I think this protocol is awkwardly worded?

[DutchgirlRN]

We are instituting a protocol for hydration prior to iodinated contrast medium. Here's what it says:

An order initiating this protocol was written in the medical record by the prescribing practioner. (this sounds awkward?)

Lab for GFR calculation. Serum creatinine and BUN.

Obtain serum creatinine and calculate GFR 48 hours before contrast medium

Hold metformin until GFR is greater than 40ml and for 48 hours after exposure of the patient to contrast medium

All patients with GFR 30-60 ml/min

IV Fluid Bolus: 0.45% Sodium Chloride plus Sodium Bicarbonate 50mEq per liter

250 ml bolus before and after administration of contrast medium

Mucomyst 600 mg PO x 1 dose before contrast medium and Mucomyst 600mg PO every 12 hour x2 after the exam z(this is worded awkwardly)

Pt's with a GFR less than 30ml/min

Nephrology evaluation prior to imaging or consideralternate imaging approaches if any risk factors present

Dialysis Patients:

No hydration necessary, continue with exam (isn't it only if dialysis is scheduled for the patient within so many hours of the exam.

How to we figure in CHF patients who are on fluid restrictions? Those with COPD? Wheezing?

Any suggestions to make this protocol clearer and more concise? Thanks !!!!!

[KnittingRN7]

We just worked on our protocol and are changing from creats to GFR. We use the NDRD for GFR. It is calculated by age, sex, creat, and if african-american or other ethnicity. I found that any woman over 65 with a creat of even a 1 or 1.2 will have a GFR under 60, men stay about 20pts higher as the ages progress. We were going to give mucomyst to any pt with GFR

We standardized our protocol with what the Interventional Cardiologists use.

If the GFR is

We instruct for 64oz or more of fluids after, unless low EF then just drink slightly more than usual. Dialysis pt's no mucomyst or fluids just have to dialyze either that day or within 24hrs.

If the GFR is

We are still discussing IV hydration, because we are a clinic. Sodium bicarb and holding the pt for >1hr after probably won't be cost effective. We are discussing we may just run 250-500ml of saline in before and after the exam. Will need to adjust for chf pts depending on ef.

We hold metformin for 48hrs after contrast, not before. The literature says to check creat before resuming but our cardiologists don't do that. If their GFR is poor, we as nurses have suggested to the pt to have their Primary MD check it again.

It is interesting to find all the different policies.