 sat, BP NITROGLYCERINE 0.4mg SL (x3) or 1 topical 2% Sodium nitroprusside, must dilute with D5W Transfer to ICU or ED For pheochromocytoma: PHENTOLAMINE 5mg IV Chest Pain ECG O2 10 L/min Vitals, physical exam: ?CHF NITROGLYCERINE, SL Discuss with primary MD Transfer to ED/ICU Pulmonary Edema Seizures or Convulsions Severe Anaphylactoid Reaction Epinephrine 1:10,000 1ml IV over 3-5 min O2 10L/min NS or Ringer’s Benadryl 25-50 mg IV Hydrocortizone 1g IV push/30 sec Contrast-Induced Nephrotoxicity Nephrotoxicity: Risk Factors Nephrotoxicity: Risk Factors Dec 18 Injection of Contrast Extravasation Central Lines Air Embolism Enteric Contrast Enteric Contrast Summary Due to renal vascular effects and direct toxicity to tubular cells Third most common cause of in-hospital renal failure, after hypotension and surgery Definition: elevation of creatinine 25% or .5-1.0 mg/dL within 72 hours Usually asymptomatic: creatinine peaks 3-5 days, in severe oliguric renal failure: peaks 5-10 days Incidence: 7-8% arterial injections 2-5% venous injections ~0% venous injections if no risk factors Contrast-Induced Nephrotoxicity Byrd and Sherman, 1979: Renal insufficiency (creat1.5) Diabetes Dehydrat