Contrast reaction management in Radiology

Radiocontrast Reaction Management

Objectives

Recognize signs and symptoms of radiocontrast reaction

Verbalize steps for managing a radiocontrast medication reaction

Discuss administration process for radiocontrast medication

Contrast Medication Administration Process

01

Provider initiates an order for a specified contrast medication

02

A pharmacist reviews the order

Imaging Technologist, nurse, or provider screen the patient prior to administration for contraindications or risk factors

03

Imaging technologist or nurse verifies patient identity prior to administration of the medication contrast

Potential Complications: Allergic-like Reactions

• Mild: Limited urticaria/pruritis, limited cutaneous edema, limited “itchy”/“scratchy” throat, sneezing/conjunctivitis/rhinorrhea, or nasal congestion

• Moderate: Diffuse urticaria/pruritis, diffuse erythema with stable vital signs, facial edema without dyspnea, throat tightness or hoarseness without dyspnea, or wheezing/bronchospasm with mild or no hypoxia

• Severe: Diffuse edema or facial edema with dyspnea, diffuse erythema with hypotension, laryngeal edema with stridor and/or hypoxia, wheezing/bronchospasm with significant hypoxia, or anaphylactic shock (hypotension + tachycardia).

Potential Complications: Physiologic Reactions

• Mild: Limited nausea/vomiting, transient flushing/warmth/chills, headache/dizziness/ anxiety/altered taste, mild hypertension, or vasovagal reaction that resolves spontaneously
• Moderate: Protracted nausea/vomiting, hypertensive urgency, isolated chest pain, or vasovagal reaction that requires and is responsive to treatment
• Severe: Vasovagal reaction resistant to treatment, arrhythmia, convulsions/seizures, or hypertensive emergency.

Radiocontrast Reaction Management

• A STAT is called regardless of route of administration or severity of reaction symptoms.
• Steps for activating a STAT are as follows:
• Call 1-1111 (Flight Com Operator)
• Inform the operator you have a STAT due to a contrast reaction.
• Inform the operator whether the patient is an adult or pediatric.
• Inform the operator of the patient location. Provide the operator with your call back phone number

Radiocontrast Reaction Management

• If the patient is in the MRI, immediately move the patient to a location external to Zone 4 (MRI exam room) and initiate Basic Life Support (BLS) if indicated. A technologist will be assigned to guard the Zone 4 door while moving the patient to prevent safety hazards
• All other departments provide immediate first aid and BLS until the STAT Team arrives.
• Have a department crash cart at the patient’s side and plugged into an electric outlet.
• Obtain radiocontrast reaction kit
• Assign personnel to key visible positions to direct the ED Response Team to the STAT location.
• Alert the attending radiologist as soon as possible

Radiocontrast Reaction Kit Contents

• IM Epinephrine mini pack: Epinephrine 1mg/ml vials x 3, 1mL syringes x3, IM needles x3
• Diphenhydramine 50mg/mL vial x1
• Hydrocortisone 100mg/2mL vial x1
• Albuterol HFA inhaler x1
• 500mL Normal Saline

**Please return used kits to central pharmacy with a patient label**

Anaphylaxis kit outer packaging

Anaphylaxis kit interior packaging with epinephrine warning label

IM Epinephrine mini safety pack

Contents of IM Epinephrine mini safety pack

500 mL bag of Normal Saline is located in the tackle box with the remainder of the kit contents.

References

• https://vanderbilt.policytech.com/dotNet/documents/?docid=20327
• https://vanderbilt.policytech.com/dotNet/documents/?docid=15022
• https://vanderbilt.policytech.com/dotNet/documents/?docid=15063