Contrast media for urography and IVU

IODINE
Only element for intravascular radiological contrast Packaged to be delivered safely Fully substituted benzoic acid molecule First used 1928 Swick

Radiographic contrast media

Imaging not therapeutic agents Hydrophilic , low lipid soluability, low binding affinity Following IV injection enter extravascular and extracellular space [ not CNS] , they do not enter cells and 90% eliminated via kidneys in 12 hours.

RCM HOCM
Ionic monomersurograffin

Ionic dimers hexabrix

RCM LOCM/IOCM
Non ionic monomer omnipaque

Non ionic dimer visipaque

Adverse reactions
RCM are drugs and are liable to occasional and unpredictable ADR. They are administered in enormous doses compared with other drugs It is essential to have a sound and defensible indication for their use Deaths USA 500/year

Adverse contrast reaction prevalence

Risk factors

Other risk factors

Severe cardiac disease Sickle cell disease Myeloma Phaeochromocytoma Renal disease Anxiety and apprehension 20 40% of the population are at increased risk

Adverse contrast reactions Non idiosyncratic [ dose related]

Cause direct chemotoxic/hyperosmolar - nausea and vomiting - Cardiac arrhythmia - Renal failure - Pulmonary oedema

Adverse contrast reactions

idiosyncratic - anaphylactoid Occur unpredictably, independent of dose Not a true IgE mediated reaction Cause unknown - hives, itching - Facial, laryngeal oedema - Bronchospasm,respiratory collapse - Circulatory collapse

Adverse contrast reactions

delayed Erythematous rashes Fever, chills, flu like symptoms Joint pain Headache fatigue Abdominal pain , diarrhoea

Treatment 1
95% of serious reactions occur within 15minutes of injection Maintain IV access All IVU/CT rooms have emergency drugs box. All rooms have contrast reaction poster Low theshold for calling crash team.

Treatment 2 ESUR guidelines

Crash trolley Airway + O2 IM adrenaline 1:1000 0.5ml and repeat IV fluid H1- blocker diphenhydramine 25- 50 mg IV

ESUR guidelines for prevention of reactions

Identify risk factors- think about other imaging techniques Use LOCM for all IV/IA injections Premedicate at risk patients 30mg Pred 12 and 2 hrs pre injection Observe all patients for 20 mins post IV Have emergency drugs and personnel available.

Other guidelines
All patients should be well hydrated Stop metformin at the time of injection for 48hours and then restart High doses of contrast impair renal function This will be more severe and may be irreversible in those with preexisting renal impairment creat >150

Urography and IVU

Always use LOCM 2 hours NBM only 50 100mls 300/350 half strength contrast if injected directly via antegrade or retrograde.