a common emergency case in radiology department

1. Management of patients with adverse
contrast reactions in radiology department
Presented by Akari Kyaw
Fourth year,
Medical Imaging Technology

2. Do you know about contrast media?
Chemical substance which is introduced into
human body via various routes to visualize
certain structures not seen in plain radiography
Increase the contrast of structures or fluids
within the body in medical imaging
Commonly used to improve the visibility of
blood vessels and the gastrointestinal tract.

3. Classification of contrast media
Contrast Media
Positive CM
Negative
CM
Water
soluble(eg.iodine)
Water insoluble
(eg.barium) Oily CM
Ionic Non-ionic
Non-ionic
Monomer
Ionic Monomer
Ionic dimer
Air,Gas,
CO2

4. Methods of introducing contrast media
The four most common methods
 Ingestion _ drinking the CM
 Retrograde administration – administration of CM against the
normal body flow
 Intrathecal administration _ introducing the CM into the sheath
 Parenteral administration _ injecting the medium into the
bloodstream

5. Adverse reactions of CM?
 Radiocontrast media (RCM) are medical drugs used to improve the visibility
of internal organs and structures in X-ray based imaging techniques.
 They may have side effects ranging from itching to a life-threatening
emergency, known as adverse reactions of contrast media.

6. Possible situations of adverse reactions
• Diabetes mellitus
• Periprocedural hypotension
• Dehydration or volume contraction
• Age > 70 years
• Congestive heart failure
• Myocardial infarction within the previous 24 hours
• Multiple doses of contrast media
• Allergy to contrast compounds

7. Categories of contrast media reaction
CM
reactions
PhlebitisExtravasation Mild Moderate Severe
Local Systemic

8. Local reactions
 Affect only the specific region of the body at which the contrast media has been
injected into the venous system
 Extravasation - leakage of iodinated CM outside the vessel and into
surrounding soft tissues
- can cause ulceration and tissue necrosis within 6 hrs
following the event

9.  Phlebitis - inflammation of a vein
Signs - pain
redness
possibly swelling surrounding the venous access site

10. Systemic reactions
Mild
 Nonallergic reaction
 Not require drug intervention or medical assistance
 Based on anxiety and/or fear
 Not life-threatening

11. Symptoms of mild reactions
• Anxiety
• Lightheadedness
• Nausea
• Vomiting
• Metallic taste
• Mild erythema
• Warm flushed sensation

12. Moderate
 True allergic reaction(anaphylactic reaction)
 Lead to a life-threatening condition
 Medical resistance without delay
 Symptoms
 Possible laryngeal swelling
 Urticaria(moderate to severe hives)
 Bronchospasm
 Angioedema
 Hypotension
 Tachycardia or bradycardia

13. Severe
 Vasovagal reaction
 Life threatening reaction
 Symptoms
 Hypotension
 Bradycardia
 Cardiac arrhythmias
 Laryngeal swelling
 Possible convulsions
 Loss of consciousness
 Cardiac arrest
 Respiratory arrest
 No detectable pulse

14. How do we manage/treat these reactions?

15. For local reactions
 Notify department nurse/or physician
 Elevate the affected extremity above the heart
 Use a cold compress followed by warm compress first
 Document the incident

16. For systemic reactions(Mild, Moderate, Severe)
 Monitoring
 Document all reactions to the CM reaction
 Call for medical assistance
 Possible hydration
 Administration of Lasix
 Interventional cardiac medications
 Antiseizure medications
 Renal dialysis

17. Drugs used in treatment of CM reactions
 Oxygen 10-12 L and intravenous isotonic fluid (eg, 0.9% isotonic sodium
chloride solution
 Intravenous atropine 0.6-1 mg, repeated every 3-5 minutes as needed until a
total of 3 mg
 Diphenhydramine 50 mg
 Cimetidine 300 mg
 Rantidine 50 mg
 Epinephrine
For urticaria

18. This Photo by Unknown Author is

19. Complications
• Cardiac system – pulses electrical activity
• Respiratory system – pulmonary edema
• Vascular system – venous thrombosis
• Nervous system – seizure induction
• Renal system – temporary failure or complete shutdown

20. Preparations and prevention
Preparations in radiology department
Fully stocked emergency response cart must be readily
available, it should contain;
• cardiopulmonary resuscitation equipment
• portable oxygen
• suction
• blood pressure apparatus
• defibrillator and monitor
• masks
• cannula
• Needles and syringes

23. Prevention
• Patient history
 Allergic to any drugs
 Allergic to any food
 Allergic to iodine
 Currently taking drugs
 Etc.
• Blood chemistry
 Creatinine(0.6 t0 1.5mg/dl)
 BUN(25 mg/ 100 ml)
• Premedications
• Selection and preparation of contrast media