CT Enterography with Volumen: Protocol
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Dilated SB with VoLumen  |
Duodenal Polyps due to Polyposis Syndrome  |
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Does faster injection rates result in higher extravasation rates?
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“ Performing high flow rates with low-diameter IV catheters (e.g., 22-gauge catheters) and a location of IV catheter in the hand is associated with a higher extravasation rate.” Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. Wienbeck S et al. AJR Am J Roentgenol. 2010 Oct;195(4):825-9 |
“The extravasation rate was highest with 22-gauge IV catheters (2.2%; p < 0.05) independently of the anatomic location. For 20-gauge IV catheters, extravasation rates were significantly higher in the dorsum of the hand than in the antecubital fossa (1.8% vs 0.8%; p = 0.018). Extravasation rates were higher in older patients (≥ 50 vs < 50 years, 0.6% vs 1.4%; p = 0.019).” Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. Wienbeck S et al. AJR Am J Roentgenol. 2010 Oct;195(4):825-9 |
“ This study evaluated the effect of intravenous (IV) catheter gauge size on catheter placement, contrast infusion, and image quality for patients undergoing IV contrast-enhanced multidetector computed tomography (MDCT).” Catheter insertion for intravenous (IV) contrast infusion in multidetector-row computed tomography (MDCT): defining how catheter caliber selection affects procedure of catheter insertion, IV contrast infusion rate, complication rate, and MDCT image quality. Johnson PT, Christensen G, Lai H, Eng J, Fishman EK. J Comput Assist Tomogr. 2014 Mar-Apr;38(2):281-4 |
“Experienced IV starters usually achieve IV access in one attempt by tailoring IV catheter gauge to vein quality; however, target infusion rates are not likely to be achieved with 22- and 24-gauge catheters, used in nearly 1/3 of the patients in this study.” Catheter insertion for intravenous (IV) contrast infusion in multidetector-row computed tomography (MDCT): defining how catheter caliber selection affects procedure of catheter insertion, IV contrast infusion rate, complication rate, and MDCT image quality. Johnson PT, Christensen G, Lai H, Eng J, Fishman EK. J Comput Assist Tomogr. 2014 Mar-Apr;38(2):281-4 |
“The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for i.v. contrast infusion during MDCT.” I.v. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications. Johnson PT, Christensen GM, Fishman EK. AJR Am J Roentgenol. 2014 Jun;202(6):1166-70. |
Standard 18g vs Nexiva 20g  |
“A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to i.v. contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.” I.v. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications. Johnson PT, Christensen GM, Fishman EK. AJR Am J Roentgenol. 2014 Jun;202(6):1166-70. |
BD Nexiva Diffusics Injection Rates  |
20 G Nexiva Diffusics. 10.0 cc/sec injection rate  |
IV Catheter Safety
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Metastatic Neuroendocrine Tumor  |
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Intravenous Contrast Non ionic
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What are the risks to our patients from iodinated contrast agents? How do you minimize the risks from iodinated contrast agents? |
Algorithm for Management of Patients Receiving Iodinated CM  |
IV Contrast and NPR  |
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“The risk of acute kidney injury (AKI) developing in patients with reduced kidney function following exposure to intravenous iodinated contrast media has been overstated. This is due primarily to historic lack of control groups sufficient to separate contrast-induced AKI (CI-AKI; ie, AKI caused by contrast media administration) from contrast-associated AKI (CA-AKI; ie, AKI coincident to contrast media administration).” Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation Davenport MS et al. Radiology. 2020 Mar;294(3):660-668. |
“Patients with AKI or eGFR less than 30 mL/min/1.73 m2 (including nonanuric patients undergoing maintenance dialysis [see below]) should prompt consideration by the referring professional and radiologist to discuss the risks and benefits of contrast media administration acute kidney injury (AKI) or an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 who are not undergoing maintenance dialysis.” Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation Davenport MS et al. Radiology. 2020 Mar;294(3):660-668. |
“The presence of a solitary kidney should not independently influence decision making regarding the risk of CI-AKI. Ad hoc lowering of contrast media dose below a known diagnostic threshold should be avoided due to the risk of lowering diagnostic accuracy.” Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation Davenport MS et al. Radiology 2020 (in press) |
