TITLE/DESCRIPTION: IODINATED C0NTRAST MEDICATION ADMINISTRATION

Transcription

1 TITLE/DESCRIPTION: IODINATED C0NTRAST MEDICATION ADMINISTRATION PROCEDURE DEPARTMENT: Radiology PERSONNEL: All Personnel in Radiology EFFECTIVE DATE: March 2008 REVISED: Feb 2012, 1/15, 05/17 POLICY: IODINATED CONTRAST MEDICATION ADMINISTRATION PURPOSE: To provide Radiology personnel with guidelines for storing and administering iodinated Contrast medications. POLICY: 1. Radiology technologists and radiology nurses involved in exams that include administration of contrast will be trained in emergency protocol, and be able to demonstrate competency annually to recognize the symptoms of contrast reactions, extravasations and implementation of treatment. 2. All radiology technologists and radiology nurses involved in the preparation of imaging medications will demonstrate competency annually in product preparation. 3. Any contrast that is mixed by radiology staff will be labeled with the date and time that it is mixed, and should be disposed of within 24 hours.

2 4. Contrast medication dosing is according to protocol. 5. Contrast is stored per manufacturer s recommended guidelines. PROCEDURE: IODINATED CONTRAST MEDIA IV ADMINISTRATION 1. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Verify and document that patient is not pregnant. If the patient may be pregnant, the technologist or nurse should discuss this with the patient s physician. 2. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Patient report or documented history of allergic reactions to iodinated contrast. If the patient meets any of the criteria above, the technologist or nurse should discuss this with the patient s physician who will determine if the patient may need to be pre-medicated, cancelled, or another test ordered. 3. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Patient report or documentation of history of pheocromocytoma. If the patient has pheochromocytoma,, the radiology technologist or nurse will consult with the radiologist on duty. 4. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Patient age 65 or greater. b. Pending serum creatinine result at the time of contrast administration.

3 c. Patient report or documented history of serum creatinine level greater than 1.5 mg/dl. d. Patient report or documented History of any of the following: Renal disease Kidney tumors Single kidney Diabetes mellitus (insulin or other meds) Family history of kidney failure Proteinuria Multiple Myeloma (paraproteinemia syndromes) Intravascular volume depletion (CHF, Liver disease with ascites) Collagen vascular disease (SLE, Scleroderma, RA) Solid organ transplant Receiving Chemotherapy e. Patient is an inpatient, or emergency room patient. If the patient meets any of the criteria listed above, a serum creatinine within 30 days must be available. As appropriate, obtain an order for a stat serum creatinine level, ensuring that the result is available prior to contrast administration. If the patient has acute renal disease, the radiology technologist or nurse will consult with the patient s nephrologist for guidance before proceeding.

4 Iodinated Contrast Media Administration- GFR Guidelines GFR Levels--- Iodinated Contrast to be used GFR above 45- Omnipaque 350 GFR 30 to 45- Visipaque 320 GFR less than 30- Contact ordering physician. May continue with Visipaque with ordering physician approval. Patient on Dialysis- Contrast administration per Nephrologist 5. Inject contrast media following the guidelines below: a. Verify that the radiologist or physician designee is in the department, and are available to respond to adverse contrast reactions. b. Emergency equipment and emergency pharmaceuticals must be available. c. Explain procedure to patient, answer any questions. d. Perform a Contrast Time Out. A Contrast Time Out consists of the technologists checking the patient s name and date of birth, verifying the patient has been screened as listed above, verifying the type of procedure ordered, verifying the type and amount of contrast to be given. This should be done immediately before the injection of contrast. e. Complete the Radiology "Contrast Assessment form in the hospital information system. The performing technologist is responsible to verify documentation before injection. f. The type, quantity and dose of contrast to be administered should be chosen according to the Radiology department protocol. g. During the injection, observe for signs of extravasation, i.e., pain, swelling, firmness of tissue or discoloration. Discontinue injection immediately if extravasations or adverse reaction occurs. All extravasations greater than 30ml

