This manual give us recommendation and training of use of contrast media in proper way and to manage any reaction if occur.

1. AmarjeetKumar
B.Sc.MIT, M.Sc.MIT, MPA
RadiologyTechnologist
JPNATC
AIIMSDELHI
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3. purpose
 Various forms of contrast media have been used to
improve medical imaging.
 To assist radiologists & technologist in recognizing
and managing the small but real risks inherent in the
use of contrast media.
 Adverse side effects from the administration of
contrast media vary from minor physiological
disturbances to rare severe life-threatening situations.
 Trained personnel, equipment, and medications.
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4. Patient selection strategy
 1. Assessment of patient risk versus potential benefit
of the contrast-assisted examination.
 2. Imaging alternatives that would provide the same
or better diagnostic information.
 3. Assurance of a valid clinical indication for each
contrast medium administration.
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5. Patient selection strategy (Cont..)
 1) to ensure that the administration of contrast is
appropriate for the patient and the indication;
 2) to balance the likelihood of an adverse event with
the benefit of the examination;
 3) to promote efficient and accurate diagnosis and
treatment.
 4) to be prepared to treat a reaction should one occur.
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6. Is fasting Prior to
Intravascular
Contrast Media
Administration is
needed ?
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7. MR CONTRAST AGENT IODINATED CM
US CONTRAST AGENT BARIUM SULPHATE
Types of contrast media 7

8. IODINATED CM
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9. 9

10. Administration of CM
HAND INJECTION
PRESSURE
INJECTOR
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11. Commonly used technique
PRESSURE
INJECTOR
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12. IV Cannula flow rate
MAX.
FLOW
RATE
(ml/sec)
18G 24G
22G
20G
16G
1
2
3
4
5
PINK
GREY GREEN YELLOW
BLUE
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13. Is contrast
media
warming is
needed ?

14. Warming of contrast media
needed in:
Extrinsic warming of body temperature (37°C) may be helpful to
minimize complications and improve vascular access.
 For high-rate (> 5 mL/second) IV LOCM power injections.
 For higher viscosity contrast such as iopamidol 370.
 For direct arterial injections through small-caliber catheters (5
French or smaller).
 For intravenously injected arterial studies in which timing and
peak enhancement are critical features
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What is this condition called ?

16. Extravasation of CM
1. Less Reported non frequent
2. Patient complain of swelling and burning pain at injection site.
3. Does not depend on flow rate.
4. Toxic to surrounding tissue.
5. May cause compartment syndrome.
6. Less commonly Skin ulceration and tissue necrosis can occur.
7. Treatment include cold and heat compression
8. Elevation of limb or extremity above the heart level.
9. If volume extravasated is more than 100ml surgical consultation is
needed prior to discharge and follow ups taken for next 24 hours.
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17. Who are at more risk of
contrast extravasation?
 Those who cannot communicate adequately. (eg. Infant, elderly and
children)
 Patients severely ill or debilitated patients.
 Abnormal circulation in the limb to be injected(eg. Venous thrombosis,
prior radiation therapy or extensive surgery.
 Certain intravenous sites (e.g. hand, wrist, foot, ankle) are more likely to
result in extravasation.
 IV lines placed for more than 24 hours and multiple puncture sites.
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18. Risk factor for adverse events
 Allergy
 Asthma
 Renal insufficiency
 cardiac status
 anxiety
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19. Contrast reactions or Acute
adverse events
 Acute adverse events can be categorized as either allergic-like or
physiologic, and organized into three general categories of severity (mild,
moderate, or severe)
 Low incidence due to changing Iodinated contrast media from HOCM to
LOCM.
 majority of adverse side effects to LOCM are mild non-life-threatening
 Severe and potentially life-threatening adverse events continue to occur
rarely and unpredictably within 20 min of contrast administration.
 Delayed contrast reaction may also occur.
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20. Gadolinium based contrast
reactions
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GBCM Exam,
68700
REACTIONS, 55

21. Does contrast media affects
kidney ?
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o The diagnosis of Post Contrast - Acute kidney injury (PC- AKI) is made
according to the KDIGO criteria if
o 1) Absolute serum creatinine increase ≥0.3 mg/dL (>26.4 µmol/L).
o 2) A percentage increase in serum creatinine ≥ 50% (≥1.5-fold above
baseline).
o 3) Urine output reduced to ≤ 0.5 mL/kg/hour for at least 6 hours

22. KFT test needed or not ? 22
 Serum creatinine concentration is the most commonly used measure of
renal function, but it has limitations as an accurate measure of glomerular
filtration rate (GFR).
 Calculated estimated glomerular filtration rate (eGFR) is more accurate
than is serum creatinine.
 eGFR calculation https://www.kidney.org/professionals/k
doqi/gfr_calculator

23. Treatment of contrast
reaction
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• Starts with a well-designed plan and a properly trained staff.
• Basic life support training, on-site personnel should be trained in the rapid
recognition, assessment, diagnosis, and treatment of contrast reactions.

24. In evaluating a patient for a potential
contrast reaction, five immediate
assessments should be made if
clinically feasible:
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• What is the patient’s general appearance ?
• Can the patient speak ? How does their voice sound ?
• What is the quality of the patient’s breathing ?
• What is the patient’s pulse ?
• What is the patient’s blood pressure?

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27. The following minimum medications &
equipment should be within or near any
room in which contrast media is to be
injected:
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MEDICATION:
• Epinephrine IM 1mg/1mL (auto-injector or vials with needle and
syringe for use)
• Inhaled short-acting beta-agonist (inhaler or nebulizer)
• Anti-histamine
EQUIPMENT:
• Access to oxygen
• Defibrillator or automated external defibrillator (AED)
• Blood pressure and pulse monitor
• Pulse oximeter
• Stethoscope

28. The following discretionary medications
and equipment may be considered for
inclusion within or near any room in which
contrast media is to be injected:
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