Notes

UMass Memorial

• No inpatients except for Code Strokes
* No pediatric cases (<18 y/o) from University or Memorial Campus
  * EXCEPT Neuro
* No Harrington cases overnight (starting at 11pm)
  * EXCEPT plain films
* No Coronary CTAs

Initial Response to Anaphylactic Reaction

1 cc of 1:10,000 epinephrine or 0.1 cc of 1:1,000 epinephrine
Be sure to recognize the difference between 1:10,000 and 1:1,000 dilutions of epinephrine, which are 10 times stronger

GFR Guidelines for Iodinated Contrast

ESTIMATED GFR (ml/min/1.73 m2)	RECOMMENDATION
≥ 60	Negligible risk. Contrast may be given without volume expansion therapy.
45-60	Low risk. Estimates of CIN incidence in patients with eGFR ≥ 45 in large series range from 0% and 2.5%. Oral hydration is recommended, to consist of at least 500 ml (i.e. 2 cups) before contrast administration. After the procedure, the patient should drink at least 1 cup of water per hour for 8 hours
30-44	Intermediate risk. The incidence of CIN in patients with eGFR between 30 and 45 has been estimated to be between 2.9 and 9.8%. Contrast should be administered only if it is considered essential for diagnosis. Intravenous hydration is recommended, to consist of normal saline (NS) 250 cc prior to the CT examination and 250 cc following the examination.
<30	Higher risk. The incidence of CIN in patients with eGFR less than 30 is greater than 10% in large cohorts. Contrast should not be administered unless the patient is on dialysis and anuric, or if contrast is considered diagnostically imperative and the benefits of contrast outweigh the risk of CIN. The referring attending physician should document the need for contrast and that the benefit of contrast outweighs the risk of CIN in the patient’s medical record. Pre-procedural protection again CIN, if any, will be determined on a case-by-case basis after consultation with the attending radiologist.

Steroid Prep Regimens

Oral

Prednisone
- 50 mg PO 13 hours, 7 hours, and 1 hour prior to contrast
Benadryl*
- 50 mg PO 1 hour prior to contrast

Intravenous

13 hours Oral steroid prep is preferred. This is an alternative if patient cannot take PO, or if the study cannot wait 13 hours**

Hydrocortisone
- 200mg IV at least 3 hours prior to scan
Benadryl*
- 25-50 mg IV 1 hour prior to scan

*sedating; patient must have driver
**ACR Manual on Contrast Version 6, 2008:
'It is clear that administration for 3 hours or fewer prior to contrast does not decrease adverse reactions'
'In emergency situation, 200 mg IV hydrocortisone and 50 mg IV benadryl 1 hr prior to scan and q 4 hours until procedure is over, has been used'

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