Withholding metformin pre-contrast

[dianah, ASN]

What is your protocol for withholding metformin before pt receives IV contrast for CT, IVP, angio, heart cath?? Based on recent literature, we withhold it the day of exam and 48hr after, making sure urine output remains good (if outpt), or there is no change in BUN/creat post exam (if inpt), before restarting it. Have recently found that other labs withhold it for 48hr pre-exam, and then restart after exam. Just curious what other labs/depts are doing, and their rationale.

Also, do you use nonionic contrast exclusively, or is its use based on patient risk factors (diabetic, renal function, etc)?

Thanks for the input! --- Diana

[Audreyfay]

Our protocol is the same as yours...withhold on the day of exam and 48 hr after if BUN/Cr is WNL. I'm not sure about the contrast since I don't actually work in XR.

[dianah, ASN]

Thx Audreyfay! Look forward to other responses. . .

[NurseGirlKaren]

Same as you. We have both regular and non-ionic contrast, but use non-ionic 98% of the time. There is one doc who will argue 'til he's blue in the face that contrast choice makes no difference in contrast induced nephropathy. We're supposed to use non-ionic only if the patient meets certain criteria (diabetic or renal insufficiency or contrast allergy etc). But if the doctor wants non-ionic, we'll use it regardless.

[Chttynurs]

Yup, we do the same as you. Withhold 24 hours before and 48 hours after then resume...if creat is okay. I don't work radiology but we send patients sometimes. :)

[dianah, ASN]

Glad to hear you're informed, even if you don't work Radiology! Sadly, some nurses are totally unaware of the risks of giving contrast, as well as the risks associated w/pt taking metformin and giving contrast. Good for you!! Thanks for all the responses!