Administration of Contrast, Isotopes & Radiopharmaceuticals
Policy:
The contrast pharmacology has undergone tremendous changes in 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 & any contrast / isotope / radiopharmaceutical given after risk assessment.
The customer / patient is informed of the pros / cons of the contrast/ radiopharmaceuticals and its hazardous effect, if any. The details of any past allergy / reaction of contrast is also taken from the patient. In case of any reaction in the past than the anaesthetist is informed and he decides whether the contrast can be given or not and if yes than it is administered in his presence.
If in doubt, referring clinician is consulted before giving contrast.
Least toxic contrast is always selected.
Possibility of pregnancy in a child bearing age group female is kept in mind.
Procedure of Contrast Administration
The technologist will verify 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 anxiety of injection. 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 which has been 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 anaesthetist. If adversity of reaction warrants, indoor care/ ICU care, patient is transferred to nearby hospital of patient’s choice / Sarals choice in our ambulance with doctor / techie accompanying the patient.
Conditions for insisting on eGFR before IV CT / MRI contrast administration – eGFR report / creatinine report should not be more than 4 weeks old, unless there is episode of recent ailment
- Age more than 60yrs.
- 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 asked for pertains to renal system – KUB / urography
- Known case of malignancy / cancer
Contraindications to MRI / CT Contrast
- Please rule out allergy to contrast in past.
- Please rule out compromised renal function.
- a) If eGFR < 30, avoid contrast administration, unless ordered specifically by referring consultants / radiologist with full knowledge of renal status.
- b) If patient is on dialysis & contrast CT is advised – our radiologist to consult referring physician about advisability of CECT before dialysis.
- As per department policy we avoid giving contrast to infants (<1 year and pregnant patient. If in case contrast is to be given to infant / pregnant patient a prior permission from referring doctor is taken & patient informed accordingly. Consent of patient in obtained on consent form.