“The creatinine level increases in patients who are not receiving contrast material as often as it does in published series of patients who are receiving contrast material. The role of contrast material in nephropathy may have been overestimated.” Frequency of Serum Creatinine Changes in the Absence of Iodinated Contrast Material: Implications for Studies of Contrast Nephrotoxicity Newhouse JH AJR 2008; 191:378-382 |
STUDY OBJECTIVE: The study objective was to determine whether intravenous contrast administration for computed tomography (CT) is independently associated with increased risk for acute kidney injury and adverse clinical outcomes. CONCLUSION: In the largest well-controlled study of acute kidney injury following contrast administration in the ED to date, intravenous contrast was not associated with an increased frequency of acute kidney injury. Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Hinson JS, Ehmann MR, Fine DM, Fishman EK, Toerper MF, Rothman RE, Klein EY Ann Emerg Med 2017 Jan 19. pii: S0196-0644(16)31388-9 |
“Rates of acute kidney injury were similar among all groups. Contrast administration was not associated with increased incidence of acute kidney injury (contrast-induced nephropathy criteria odds ratio=0.96, 95% confidence interval 0.85 to 1.08; and Acute Kidney Injury Network/Kidney Disease Improving Global Outcomes criteria odds ratio=1.00, 95% confidence interval 0.87 to 1.16). This was true in all subgroup analyses regardless of baseline renal function and whether comparisons were made directly or after propensity matching. Contrast administration was not associated with increased incidence of chronic kidney disease, dialysis, or renal transplant at 6 months.” Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Hinson JS, Ehmann MR, Fine DM, Fishman EK, Toerper MF, Rothman RE, Klein EY Ann Emerg Med 2017 Jan 19. pii: S0196-0644(16)31388-9 |
Renal Function and Intravascular Iodinated Contrast Administration  |
Renal Function and Intravascular Iodinated Contrast Administration Dialysis Patients: Additional labs will not be needed as dialysis patients are already recognized to have an eGFR <30 mL/min/1.73m2 |
Renal Function and Intravascular Iodinated Contrast Administration If the patient has any of the following risk factors and there is no eGFR value on record within 90 days, a serum creatinine/eGFR will be performed:
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Renal Function and Intravascular Iodinated Contrast Administration If the patient has any of the following risk factors and there is no eGFR value on record within 90 days, a POCT creatinine/eGFR will be performed:
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Adult and Pediatric Patients  |
Should you place IV contrast in a warmer prior to using it? Yes / No / Not Sure |
Why would you not warm iodinated contrast?
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Warming of ICM is recommended as follows
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“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 |
”Extrinsic warming to 37°C reduced allergic-like reaction rates to iopromide 370, iopamidol 370, and iohexol 350, which are LOCM. The results of the present study were clinically significant and were in accordance to the latest contrast media guidelines. Moreover, contrast media guideline promote a practical way of ad- ministering medications to help alleviate patient burden.” Extrinsic warming of low-osmolality iodinated contrast media to 37°C reduced the rate of allergic-like reaction Bin Zhang et al. Allergy Asthma Proc 39:e55–e63, 2018; doi: 10.2500/aap.2018.39.4160) |
24 vs 13 vs 5 Hour Contrast Prep “Accelerated intravenous premedication with corticosteroids beginning 5 hours before contrast-enhanced CT has a breakthrough reaction rate noninferior to that of a 13- hour oral premedication regimen.” Intravenous Corticosteroid Premedication Administered 5 Hours before CT Compared with a Traditional 13-Hour Oral Regimen Benjamin M. Mervak et al. Radiology (in press) |
“Our data support the replacement of a 13-hour oral premedication regimen with a 5-hour intravenous premedication regimen in patients with competing medical priorities (eg, inpatients, those in emergency departments).” Intravenous Corticosteroid Premedication administered 5 hours before CT compared with a Traditional 13-hour Oral regimen Mervak PM et al. Radiology 2017; 285:425–433 |
“Faster premedication should reduce the indirect harms of pre- medication in hospitalized patients at high risk for reactions to contrast media.” Intravenous Corticosteroid Premedication administered 5 hours before CT compared with a Traditional 13-hour Oral regimen Mervak PM et al. Radiology 2017; 285:425–433 |