CT IV CONTRAST

1: Patients receiving IV contrast should be NPO for solid food, water only, for 4 hours prior to scan. If it is a truly emergent study: May proceed without the waiting period with

radiologist consent.

2: If GFR under 40: Usually without IV contrast. If IV Contrast deemed necessary by Radiologist and referring clinician (requiresradiologist to referring clinician discussion),

then Nephrology consult is required.

3: Creatinine and GFR within the past 30 days MUST be obtained if the patient has any of the following:

  1. Anyone over the age of 60
  2. Under the age of 60 and has any of the following:

-Diabetes

-Renal Disease – ACR defines this as:

-Dialysis

-Kidney transplant

-Single kidney

-Renal cancer

-Renal surgery

-Multiple myeloma

  1. Chemotherapy within the past 3 months

4: Consult Table Below for Hydration Protocolsand IV Contrast Type (Isovue) Due to GFR

eGFR (mL/min/1.73 m2) / Non-diabetic / Diabetic
™ 60 / Normal / Hydrate well orally
50-60 / Hydrate well orally / Hydrate well orally + IV hydration with 250mL normal saline Prior to scan.
40-50 / Hydrate well orally + IV hydration with 250mL normal saline Prior to AND250mL normal saline Following the scan. / Hydrate well orally + IV hydration with 250mL normal saline Prior to AND
250mL normal saline Following the scan.
< 40 / Risk of CIN is too high for safe use of IV contrast; radiologist to discuss with referring clinician; if no alternative to IV contrast enhanced CT and non-emergent exam, then refer to Dr. Collins for nephrology consult. / Risk of CIN is too high for safe use of IV contrast; radiologist to discuss with referring clinician; if no alternative to IV contrast enhanced CT and non-emergent exam, then refer to Dr. Collins for nephrology consult.

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CT IV CONTRAST CONTINUED

5: Diabetic patients taking Metformin with no evidenceacute kidney injury and with eGFR30 mL/min/1.73m², there is no need to discontinue metformin either prior to or

following the IV administration of iodinated contrast media, nor is there a need to reassess the patient’s renal function (as measured by eGFR).

6: If the patient is on dialysis, IV Contrast may be administered, BUT Dialysis MUST be performed within 24 hours after receiving IV Contrast.

7: If a patient has an allergy to shellfish, it does NOT mean that they are allergic to IV Iodine Contrast. The two are not related. These patients MAY receive IV Iodine Contrast.

However, this may indicate that the patient could be atopic (hypersensitive) and could have an increased risk for reaction. Monitor these patients closely.

8: Pretreatment Policy:

-If a patient is scheduled for an exam with contrast and the patient has previously had an exam using that same type of contrast (i.e. gadolinium, iodinated)

without adverse reaction, then the patient may receive the same type of contrast without pretreatment.

MILD REACTION:-Less than 12 hives

-Sneezing

-Itching

-If having the same contrast injected, pretreat.

-If having the opposite contrast injected do not pretreat unless the patient has a history of:

-Asthma

-Hayfever

-Eczema

-Multiple drug allergies (Greater than 3)

-2 or more mild reactions to the opposite contrast – check with radiologist

MODERATE TO SEVERE REACTION: DO NOT INJECT CONTRAST

-Upper airway edema

-Bronchospasm

-Diffuse rash (Greater than 12 hives)

-Anaphylaxis to either contrast agent

PRETREATMENT PROTOCOL

Prednisone / 50 mg P.O. / 13 Hours Prior to Exam
Prednisone / 50 mg P.O. / 7 Hours Prior to Exam
Prednisone / 50 mg P.O. / 1 Hours Prior to Exam
Benadryl / 50 mg P.O. / 1 Hours Prior to Exam

*Patients receiving Pre-Treatment should not operate a vehicle or machinery after taking Benadryl as this

medication may cause drowsiness and diminished reflexes.Patient must have a driver.

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CT IV CONTRAST CONTINUED

9: Breastfeeding mothers receiving IV contrast DO NOT have to make any changes to their normal breastfeeding schedule.

<1% of dose is excreted in breast milk, <1% of that is absorbed by infant GI tract. Therefore: <0.01% of total dose absorbed by infant, which is less than 1% of recommended

infant dose of IV contrast.

10: After receiving IV contrast, patient must wait 48 hours before receiving another dose.

(Exceptions: Emergent studies with radiologist consent)

11: For Pediatric contrast studies: Give 1mL per pound up to 100 pounds

12: For Adults under 100 pounds: Give 1mL per pound up to 100 pounds.

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