5 will be reported to the radiologist or physician designee, and a QA form prepared. h. During and following the injection, the administering individual will remain with the patient to observe for possible reactions. At the first sign of reaction, the administration will be stopped and immediately reported to the radiologist or physician designee. (If not present for injection). DOCUMENTATION: 1. The administering technologist or nurse will document the following on the Contrast Assessment form in Sunrise: a. The 5 Rights performed. b. The patient screening information. c. Patient identity verified. d. Patient education/ questions answered. e. Contrast type and amount administered. f. Lot number and expiration date. g. Home medications. h. Patient History. i. Injection Site. j. Needle Size. k. Injection method. SPECIAL CONSIDERATIONS/ADDITIONAL INFORMATION:

6 1. Pre-assessment of the patient identifies possible risk factors of contrast reactions. Patients with a known history of reaction to contrast media may be pre-medicated with antihistamines and/or steroids. The following is the recommended schedule for contrast allergy pre-medication which the patient may obtain through their primary or ordering physician: Prednisone 50mg P.O. take one 13, 7 & 1 hr. prior to scan Benadryl 50mg P.O. - 1 hr. prior to scan Urgent or Emergent Imaging Requiring Iodinated Contrast Media: If a patient has a history of a contrast reaction and needs contrast-enhanced imaging urgently or emergently, the ordering physician should contact the attending radiologist. Alternatives to the pre-medication regimen noted above and other imaging options should be discussed. 2. Diabetics taking metformin, i.e., Advandamet, Metaglip, Glucophage, Glucophage XR, Glucovance,, Glumentza, Fortamet, Riomet, ActoplusMet, AvandaMet, Janumet, or PrandiMet, must stop the medication at the time of the examination or procedure and withhold it for 48 hours following IV iodine contrast administration. Outpatients are instructed by the technologist or nurse to withhold metformin for 48 hours and to maintain hydration by drinking extra oral fluids. Outpatients are instructed to call their physician to ask if they need to take a substitute medication during the 48 hours that they have to be off Metformin, and to ask their physician if they need to have lab work done to be sure their kidneys are working properly before resuming the Metformin. Inpatients automatically get an order for Metformin to be held for 48 hours post

7 exam. IODINATED CONTRAST MEDIA ADMINISTRATION, NON INTRAVENOUS ALL 1. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Verify and document that patient is not pregnant. If the patient may be pregnant, the technologist or nurse should discuss this with the patient s physician. 2. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Patient report or documented history of allergic reactions to iodinated contrast. If the patient meets any of the criteria above, the technologist or nurse will substitute Barium Sulfate for Oral or Rectal administration when not contraindicated, and will discuss with the ordering physician otherwise. ORAL CONTRAST ADMINISTRATION 3. Screen the patient for the following conditions or circumstances prior to contrast administration: a. Patient report or documented history of (or risk of): Bowel Obstruction Appendicitis Patient is scheduled for surgery

8 Bowel Perforation Patient is an ER patient If the patient meets any of the criteria above, the technologist or nurse will substitute contrast according to Radiology Department protocol. 4. Administer contrast media following the guidelines below: a. Verify that the radiologist or physician designee is in the department, and are available to respond to adverse contrast reactions. b. Emergency equipment and emergency pharmaceuticals must be available. c. Explain procedure to patient, answer any questions. d. Perform The 5 Rights. The 5 rights consist of: Right Patient, Right Time and Frequency of Administration, Right Dose, Right Route of Administration, Right Drug (contrast). e. Complete the Radiology "Contrast Assessment form in the hospital information system. The performing technologist is responsible to verify documentation before administering the contrast. f. The type, quantity and dose of contrast to be administered should be chosen according to the Radiology department protocol. g. When an inpatient has oral contrast ordered for a CT scan, the radiology technologist or nurse will perform the patient

9 screening by checking the EMR documentation and calling the patient s nurse. g. The radiology technologist or nurse will mix the oral contrast medication according to the contrast protocol. The medication will be labeled and sent to the patient s nurse on the floor to be administered. DOCUMENTATION: 1. The administering technologist or nurse will document the following on the Contrast Assessment form in Sunrise: a. The 5 Rights performed. b. The patient screening information. c. Patient identity verified. d. Patient education/ questions answered. e. Contrast type and amount administered. f. Home medications. g. Patient History.