Premedicating patients with contrast allergies?????

[Lori Ann]

When patients have contrast allergies, our Radiologists prefer oral preps. It is a 13 hour prep. We have standing orders for inpatients. How do other hospitals prep their outpatients? At present, our outpatients come in the day before, and our CT techs hand out the prep (which is ordered by our MD Director). We need to find a better solution, since techs really are not allowed to dispense medications. We have 2 FT RNs and 1 PT. RN hours are 0630 to 1500. Any suggestions?

[dianah, ASN]

We nurses prepared the prescriptions (had a stamp for each), and had the Radiologists sign them (or we phoned them in), and instructed the patients on taking them. It worked for us; not in our scope of practice to dispense meds themselves, but yes to the scrips (they could be picked up at the patient's convenience, as long as they could get them filled and taken in time for the exam). :)

[hawks5]

We also created pre-printed scripts that can be called into a pharmacy or handed out at the front desk- (prednisone and benadryl).

Another option is a quick prep (set of pre-printed orders) we do for add-on cases etc. with IV methyl-prednisone, benadryl, and pepcid. Our radiologists have been great about signing orders/scripts.

[mawlvn]

Our outpatient DI department also has pre printed script signed by the radiologist that can be filled at our pharmacy. Add ons are only given IV benadryl pre and post.

[vandebar]

Our patients identified with a contrast allergy during the phone triage process get tagged for a plan of care for contrast allergies and standing orders are followed. This includes prednisone 60mg po the night prior to the procedure and repeated the morning of the procedure. Also benadryl 25 mg po the night before the procedure and 25mg po benadryl repeated one hour prior to the procedure. Please note that this is a cardiologist standing order. These patients will receive on arrival Solumedrol 125mg IVP prior to the procedure. Any patient having any kind of reaction to iodine, (including seafood) will be given the above order by the cardiologist. NOW whats INTERESTING is that our radiologist use a completely different standing order which is the prednisone 13 - 7 - 1 hour prior to procedure, an H2 blocker. Any patient having a rash or hives would receive that order. For our radiologist, patients who experienced a reaction that included SOB, swelling, edema, bronchospasm...etc... then the 13-7-1 PLUS H2 blocker, plus an IV steroid. The oral prep is called into the patients pharmacy by the triage nurse. A standing order is flagged in the chart for the radiology nurse.

[zena231]

I schedule outpatient radiology procedures and we have the rad techs tell the scheduling dr's office the prep and they are responsible for giving a script and the medication info to the patient.

Our prep orders are:

13 hours before appt(scan time)

50 mg prednisone

7 hrs before

50 mg prednisone

1 hr before appt

50 mg prednisone and

50 mg benedryl

[DutchgirlRN, ASN, RN]

I work in a free-standing outpatient medical imaging center. If a patient requires premedication for a contrast allergy we give them pre-printed prescriptions and re-schedule their test at the hospital next door.

[lamazeteacher]

When patients have contrast allergies, our Radiologists prefer oral preps. It is a 13 hour prep. We have standing orders for inpatients. How do other hospitals prep their outpatients? At present, our outpatients come in the day before, and our CT techs hand out the prep (which is ordered by our MD Director). We need to find a better solution, since techs really are not allowed to dispense medications. We have 2 FT RNs and 1 PT. RN hours are 0630 to 1500. Any suggestions?

What medication(s) are in the "prep"?

[lamazeteacher]

I work in a free-standing outpatient medical imaging center. If a patient requires premedication for a contrast allergy we give them pre-printed prescriptions and re-schedule their test at the hospital next door.

Please tell me what is on the prescription and if you know, how the patients do with the contrast after taking it.

[5780]

To lamazeteacher - there is obviously a variety of approaches. I certainly have had patients with contrast allergies who do just fine with only a prednisone prep (the man I'm thinking of has had two fistulograms in the last six weeks). It is up to the ordering physician to order the prep as well, but the techs in our department usually call the nurse if they have a patient with an allergy, even if the patient has been prepped. I don't know if there is any standard prep for contrast allergies. This now gives me something new to learn! (I love my job!)

[dianah, ASN]

I don't know if there is any standard prep for contrast allergies. This now gives me something new to learn! (I love my job!)

Each Radiology or Imaging Department *should* have its own protocols for contrast allergy premedication.

ACR (American College of Radiologists, I think) have a Contrast Administration publication that may be helpful for guidance. Your Radiologists should be able to get a copy of the most updated version.