I think this protocol is awkwardly worded?

The prescribing practitioner is responsible for writing orders initiating pre-exam hydration protocol, to include (but not limited to) the following:
1. Serum BUN and creatinine drawn [within one month of iodine contrast-enhanced exam].
2. Imaging Staff to calculate eGFR 48 hours before exam.
If eGFR between 30-60ml/min:
*IV fluid: 0.45% NaCl with NaHCO3- 50mEq/Liter, 250ml bolus before and 250ml after contrast administration [probably need a rate here, e.g., 999ml/hr X 250ml].
*Mucomyst 600mg PO X 3 (total 1800 mg): One dose before contrast administration, one dose 12 hours and one dose 24 hours post-contrast administration.
If eGFR <30ml/min:
*Nephrology evaluation prior to imaging
*Consider alternative non-iodinated contrast imaging

3. Hold Metformin day of exam and for 48 hours after contrast administration.
4. If eGFR <40ml/min, hold Metformin until it is >40ml, and then for 48 hours post-contrast administration.
5. Dialysis patients: No pre-exam hydration necessary. [check w/your Nephro dept re: preferences for post-exam dialysis: within 24 hr of contrast? same day as contrast given??]

Dutch:
Do you use the same contrast for ALL exams?? If not, the criteria for administering contrast to higher-risk pts must be spelled out.
My questions/comments are in brackets, e.g., does your center require labs within two weeks of the exam? One month? The orders/protocol must reflect the practice.
How do the ordering MDs get the protocol, to write the hydration orders? (what is the system?)

Let me know if I've mis-interpreted the orders; we can always re-arrange and re-write!
--- D

How can the BUN/creat be drawn within 24hr, and the eGFR be calculated within 48 hr????

The Radiologist is the MD who signs the hydration orders? I'm confused.

When we needed a policy written, years ago my Chief Rad. told me, "just write what you do."

Thus, if there's a cutoff age that requires prehydration, write it in the protocol.
If there are risk factors which, if present, require prehydration, write it.
If the Radiologist is the one who writes the prehydration orders (after reviewing the exam orders/reason and patient's hx [risk factors!]), write it in the protocol.

Our lab automatically gives an eGFR, on any Chem 7 (don't know which formula it uses).