Diagnostic Imaging

System of work for the Supply/administration of ….

Omnipaque 300 and 350mg (IOHEXOL) For CT examinations of the Head Neck Thorax, Abdomen and Pelvis

Define situation/condition / Omnipaque is used in x-ray examinations in many parts of the body for adults and children (non-medical practitioners are excluded in this PGD from administration in children below the age of 16). It can make it easier to find and see diseases and improves the diagnostic information needed by the doctor.
X-ray contrast for use in adults and children for CT as justified by Practitioner/Radiologist
Examination justified against referral criteria.
Criteria for inclusion / All patients referred for and justified by a practitioner/Radiologist for a contrast enhanced Computer Tomography Scan.

Criteria for exclusion

/
  • Previous allergic reaction / anaphylactic reaction or Proven hypersensitivity (even if classified as mild) to a contrast medium containing iodine.
  • History of severe reaction to iodinated I.V contrast.

Action if excluded /

Further advice should be sought with an over-seeing Consultant Radiologist.

Relevant history. / Special precautions in cases of the following:
  • Hyperthyroidism
  • Myasthenia gravis

Serious cardiac disease

  • Pulmonary hypertension
  • Renal impairment
  • Paraprotienemias
  • Diabetic patients taking Metformin.
  • Pregnancy
  • Epilepsy
  • Asthma
  • Blood or bone marrow disorder
  • Alcohol or drug dependency
  • Manifest Thyrotoxicosis

Further advice should be sought with an over-seeing Consultant Radiologist.
Action if patient declines / Refer to radiologist and contrast media reaction protocol
2. Characteristics of staff
Qualifications required / State Registered Radiographers and nursing staff with:
Verification to proceed by Radiologist of administration of contrast.
Cannulation course.
Treatment of anaphylaxis course.
Minimum of 40 direct and indirect supervised procedures, and the administration of contrast.
Assessed and signed as competent by a Radiologist.
Additional requirements / Audit to demonstrate regular practice.
Applies to the Diagnostic imaging staff indicated in ‘Staff Group’ that may administer, without medical prescription, omnipaque 300 or 350 mg I/ml as detailed below providing there is a radiologist in the department excluding children under the age of 16.
Continued education & training requirements / Support and development as required from Radiologists and self directed learning using reflective practice.
3. Description of Treatment
Name of Medicine / Omnipaque 300/350
Legal status of medicine / POM
Dose / 50-150 mls in adults depending upon prescribed body part as determined by Radiologist. In Children below 7 years of age 3ml/kg b.w. Over 7 years of age2ml/kg b.w.
Route /

Intravenous

Frequency / Once during the procedure
Total dose/number of doses /

One dose

Patient to be observed in department for 15mins post procedure
Drug / Contraindications/
Cautions / Common Adverse Effects / Interactions / Notes
Omnipaque 300/350 / Omnipaque should not be mixed with other drugs. A separate syringe should be used. Shelf life 3 years, expiry date is indicated on the label. Contraindicated in manifest thyrotoxicosis, history of serious reaction to omnipaque. / Sensation of warmth or a metallic taste in the mouth, low risk of an allergic reaction. Patients should be made aware to look for signs of wheeziness, skin rash. / Contraindicated in Manifest thyrotoxicosis, history of serious reaction to iodinated contrast media.
Special precautions should be made with patients who are diabetic and taking metformin and or have impaired renal function. Serum creatinine should be measured. Metformin should be stopped and not resumed for 48 hours where there is any suspicion of renal inpairment. Metformin should only be restated 48 hours later if renal function is not diminished (serum creatinine has not increased). Patients should be fully hydrated 24 hours before and after administration of omnipaque 300.
Follow up treatment
Written/verbal advice for patient /
  • Patient may feel a slight sensation of warmth and have a metallic taste during the and shortly after the injection.
  • The patient may feel a sensation of micturition.
  • Some patients may feel nauseas.
  • Patient should not feel any discomfort at the injection site during the administration of the contrast.
  • Patient should inform staff of any breathing difficulties and or skin irritation.
Post:
  • Patient will be advised to keep hydrated for 12 hours following the administration of IV contrast.
  • The patient is advised to contact her GP/AE should symptoms of allergy occur within six hours post procedure i.e. rash, swelling or breathlessness.

Specify method of recording supply and /or administration / Administration, batch number and expiry details to be recorded on the radiology information system (RIS)
Procedure for reporting ADRs to Medical Practitioner / Identify mild ADR in the comment field in contrast page in Radiology system. - No other action to be taken.
Identify moderate & severe ADR in the front page ALERT FIELD.
Complete clinical alert sticker for patient’s notes and send a yellow form to the GP.
Management of Group Directions:
Group direction developed by: / Graeham Mann- Superintendent CT scanner.
Dr. Anthony Cave– Consultant Radiologist.
Gillian Honeywell – Chief Pharmacist.
Authorizing Doctor/s: / Dr. Anthony Cave
Signature
Date applicable:
Reviewed: / December 2008
April 2011
Review date: /
December 2012
Senior Nurse (or senior member of the profession undertaking the PGD) / Graeham Mann Superintendent CT scanner.
Signature
Clinical Directorate Pharmacist / Gillian Honeywell
Signature
Approved by Nursing Policy Group
(or other appropriate professional body) / Signature
Signed by chair of committee
Approved by Clinical Standards Group / Signature
Signed by chair of committee (making the Trust liable for the supply and administration of medicines under the PGD, subject to its proper application by authorised and competent personnel.

The group direction is to be read, agreed to, and signed by all staff it applies to. One copy is to be given to the health professional, another kept in the department.

______

I have read the System of Work and agreed to use it in accordance with the criteria described.

All professionals who will be using the PGD need to read it and sign. Their review date should ideally be linked to appraisals or other personal review processes to ensure that they are still competent to be approved practitioners under the PGD

Name:

Signature:

Date:

Review date:

Name:

Signature:

Date:

Review date:

Name:

Signature:

Date:

Review date:

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