acr iv contrast guidelines hydrea

As a result, recent guidelines from the American College of Radiology are more measured in the management of this medication around the time of intravascular iodinated contrast administration: In patients with no evidence of AKI and with eGFR ≥30 mL / min/1.73m2 , there is no need to discontinue metformin either prior to or following the intravenous administration of iodinated contrast media, nor is there an obligatory need to reassess the patient’s renal function following the test or procedure.In patients taking metformin who are known to have acute kidney injury or severe chronic kidney disease (stage IV or stage V; i.e., eGFR< 30), or are undergoing arterial catheter studies that might result in emboli (atheromatous or other) to the renal arteries, metformin should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been re-evaluated and found to be normal.Acute adverse reactions to the intravascular administration of iodinated contrast material occur in < 1% of patients. Noncardiogenic pulmonary edema can be allergic-like or physiologic; if the etiology is unclear, it may be judicious to assume that the reaction is/was an allergic-like one.A prior allergic-like reaction to intravascular iodinated contrast is the most substantial risk factor for a recurrent reaction upon future contrast administration. When extravasation does occur, complications are more severe in extremities with poor vascular or lymphatic circulation (e.g., on the side of a prior mastectomy with radiation or lymph node dissection) or when extravasation occurs on the dorsum of the hand of foot [4]. These opinions and recommendations are only applicable to intravenous (eg, contrast material–enhanced CT) as opposed to intra-arterial (eg, coronary artery angiography) contrast media administration, because intra-arterial administration has unique considerations that do not apply to the intravenous route of administration (eg, requirement for arterial access, atheroembolic complications, population-specific risk factors for AKI) (It is important to recognize that in clinical practice, a multitude of factors are used to determine whether intravenous contrast media should be administered (eg, probability and necessity of an accurate diagnosis, alternative methods of diagnosis, risks of misdiagnosis, expectations about kidney functional recovery, allergic-like reaction risk). A Radiology nurse or a Radiology technologist may administer intravenous contrast media under the general supervision of a physician.

Individualize treatment based on tumor type, disease state, response to treatment, patient risk factors, and current clinical practice standards.Base all dosage on the patient’s actual or ideal weight, whichever is less.HYDREA is a cytotoxic drug. Importantly, patients with a mild index reaction have a very low risk (< 1%) of developing a moderate or severe reaction in the future (2).The use of premedication to prevent recurrent allergic reactions to intravascular iodinated contrast remains controversial. All patients with a serum creatinine (regardless of age) which measures < 2.0 mg/dL (and/or eGFR > 40) are eligible for intravenous iodinated contrast administration.

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There is no clear superiority of 0.9% normal saline or sodium bicarbonate solutions for prophylaxis in this setting.Based on existing evidence, the UCSF Department of Radiology employs a practical but conservative approach to screening and volume expansion for the prevention of post-contrast acute kidney injury:Many other interventions have previously been proposed to reduce the incidence in patients and are deserving of further mention:Patients on dialysis can receive IV contrast, but the fact that a patient is on dialysis should NOT be regarded as automatically allowing the administration IV contrast, because of several potential hazards, including:While these hazards of giving IV contrast to dialysis patients may be relatively small, these risks should be weighed against the likely diagnostic benefit of contrast administration.

The advantage of cetirizine is that it is not associated with the side effect of drowsiness that accompanies the use of diphenhydramine (Benadryl®).

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