Questions ~ Why are these questions pertinent to why not to give CT contrast?

Home Health Columnist / Guide · Jun 26, 2007

DutchgirlRN, ASN, RN · Jun 26, 2007

Karen, I surfed through that whole site and couldn't find any information on contrast and indications not to give it and/or why?

smk1, LPN · Jun 26, 2007

I'm not sure, but in my ACLS handbook people who are at high risk/suspicious for a CVA are not given contrast CT scans. (perhaps the dye increases the risk for an occlusion? HTN puts you at increased risk for a stroke so maybe it is just a CYA thing, double check the BP etc...

I'd like to see the answer to this as well.

Editorial Team / Admin · Jun 26, 2007

we are in the process of redoing our contrast history forms. there are several questions we ask that i have no idea why the answers, whether yes or no, are pertinent to whether we give the contrast or not.
obviously if they are diabetic we need to know, obviously if they are allergic to iodine or shellfish we have to know.
okay...why do we need to know if they have high blood pressure? if they do we give the contrast anyway. hypertensive pts are at increased risk for cin, depending on the state of their kidneys. i see it more as a heads-up for us as caregivers. article:
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=16298441&dopt=abstract
why do we need to know if they have had a heart attack?this article addresses prevention of complications post-acute mi, but also covers htn and other conditions r/t admin of contrast. http://eurheartjsupp.oxfordjournals.org/cgi/content/full/7/suppl_g/g13 chest pain? irregular heart beat? if the answer is yes we give the contrast anyway.
we ask if they've had multiple myeloma here's an article addressing the question of mult. myeloma and contrast admin: http://radiology.rsnajnls.org/cgi/content/abstract/183/2/519 , enviromental allergies, asthma? yes, you give the contrast, but you are now aware that the pt is at increased risk for cin and you have obtained the ok (either from your radiologist or pre-set protocols) to go ahead and give. risk vs benefit.
again, if the answer is yes we give the contrast anyway.
what questions do you ask? does anyone know why any of the above questions are pertinent in regards to the contrast that we give anyway? here's a good article r/t potential problems caused by contrast admin: http://www.aafp.org/afp/20021001/1229.html
thanks for any help you can give or any opinions about why these particular questions are important in regards to contrast?

kudos to you, dutch, for asking questions and for reviewing/updating policies/practices. :)

DutchgirlRN, ASN, RN · Jun 26, 2007

Dinnah, those links are awesome. I tried Googling last night for quite a while and couldn't come up with anything. You're most awesome!

Editorial Team / Admin · Jun 26, 2007

You are most welcome and again, deserve props for asking the questions! :)

HeartJulz · Feb 3, 2008

From the bit I have read upon this issue relates soley to just having a 'heads up' ... in case they need to intervene...here is a link but it doesnt say the 'why' it just states those pts. who may be contraindicated...

http://www.hrgimaging.com/html/fifth_level/faq_cat1.htm

DutchgirlRN, ASN, RN · Mar 25, 2008

from the bit i have read upon this issue relates soley to just having a 'heads up' ... in case they need to intervene...here is a link but it doesnt say the 'why' it just states those pts. who may be contraindicated...
http://www.hrgimaging.com/html/fifth_level/faq_cat1.htm

i've been looking for some plain simple english information to make up a brochure for the patients (to be handed out at the doctors office) this has been a big help in how to organize the info...thanks! :wink2:

santhony44, MSN, RN, NP · Mar 25, 2008

A radiologist I've referred patients to requires a BUN and creatinine done before he'll do contrast. That's not the practice where I am currently. Anyone think this is a good idea?

I've read some of the references given here. This particular radiologist requires it for every single patient, regardless of history.

I'm wondering if our policy needs to be revised.

Editorial Team / Admin · Mar 25, 2008

If the pt has had one within the past two weeks to a month, and has no other contraindications (e.g.: diabetes, HTN, heart dz, and all previous labs have been NORMAL), will he still require a new one be drawn?

Sounds like he's just covering himself/doesn't want any surprises/doesn't want to harm the pts.

Have you thought of asking him about it (get a private tutorial )?

DutchgirlRN, ASN, RN · Mar 25, 2008

a radiologist i've referred patients to requires a bun and creatinine done before he'll do contrast. that's not the practice where i am currently. anyone think this is a good idea?
i've read some of the references given here. this particular radiologist requires it for every single patient, regardless of history.
i'm wondering if our policy needs to be revised.

sounds to me like a case of "old habits die hard" and "cya". gfr is the current standard for whether or not the patient has sufficient renal function prior to ct contrast infusion. the current screening guidelines are anyone over 60 y/o, diabetic, known renal failure, has only 1 or 1 and 1/2 kidneys, multiple myeloma, etc..... great article:

http://www.carj.ca/issues/2007-apr/79/79.pdf