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Rapid Response Team/CODE call 23-4444
Rapid Response Team/CODE call 23-4444
Contrast Reaction Management | GFR/Renal concerns | Injection (ports, rates, etc.)
Contrast Reaction Management | GFR/Renal concerns | Injection (ports, rates, etc.)
For contrast extravasation, see a different page: CONTRAST EXTRAVASATION
CONTRAST REACTION MANAGMENT
CONTRAST REACTION MANAGMENT
Stop the contrast
Start with cardiac leads, pulse ox, BP cuff
Get oxygen face mask ready
Get the Anaphylaxis kit
Know your BLS/ACLS
ANAPHYLAXIS KIT LOCATIONS
ANAPHYLAXIS KIT LOCATIONS
MS-West
MRI: In locked cabinet in MRI Zone II near patient changing area (code, click here regarding MRI safety zones)
MS-St. Luke's
MS-Chelsea
MRI Tech Room
MS Union Square
MR 2 : Grey cabinet on left has Epi pens, ask techs
Has a crash cart near XR tech area
ANAPHYLAXIS KIT CONTENTS
ANAPHYLAXIS KIT CONTENTS
Albuterol nebulizer 0.083% (2.5 mg/3 mL)
Diphenhydramine 50 mg vial
Epinephrine 1:1,000 vial (1 mL)
Glucagon 1 mg/1 mL vial
Methylprednisolone 125 mg/2 mL vial
18G 1-1/2" safety needle
1 mL syringe
Alcohol prep pads
Anaphylaxis box diagram
Pediatric dosing chart (glucagon/methylprednisolone)
Anaphylaxis adult algorithm
REFERENCES
The information contained on this page reflects the Contrast Media Card 12/19/17
Refer to your contrast reaction cards
Check the current MS West Department of Radiology guidelines for the official policy
Radiographics: Safe Use of Contrast Media: What the Radiologist Needs to Know
GFR / Renal concerns?
GFR / Renal concerns?
CT: IV contrast administration policy
CT: IV contrast administration policy
MRI: IV contrast administration policy
MRI: IV contrast administration policy
OTHER TYPES OF CONTRAST REACTIONS & MANAGEMENT (CLICK; COLLAPSIBLE)
OTHER TYPES OF CONTRAST REACTIONS & MANAGEMENT (CLICK; COLLAPSIBLE)
LIMITED CUTANEOUS REACTION: rash or mild hives
Stop injection, no treatment needed in most cases, observe
Diphenhydramine (Benadryl®) PO 25-50 mg
SEVERE DISSEMINATED URTICARIA
Diphenhydramine (Benadryl®) IM or IV 25-50 mg
Epinephrine IM (1:1,000) 0.3 mL (0.3 mg)
BRONCHOSPASM AND/OR FACIAL OR LARYNGEAL EDEMA
O2 6-10 liters/min (via mask)
Attach monitors
Beta-agonist inhalers 2-3 puffs, repeat prn (albuterol, metaproterenol (Alupent®), terbutaline (Brethaire®)
If unresponsive to inhalers, give Epinephrine IM (1:1,000) 0.3 mL (0.3 mg)
OR if hypotension evident, Epinephrine (1:10,000) slowly IV 1 mL (0.1 mg), repeat PRN to max 1 mg
ANAPHYLACTOID REACTION: hypotension and tachycardia
Legs elevated > 60° or Trendelenburg position
Give O2 6-10 liters/min (via mask)
Attach monitors
NS or LR 1000 mL bolus
Unresponsive to IVF: Epinephrine (1:10,000) slowly IV 1 ml (=0.1 mg), repeat prn to max 1 mg
VAGAL REACTION: hypotension and bradycardia
Legs elevated > 60° or Trendelenburg position
Give O2 6-10 liters/min (via mask)
Attach monitors
NS or LR 1000 mL bolus
Unresponsive to IVF: Atropine 0.6-1 mg IV slowly, repeat atropine up to total of 0.04 mg/kg (2-3 mg) in adult
HYPERTENSIVE CRISIS
Give O2 6-10 liters/min (via mask)
Attach monitors
