Management of patients with adverse contrast reactions in radiology departments involves categorizing reactions as local (phlebitis or extravasation) or systemic (mild, moderate, or severe), then providing appropriate treatment. Local reactions are managed by elevating the affected area and applying hot or cold compresses. Systemic reactions require monitoring vital signs, administering medications like oxygen, fluids, epinephrine or antihistamines, and calling for medical assistance for severe reactions. Preventing reactions involves thorough patient history, testing, use of premedications, and selecting the proper contrast medium.
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Contrast Media Management
1. Management of patients with adverse
contrast reactions in radiology department
Presented by Akari Kyaw
Fourth year, MIT
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
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
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
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
21.
22.
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
24.
25. References
K. L. Bontrager and J. P. Lampignano (2014) Text
Book Of Radiographic Positioning And Related
Anatomy, 8th Edition