Download Hydration Policy for High Risk Patients Requiring Intravenous Contrast

Hydration Policy for High Risk Patients Requiring Intravenous
Contrast
Aim

To prevent contrast-induced nephrotoxicity by maintaining good hydration and
urine output.
Scope
High Risk patients e.g. compromised renal function/ renal disease, diabetes,
and patients over 50 years of age.
Renal Impairment –defined as

Males
=Serum Creatinine of >120 µmol/L

Females
=Serum Creatinine of

eGFR<60ml/min/1.73m²
>100µmol/L
(Reference range as supplied by Medlab Central Palmerston North)
Patient Management
For Medical Practitioners requesting Radiology Imaging requiring IV contrast i.e. CT,
MRI, Fluoroscopy. IVU

Assess for risk factors as above

Check renal function
a)
1-2 days prior to examination in compromised patients
b)
3 months for others
A) If serum creatinine 120-150 µmol/L(males) or 100µmol/L (females) or if
eGFR between 40 and 60
1.
If euvolaemic or hypovolaemic:

Commence IV fluids. Normal saline 1000mls over 4 hours prior
to test

After examination, continue good hydration

Check renal function the day after examination

Visipaque (Iodixanol)contrast to be used
Radiology/quality/manuals/currentmanuals/CTmanual2011
2
If in obvious fluid overload:

Consider postponing the examination

Consider another diagnostic examination
B) For patients with serum creatinine of over 150 µmol/L(males) or over 130
µmol/L(females) or eGFR <40ml/min

Consider another form of investigation e.g. Ultrasound or non contrast CT.
Discuss with Radiologist. If they consider that contrast medium can be safely
given, then admit for IV Hydration (½ normal saline) and oral N acetylcysteine
protocol. Visipaque (Iodixanol)is to be used

If contrast examination is essential then referral to the On-Call medical
physician is recommended as individualised fluid management is required

With Creatinine >150 µmol/L intravenous contrast medium is not
recommended

Arrange follow-up Creatinine at the day after examination
Patients on Metformin

Refer to Quality Manual-Metformin Protocol section 27
Dr Ros Iversen Clinical Director
Dr John de Villiers Radiologist
Dr Charles Robinson-Radiologist
Dr Ross Stevens Radiologist
Radiology/quality/manuals/currentmanuals/CTmanual2011
Metformin Protocol
PATIENTS WITH DIABETES
ON METFORMIN FOR IV CONTRAST
Renal function in past year
Abnormal
Normal
Clinician review of Metformin use
Radiologist review of need for IV contrast
Stop Metformin for 48
hours post contrast injection
IV Contrast required
IV Contrast not required
Stop Metformin the morning of IV
Contrast injection and for 48 hours
following IV contrast
Abnormal renal function
Normal renal function
Clinician review of
Metformin use
Radiology/quality/manuals/currentmanuals/CTmanual2011
Restart Metformin