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Iodinated Contrast Media Guideline

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IODINATED CONTRAST MEDIA GUIDELINE FACULTY OF CLINICAL RADIOLOGY THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF RADIOLOGISTS® Name of document and version: Iodinated Contrast Media Guideline, V2.3 Approved by: Faculty of Clinical Radiology Date of approval: March 2018 Suggested Citation: The Royal Australian and New Zealand College of Radiologists. Iodinated Contrast Media Guideline. Sydney: RANZCR; 2018. ABN 37 000 029 863 Copyright for this publication rests with The Royal Australian and New Zealand College of Radiologists ® The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Australia Email: [email protected] Website: www.ranzcr.edu.au Telephone: +61 2 9268 9777 Disclaimer: The information provided in this document is of a general nature only and is not intended as a substitute for medical or legal advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Document name Iodinated Contrast Media Guideline Description The Iodinated Contrast Media Guideline is intended to assist The Royal Australian and New Zealand College of Radiologists®, its staff, Fellows, members and other individuals involved in the administration of iodinated contrast media to patients undergoing medical imaging procedures. Created By Standards of Practice and Accreditation Committee Date Created 2011 Maintained By Faculty of Clinical Radiology, Policy and Advocacy Unit Version Number Modifications Made Date Modified 2011 Document published 2.0 Document updated and published April 2016 2.1 Grammatical error corrected in R31 February 2017 2.2 Nitroglycerin dosages corrected in R39 June 2017 2.3 Adrenaline dosage corrected in R56 March 2018 Iodinated Contrast Media Guideline, V2.3 © The Royal Australian and New Zealand College of Radiologists® March 2018 Page 2 of 39 TABLE OF CONTENTS 1. Introduction 5 1.1 Purpose and Scope ............................................................................................................................... 5 1.2 The Intent of this Document .................................................................................................................. 5 1.3 Guideline Methodology – Agree II Tool ................................................................................................. 5 1.4 Iodinated Contrast Media Guideline Working Group membership and method of recruitment ............................................................................................................................................ 5 1.5 Acknowledgments ................................................................................................................................. 7 1.6 Consultation .......................................................................................................................................... 7 1.7 Determination of Scope ......................................................................................................................... 8 1.8 Format ................................................................................................................................................... 8 1.9 Funding ................................................................................................................................................. 9 1.10 Conflicts of Interest ............................................................................................................................... 9 1.11 Review Process .................................................................................................................................... 9 1.12 Definitions and Abbreviations ................................................................................................................ 9 2. Risk Assessment and Management of Patients Prior to Iodinated Contrast Media Administration 10 2.1 Hypersensitivity Reaction to Iodinated Contrast Media ....................................................................... 10 2.2 Delayed Hypersensitivity Reactions .................................................................................................... 11 2.3 Premedication of Patients with Prior Anaphylactic Reactions to Iodinated Contrast Media .................................................................................................................................................. 12 2.4 Contrast Media Induced Kidney Injury and Metformin Associated Lactic Acidosis ............................. 12 2.5 Clinical Estimation of Renal Function .................................................................................................. 15 2.6 Screening Patients with Regard to Their Need for Renal Function Testing ........................................ 16 2.7 Periprocedural Strategies to Mitigate the Risk of CI – AKI in Higher Risk Individuals ......................... 19 2.8 Metformin and Contrast Media ............................................................................................................ 20 2.9 Other Medical Conditions That Need to Be Considered Before the Administration of Iodinated Contrast Media .................................................................................................................... 20 2.10 Breast Feeding .................................................................................................................................... 23 2.11 Pregnancy ........................................................................................................................................... 23 3. General Safety Issues 24 3.1 Intravenous Access and Contrast Media Extravasation ...................................................................... 24 3.2 Training ............................................................................................................................................... 25 3.3 Contrast Media Administration ............................................................................................................ 25 3.4 Emergency Equipment ........................................................................................................................ 25 3.5 Contrast Media Storage, Warming and Disposal ................................................................................ 26 3.6 Patient Information and Consent ......................................................................................................... 28 4. Management of Anaphylactic Iodinated Contrast Media Reaction 28 4.1 Confirmation of Anaphylactic Reaction ............................................................................................... 31 4.2 Delayed Contrast Media Reactions ..................................................................................................... 31 5. Paediatric Administration of Iodinated Contrast Media – Special Considerations 32 6. Oral and Other Non-Intravascular Contrast Media Administration 32 7. Related Policy Documents 33 8. Appendices 33 9. Point of Care Tools 33 Iodinated Contrast Media Guideline, V2.3 © The Royal Australian and New Zealand College of Radiologists® March 2018 Page 3 of 39 About the College The Royal Australian and New Zealand College of Radiologists (RANZCR) is a not-for-profit association of members who deliver skills, knowledge, insight, time and commitments to promote the science and practice of the medical specialties of clinical radiology (diagnostic and interventional) and radiation oncology in Australia and New Zealand. The Faculty of Clinical Radiology, RANZCR, is the peak bi-national body for setting, promoting and continuously improving the standards of training and practice in diagnostic and interventional radiology for the betterment of the people of Australia and New Zealand. Our Vision RANZCR as the peak group driving best practice in clinical radiology and radiation oncology for the benefit of our patients. Our Mission To drive the appropriate, proper and safe use of radiological and radiation oncological medical services for optimum health outcomes by leading, training and sustaining our professionals. Our Values Commitment to Best Practice Exemplified through an evidence-based culture, a focus on patient outcomes and equity of access to high quality care; an attitude of compassion and empathy. Acting with Integrity Exemplified through an ethical approach: doing what is right, not what is expedient; a forward-thinking and collaborative attitude and patient-centric focus. Accountability Exemplified through strong leadership that is accountable to members; patient engagement at professional and organisational levels. Code of Ethics The Code defines the values and principles that underpin the best practice of clinical radiology and radiation oncology and makes explicit the standards of ethical conduct the College expects of its members Iodinated Contrast Media Guideline, V2.3 © The Royal Australian and New Zealand College of Radiologists® March 2018 Page 4 of 39 1. INTRODUCTION 1.1 Purpose and Scope This Iodinated Contrast Media Guideline is intended to assist The Royal Australian and New Zealand College of Radiologists® (ABN 37 000 029 863) (RANZCR), its staff, Fellows, members and other individuals involved in the administration of iodinated contrast media to patients undergoing medical imaging procedures. 1.2 The Intent of this Document (a) To inform the safe and appropriate use of iodinated contrast media. (b) To provide health professionals in Australia and New Zealand with
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