PLACE LABEL HERE
CONTRAST PROTOCOLS
MRI & MRA
The following orders will be implemented per physician order of the specific procedure with contrast (policy 520-11).
Orders with a “q” are indicator choices and are NOT implemented unless checked.
· Doses may be adjusted per Radiologist’s order.
· The Radiologist will be in the Imaging Department during routine business hours for contrast administration and will be contacted and respond for contrast reactions. If the Radiogist is not immediately available and interruptible, then an ED Physician and/or a Hospitalist will be contacted.
MRI & MRA, CONTRAST PROTOCOLS
Proce-dures / IV Fluid / Contrast / Route / GFR > 60Amount / GFR 31-59
Amount / GFR 30 and/or dialysis patient
Amount / Radiologist Support
q / MRI / NS 100 ml:
Initiate IV with
10 ml to flush the INT, then infuse the remainder of the 100 ml post contrast. Then, DC IV / Gadolinium
Multihance (gadolinium)
IV Not
For intrathecal use / IV
Not
for intrathecal use / Multihance (gadobenate)
10% of patient’s weight in ml / Multihance
(gadobenate)
5% of patient’s
weight in ml / Call Radiologist. Write telephone order below / Tech administers
IV contrast
q / MRA / NS 100 ml:
Initiate IV with
10 ml to flush the INT, then infuse the remainder of the 100 ml post contrast. Then, DC IV / Gadolinium
Multihance
(gadobenate)
IV Not
for intrathecal use / IV
Not
for intrathecal use / Multihance
(gadobenate)
10% of patient’s
weight in ml
(max 20 ml) / Multihance
(gadobenate)
5% of patient’s
weight in ml
(max 20 ml) / Call Radiologist. Write telephone order below / Tech administers
IV contrast
______
Date Time Technologist Signature
(Radiologist to authenticate in dictation report)
If Radiologist called, document telephone orders here:______
______
Date Time Physician Signature PID Number
Copy to pharmacy
*1-36819* FORM 1-36819 INITIATED 10/2014 Page 1 of 1