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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?
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?
26. Have you ever seen a patient develop diffuse erythema distal to the IV injection site in the absence of extravasation?
questionHere is the answer courtesy of Richard A. Vitti MD from Medical Affairs at GE Healthcare.

Rare, isolated cases of localized redness at the injection site have been reported to us at GE Healthcare over the years since the introduction of our non-ionic Omnipaque and Visipaque products. We conducted a thorough literature search and only one article was found (Cohan, 1997) that directly reports on such localized reactions. The article describes 5 cases of local injection site reactions with ionic and non-ionic media in 22,254 injections, although a 2-5% rate is reported in this article based on two older references. The authors attribute the reactions to, "local irritative effect of contrast medium on vascular endothelium."

For completeness, I have attached the Cohan reference and three other articles describing skin reactions to iodinated contrast media. The latter deal primarily with what are known as "drug rashes" or "drug eruptions" which are not unique to the iodinated contrast media class of drugs. These types of reactions are different than what has been described here.

This case should be reported to GE Healthcare's Pharmacovigilance and Safety department , toll-free, at 1-800-654-0118, option #2, then option #1. As a responsible manufacturer, GE Healthcare treats all such reactions seriously and encourages prescribers to report any adverse reactions to us.

Local Reactions after Injection of Iodinated Contrast Material: Detection, Management and Outcome Cohan RH et al Vol 4, No 11, November 2011

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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