Drugs for treatment of contrast reaction - Department of Radiology

UNIVERSITY OF WISCONSIN DEPARTMENT OF RADIOLOGY, POLICY FOR TREATMENT
OF NONIONIC RADIOGRAPHIC CONTRAST MATERIAL EXTRAVASATIONS
1. Immediate cessation of injection when a problem is detected – edema at injection sight, pressure, pain,
burning, numbness or other local complaints, and/or lack of central contrast bolus on images
2. Technologist or nursing staff should immediately inform the responsible faculty, fellow, or on-call
resident. The faculty staff MD is ultimately responsible.
3. Initial treatment can include:
• Elevation of affected extremity above the heart
• Warm or cold packs (per physician discretion) to the affected site – repeated as required
• Intermittent compression of affected site by manual compression or an ace wrap (per physician
discretion)
• Observation – frequency ,site, and available follow-up dependent on patient’s symptoms
(Radiology department or patient’s clinic or physician’s office)
• Call referring physician or clinic for any extravasation over 50 mL and instruct them as to
follow-up –
Fax Health Facts
• Educate patient about signs of tissue compromise, and advise to seek medical attention as per #5
4. Immediate plastic surgery consultation for any of the following indications:
• Known soft tissue extravasated volume exceeds 100 mL of nonionic contrast material (consultation
at smaller volumes of extravasation may be appropriate in the pediatric patient)
• Skin blistering
• Altered tissue perfusion (decreased capillary refill in the region or distal to the injection site)
• Increasing pain after 2-4 hours
• Change in sensation distal to site of extravasation
5. Patient instructed to watch for the following (patient also given Health Facts) and call their physician
(after hours if patient’s physician not available, 608-262-0143 and ask for the radiology resident on call)
for:
• Residual pain
• Blistering
• Redness or other skin color change
Hardness
• Increased or decreased temperature of skin at extravasation site (compared with temperature of skin
elsewhere)
• Change in sensation – distal to the extravasation
6. Follow-up phone calls by nurse or radiologist as appropriate
7. Documentation
• Complete hospital occurrence screen form for any confirmed and significant extravasation
• Place a note in the patient’s chart if available

12. DRUG SELECTION FOR CONTRAST REACTION
ADULT
REACTION MEDICATION DOSAGE
BRONCHOSPASM
LARYNGEAL
EDEMA
METAPROTERENOL
(ALUPENT) INHALER
2 - 4 puffs
May need higher doses
Monitor heart rate.
10 L / minute
OXYGEN
EPINEPHRINE sub Q 1:1,000 0.3 - 0.5
mL
IV 1:10,000 1mL
q 3 - 5 minutes, not to
exceed 5 mL in 15 min.
PULMONARY
EDEMA
HYPOTENSION
HIVES
SIT PATIENT UP. OXYGEN BY MASK. Securing the
airway is mandatory. If available staff is inexperienced
in intubation then a code should be called immediately.
Vigorous hydration with saline.
Elevate legs.
DIPHENHYDRAMINE
(BENADRYL)
(induces drowsiness and
should be used with
discretion in patients who
are driving).
25 – 50 mg IV
25 – 50 mg IM
VASOVAGAL
REACTION
SEIZURE
HYPERTENSIVE
CRISIS
ATROPINE
DIAZEPAM
(VALIUM)
CLONIDINE
Last updated 2/10/06
0.5 – 1 mg IV to
maximum dose of 2 mg
5 – 10 mg IV push; 30 mg
maximum dose.
200 mcg (0.2mg)
or two 100 mcg tablets
Bite, chew, and swallow.

PEDIATRIC
Last updated 2/10/06
REACTION MEDICATION DOSAGE
BRONCHOSPASM
(MODERATE)
ALBUTEROL nebulization ⇒
2.5 mg albuterol in 3ml NS
(prediluted) nebulization
OXYGEN
⇒
10-15 L/min blow by or face
mask
BRONCHOSPASM
(SEVERE)
ALBUTEROL nebulization ⇒
and/or
2.5 mg albuterol in 3 ml NS
(prediluted) nebulization
EPINEPHRINE (1:1000)
OXYGEN
⇒
⇒
0.01 mg/kg/dose (0.01 ml/kg)
SQ (max dose 0.5 ml)
10-15 L/min blow by or face
mask
LARYNGEAL EDEMA
EPINEPHRINE (1:1000) ⇒
and/or
RACEMIC EPINEPHRINE ⇒
(RE) (2.25%) nebulization
0.01 mg/kg/dose (0.01 ml/kg)
SQ (max dose 0.5 ml)
0.05 mL/kg up to 0.5 mL ml RE
in 3ml NS nebulization
OXYGEN
⇒
10-15 l/min blow by or face mask
PULMONARY EDEMA
HYPOTENSION
SIT PATIENT UP.
OXYGEN 10-15 L/min by mask
NORMAL SALINE 10-20 ml/kg slow IV push over ~5-10 min
TRENDELENBERG POSITION
HIVES
DIPHENHYDRAMINE ⇒
(BENEDRYL)
1 mg/kg IV per dose
If severe
EPINEPHRINE (1:1000)
⇒
0.01 mg/kg/dose (0.01 ml/kg)
0.02 SQ (max dose 0.05 ml)
VASOVAGAL REACTION ATROPINE ⇒ 0.02 mg/kg IV
Maximum dose of 1 mg
Minimum dose of 0.1 mg
SEIZURE
DIAZEPAM
(VALIUM)
⇒
0.2 - 0.3 mg/kg slow IV push per
dose.
may repeat in 5-10 min.
LORAZEPAM
⇒
0.01 mg/kg IV per dose