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Everything you need to know about Computed Tomography (CT) & CT Scanning


IV Contrast

question1. Why do we use IV contrast material?
question2. Do you use serum creatinine levels or GFR in your practice for establishing risk prior to CT scanning?
question3. What is GFR and why is it a more accurate measure than simply getting a creatinine level?
question4. Why are GFR numbers different for Caucasians and African Americans?
question5. Are all CT scans with IV contrast done the same way?
question6. What type of IV contrast material do we use and why?
question7. At what temperature do we store IV contrast material?
question8. Why do you warm IV contrast?
question

With extrinsic warming of contrast there is a 3x less frequency of extravasation than if not warmed when high injection rates are used.


Should you place IV contrast in a warmer prior to using it?

Yes


Why would you not warm iodinated contrast?

  • Cost and record keeping is needed
  • Purchase warmer
  • Keep log and monitor the warmer for correct temperature daily (Joint Commission rule)
  • Need to label bottles with 30 day expiration date (Joint Commission rule)

"Extrinsic warming (to 37° C) does not appear to affect adverse event rates for intravenous injections of iopamidol 300 of less than 6 ml/sec but is associated with a significant reduction in extravasation and overall adverse event rates for the more viscous iopamidol 370."

Rate of Contrast Material Extravasations and Allergic-like Reactions: Effect of Extrinsic Warming of Low-Osmolality Iodinated CT Contrast Material to 37° C
Davenport MS et al.
Radiology 2012; 262:475-484


"Discontinuation of extrinsic warming (to 37° C) did not appear to affect adverse event rates for intravenous injections of iopamidol 300 of less than 6 ml/sec but was associated with an approximate tripling of extravasation and overall adverse event rates for the more viscous iopamidol 370."

Rate of Contrast Material Extravasations and Allergic-like Reactions: Effect of Extrinsic Warming of Low-Osmolality Iodinated CT Contrast Material to 37° C
Davenport MS et al.
Radiology 2012; 262:475-484


"Because contrast media are designated as medications, the warming of contrast media has fallen under the regulation of The Joint Commission, which mandates that if contrast media are to be extrinsically warmed, there must be both a daily temperature log for each warmer and evidence of regular maintenance for the warming device(s). This regulation has led some institutions to reconsider the use of these warming devices and reevaluate whether warming iodinated contrast media to human body temperature has a significant practical, rather than just a theoretical, benefit for IV LOCM administration. Although some institutions have discontinued the routine use of contrast media warmers for low-rate (

ACR Manual on Contrast Media
Version 9 (2013)


"Extrinsic warming of iodinated contrast material to human body temperature (37°C) may be helpful to minimize complications and improve vascular opacification in the following circumstances:

  • For high-rate (>5 mL/second) IV LOCM power injections
  • For injections of viscous iodinated contrast (e.g., iopamidol 370, and presumably other contrast media with a similar or higher viscosity)
  • For direct arterial injections through small-caliber catheters (5 French or smaller)
  • For intravenously injected arterial studies in which timing and peak enhancement are critical features"
question9. What is the advantage of Visipaque as written in the literature?
question10. When do you use Visipaque-320 and when Omnipaque-350?
question11. Does the concentration of contrast mean that higher concentrations are better (AKA-isn’t a higher number better)?
question12. What is the volume of IV contrast material we use?
question13. What patients are considered high risk patients for IV contrast for CIN?
question14. Do we have set cutoffs for creatinine levels and if so what are they?
question15. Can we pretreat patients who have borderline renal function? If yes then how?
question16. Should patients be NPO for CT scanning? If yes for how long?
question17. What are the common volumes of contrast used for IV injection?
question18. What kind of IV access is ideal for use for IV contrast injection?
question19. Has there been any new developments in technology that may help us high injection rates in patients who can not tolerate an 18g needle (or at times even a 20g)?
question20. Can any IV the patient has in place be used to inject the contrast material?
question21. Can we use a central line or a PICC line for injection?
question22. What about the new “purple PICC/central lines” I hear about?
question23. What are some of the common normal “side effects” of IV contrast agents?
question24. Is there a relationship between patients receiving chemotherapy and CIN?
question25. Is it ok for patients to have both an MR and a CT with contrast on the same day?
question26. Have you ever seen a patient develop diffuse erythema distal to the IV injection site in the absence of extravasation?
question27. Patients often report a metallic taste in their mouth following use of IV iodinated contrast. Is there an explanation?
question28. Are there any contrast volume limitations for the use of IV contrast?
question29. Can you tell me a bit more about GFR and what it really means?

 

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