Give nitroglycerin 0.4 mg SL (may repeat x 3) OR topical 2% ointment, apply 1 inch strip
Transfer to intensive care unit or emergency department
For pheochromocytoma—phentolamine 5 mg IV
SEIZURES
Give O2 6-10 liters/min (via mask)
Attach monitors
Anticonvulsants
Lorazepam (Ativan®) 4 mg IV
Diazepam (Valium®) 5-10 mg IV
Midazolam (Versed®) 0.5-1 mg IV
Call Rapid Response Team 23-4444
PULMONARY EDEMA
Elevate torso; rotating tourniquets (venous compression)
Give O2 6-10 liters/min (via mask)
Give diuretics – furosemide (Lasix®) 20-40 mg IV, slow push
Consider giving morphine (1-3 mg IV)
Transfer to intensive care unit or emergency department
Corticosteroids optional
IV Contrast: Injection Guidelines
IV Contrast: Injection Guidelines
GENERAL INJECTION GUIDELINES
1. Always test line first with 10 cc NS rapid injection and flush line with 20 cc NS after injection
2. Stay in room after injection to ensure no extravasation
3. EJ: MANUALLY inject in emergency situations if no other line available.
Avoid injecting if possible.
4. Triple Lumen central venous catheter
Brown port can tolerate 3.5cc/s max and can be used for angio studies
Can only power inject through brown port for angio study if TPN not running
White/blue ports can handle 1.7cc/s max, only hand inject through white/blue ports!
5. Never inject leg/ foot. Hands ok with slow injection
6. Raise arm up onto scanner to ensure adequate contrast flow
7. Increase flow rates for larger patients
8. Decrease flow rates for smaller patients with fragile veins
9. MEDIPORT – FLUSH AFTER!
GAUGES AND MAXIMUM INJECTION RATES
GAUGE RATE cc/sec
24 (yellow) 1.5-1.7
22 (blue) 2.0 – 3.0
20 (pink) 3.0-4.0 (really up to 5.0)
18 (green) up to 5.0
Power PICC (purple) First check manufacturer (if in doubt if it is a power picc, do hand injection)
if Power PICC (purple), follow manufacturer's max allowed injection rate
MediPort First check manufacturer (if in doubt if it it is a power port, do hand injection)
if Power PORT to be injected at high rate ( i.e. PE study), you need SPECIAL NEEDLE access
GAD CONTRAST & DOSE
eGFR>45 routine agent Magnevist, dosed approximately 2 cc/kg~1 cc/lb, max 20cc
eGFR<45 Follow departmental guidelines
IODINATED CONTRAST & DOSAGES
Isovue 300 Intravenous contrast is the routine agent
Chest/Abdomen/Pelvis (not PE/dissection)
GAUGE 22 20
RATE 1.5-1.7 1.7-2.0 (3.0)
VOLUME 100 100
DELAY Chest 25 sec, A/P 70 sec
Abdomen/Pelvis Routine
GAUGE 22 20
RATE 1.5-1.7 2.0-2.5
VOLUME 100 100
DELAY 70-75 seconds
Abdomen/Pelvis Angio
GAUGE 20 18
RATE 3.0 3.5-4.0
VOLUME 100 100
DELAY 25 seconds or SureStart
PE/Dissection
GAUGE 18 20***
RATE 3.5-4.0 2.5-3.0
VOLUME 140
DELAY SureStart, Dissection is appxm 20-24s, PE is 16s
If only 20 Gauge is available, study may be limited.
Dissection study preferably get right arm IV
CT Brain (not CTA)
RATE 2.0 cc/sec
VOLUME 100cc
Neck and Chest
RATE 2.0 cc/sec
VOLUME 70 cc volume for neck, then another injection of 70cc for chest
CTA Neck
GAUGE 18 in right arm
RATE 4 cc/sec
DELAY 8-10s
CTA Head
GAUGE 18
RATE 4 cc/sec required
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