Freedom of Information Request Ref: UHB12-0282

20th March 2013

Freedom of Information Request Ref: UHB12-0282

Dear Mr Griffin

Thank you for your request for information under the Freedom of Information Act 2000, the response to which is set out below:

The following questions concern patients undergoing radiological investigations or procedures involving iodinated contrast media (this would involve the departments of radiology, vascular, MAU and renal):

1. Does your institution have specific guidelines/policy for the recognition and management of patients at risk of contrast induced acute kidney injury (CI-AKI) for the following procedures:

a. contrast enhanced CT scans

YES – electronic requesting – rules ask about renal impairment for examinations with contrast administration. Radiographers have guidelines for administration of contrast in relation to the degree of renal impairment.

b. angiogram, angioplasty and stenting

YES – electronic requesting – rules ask about renal impairment for examinations with contrast administration

c. endovascular aneurysm repair (EVAR)

We follow the Richard Bright Renal Unit Guidelines for Contrast Induced Nephropathy (CIN) which is attached.

2. If available please send the guidelines/policy by email.

See attached

3. When was this guideline last reviewed and/or revised?

The guidelines are currently under review – enhanced questions around risk factors for CI-AKI are planned along with more extensive questions relating to contrast allergies/reactions.

4. What strategies does your institution use to manage patients at risk of CI-AKI?

Recognition of patient cohort at risk of CI-AKI (risk factors, established renal impairment), provision of renal function when requesting (U&E, creatinine, eGFR), pre-hydration of patients at risk, monitoring renal function post contrast administration, advice to referrers regarding possible need to involved renal physicians if renal function deteriorates, use of isosomotic contrast agents for patients at high risk, consideration of use of alternative imaging modalities not requiring the use of iodinated contrast agents.

5. Do you routinely involve a renal physician in the pre and post procedure management of patients at risk of CI-AKI who are having a contrast enhanced investigation or interventional procedure?

Renal physicians are not routinely involved in management.

6. Do patients at risk of CI-AKI routinely have post procedure serum urea, creatinine, eGFR and electrolytes measured? If so, at what time post procedure does this happen?

Referrers are advised to monitor renal function post administration of contrast to check for acute deterioration in renal function. Duration and frequency not specified but most of these patients are inpatients and having daily bloods monitored. There is no specific process set up for outpatients but exploring the possibilities of ensuring bloods checked pre-contrast administration.

This concludes our response. We trust this has been helpful. However, please do not hesitate to contact us directly if we can be of any further assistance.

If, after that, you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within two months of the date of receipt of the response to your original letter and should be addressed to:

Trust Secretary

University Hospitals Bristol NHS Foundation Trust

Trust Headquarters

Marlborough Street

Bristol

BS1 3NU

Please remember to quote the reference number above in any future communications.

If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner can be contacted at: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF

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Yours sincerely,

Miss Sarah Da Silva

Assistant Information Governance Manager