Word: Adverse Reactions to Contrast Media BCW Patients



PurposeTo ensure the safe care of patients receiving intravenous contrast media within the radiology department. To provide guidelines for BC Children’s and BC Women’s Hospital staff for appropriate management and treatment of any adverse reaction to contrast media during an imaging examination.Site ApplicabilityBC Children’s Hospital – Medical Imaging DepartmentBC Women’s Hospital + Health Centre Practice Level/CompetenciesAll staff in the clinical area is required to have the competencies to assess and intervene as needed, in the situation of a patient experiencing a reaction to contrast medium.Policy Statement(s) All patients receiving contrast media will be monitored for adverse reactions and appropriate management.This policy applies to all patients receiving contrast media.CLASSIFICATION OF AND ADVERSE REACTION TO CONTRAST AGENTSMinor ReactionsSevere ReactionsHives / Urticaria (<5 bumps or wheals)Arm pain – radiating from the insertion siteFaintness VomitingRigors Extensive urticariaDyspneaBronchospasmEdema of face or glottis Cardiac arrestCall Vancouver Imaging Radiologist – see belowCall ADULT CODE BLUE - 7111Contact InformationVancouver Imaging RadiologistsOn-site (BCCH Orthopedic Radiology Reading Room): Mon-Fri, 0900-1800 hrsCall 6966 (within C&W) or 604.875.2345, x6966 (outside C&W) Outside these hours (VGH ED Radiology Reading Room): Call 604.328.2293 (dedicated cell phone) Alternatively, call BCWH paging at 604.875.2161 and ask for on-call Vancouver Imaging radiologist 24/7Equipment & SuppliesDrug reaction kit located in specific modality areas – General Radiology (T1-243), CT (T1-310), MI ACU (T1-360), Nuclear Medicine (T1-310) and MRI Zone 2.Crash cart located in the corridor outside MRI Zone 3 area (T1-260).ProcedureStepsKey PointsResponsible PersonAll patients receiving contrast media for their imaging procedure will be monitored for adverse reactions by the technologist, and/or MI Registered Nurse (RN) or BCW RN and/or the supervising Vancouver Imaging Radiologist, Fellow or Resident.MI RN; BCW RN; and/or TechnologistAssess patient and determine type of reaction according to the algorithm “Managing Contrast Reactions at BCCH for patients from BCW”Any signs or symptoms of a MINOR contrast reaction will be immediately reported to the supervising Radiologist, Fellow or Resident.If any signs of symptoms of a SEVERE contrast reaction are noticed, call an ADULT CODE BLUE immediately.The attending Vancouver Imaging Radiologist will direct the care of the contrast reaction. (See contact information on page 1)MI RN; BCW RN; and/or Technologist; Vancouver Imaging RadiologistIf a contrast reaction is determined the technologist or MI RN will bring the drug reaction kit and /or crash cart to the area.MI RN and/or TechnologistIf an extravasation is assessed please refer to the Lower Mainland Medical Imaging’s “Extravasation Policy”.Document the adverse reaction in the patient’s chartInclude the following:Type and dosage of contrast givenDescription of reactionTreatment given (medications, interventions)Patient’s outcomeMI RN or BCW RNCall attending Vancouver Imaging Radiologist with an update regarding the adverse event. (See contact information section on page 1)MI RN and/or TechnologistAll contrast reactions requiring treatment will be documented on the BC PSLS and the Canadian Adverse Drug Reaction Form.MI RN and/or TechnologistAlgorithm – Managing Contrast Reactions at BCCH for patients from BCWDocumentationAll events will be documented within the department’s recognized documentation system. Adverse events will be reported according to hospital policy.The technologist or nurse and supervising Radiologist are responsible for the documentation of the adverse event on:BC Patient Safety & Learning System (PSLS) Safety Event FormCanadian Adverse Drug Reaction Monitoring Program - \DefinitionsAdverse reactions to contrast media may (though rare) occur with intravenous administration and can cause a variety of adverse reactions.Mild reactions include but not limited to – flushing, pruritus, urticaria that begin during or within a few minutes post administration.Severe reactions include but are not limited to – presence of bronchospasm, wheezing, laryngospasm and stridor, hypotension or loss of consciousness. Immediate discontinuation of contrast is needed and immediate treatment is required including calling an ADULT CODE BLUE. ReferencesAmerican College of Radiology. (2018).?Manual on Contrast Media. American College of Radiology. UCSF Department of Radiology & Biomedical Imaging. (2015). Management of Acute Reactions to Contrast Media in Adults Ali, S., Alexander, A., Lambrix, M., Ramakrishna, R., & Yang, C. W. (2018). High-Fidelity Simulation Training for the Diagnosis and Management of Adverse Contrast Media Reactions.?American Journal of Roentgenology, 1-7.Boyd, B., Zamora, C. A., & Castillo, M. (2017). Managing adverse reactions to contrast agents.?Magnetic Resonance Imaging Clinics,?25(4), 737-742.Beckett, K. R., Moriarity, A. K., & Langer, J. M. (2015). Safe use of contrast media: what the radiologist needs to know.?Radiographics,?35(6), 1738-1750.Rose Jr, T. A., & Choi, J. W. (2015). Intravenous imaging contrast media complications: the basics that every clinician needs to know.?The American journal of medicine,?128(9), 943-949.Version HistoryDATEDOCUMENT NUMBER and TITLEACTION TAKEN05-Dec-2018C-0506-12-60009 Adverse Reactions To Iv Contrast Media: BCW Adult PatientsApproved at: BCCH Best Practice CommitteeDisclaimerThis document is intended for use?within?BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.?This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.? ................
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