Contrast Policy

Administration of Contrast, Isotopes & Radiopharmaceuticals

Policy

The contrast pharmacology has undergone tremendous changes in the last decade.

The following policy has taken references from AIIMS (Dr. Arun Gupta & Dr. Deva — 09873391531), ACR recommendations and from Wipro GE.

The contrast / isotopes / radiopharmaceuticals are given on the recommendation of the clinician / radiologist and / or if it is necessary to have proper study of the investigation. Contrast is given in all cases only after taking the proper consent from the patient or their attendant by the technologist or doctor.

Proper history of patient is taken; past history & record, including blood test reports, is considered before administration of contrast.

High risk patients are identified, and any contrast / isotope / radiopharmaceutical is given only after risk assessment.

The customer / patient is informed of the pros / cons of the contrast / radiopharmaceuticals and its hazardous effects, if any. The details of any past allergy / reaction to contrast are also taken from the patient. In case of any reaction in the past, the anaesthetist is informed, and they decide whether the contrast can be given. If yes, it is administered in their presence.

If in doubt, the referring clinician is consulted before giving contrast.

Least toxic contrast is always selected.

Possibility of pregnancy in a child-bearing-age female is kept in mind.

Procedure of Contrast Administration

The technologist verifies the five rights (right patient, right medication, right dose, right route and right time). Dosage is determined by scan protocol and body weight of the patient. Before beginning injection, the technologist reassures the patient to allay injection anxiety. The patency of the IV catheter is checked by flushing with 0.9% normal saline. If there is resistance, pain, or the catheter does not flush, the technologist does not proceed; an IV cannula at a new site is placed. The patent catheter is connected to the fluid-filled high-pressure tubing via a three-way attached to the IV catheter. At the completion of the injection, the catheter is flushed with 10cc 0.9% normal saline, the high-pressure tubing is disconnected, and the IV site is inspected for any swelling or indication of extravasation. The patient is observed for any indications of contrast reaction throughout the administrative process.

Complete information of the contrast given is recorded in the report — it covers the contrast name, type, quantity & mode of administering contrast.

Any adverse reaction is managed at the centre by the anaesthetist. If the adverse reaction warrants indoor / ICU care, the patient is transferred to a nearby hospital of the patient's choice / Saral's choice in our ambulance with a doctor / technologist accompanying the patient.

Conditions requiring eGFR before IV CT / MRI contrast administration

The eGFR / creatinine report should not be more than 4 weeks old, unless there has been an episode of recent ailment.

• Age more than 60 years.
• Hypertensive patients.
• Diabetic patients.
• History of renal disease (including single kidney, renal transplant, renal tumor).
• Within 1 month of pre- and post-operative period of liver transplant.
• Test relates to the renal system — KUB / urography.
• Known case of malignancy / cancer.

Contraindications to MRI / CT Contrast

• Rule out allergy to contrast in the past.
• Rule out compromised renal function.
  • If eGFR < 30, avoid contrast administration unless ordered specifically by the referring consultant / radiologist with full knowledge of the patient's renal status.
  • If the patient is on dialysis and contrast CT is advised, our radiologist consults the referring physician about advisability of CECT before dialysis.
• As per department policy we avoid giving contrast to infants (< 1 year) and pregnant patients. If contrast is to be given to an infant or pregnant patient, prior permission from the referring doctor is taken & the patient informed accordingly. Patient consent is obtained on a consent form.