New guidelines on the use of iodinated contrast media: a report on an implementation project

Abstract

Purpose. The aim of this paper is to report on the implementation of new guidelines on the use of injectable iodinated contrast media (ICM) at our workplace and specific protocols for the preparation of patients at risk. Materials and methods. Operators received training with continuing medical education (CME) credits. The new documentation (patient history/screening form and informed consent form) is available on the hospital Web site and requests serum creatinine determination with estimation of glomerular filtration rate (GFR) for every patient. Additional tests are required for high-risk patients only. Results. Attendance rates were 57.2% among referring physicians and 74.5% among Radiology Department personnel. The Cockcroft-Gault formula was used to estimate GFR in adults. The main problem encountered in the implementation process was that referring physicians failed to evaluate the GFR in 80% of patients, with low GFR being discovered in the Radiology Department on the day of examination in 20% of patients, resulting in a need to reschedule the examination. Conclusions. Although not an easy task, implementation of the new guidelines for ICM use is both feasible and necessary. An additional refresher training course for personnel and GFR evaluation of the patient on referral are indispensable to ensure proper preparation of patients at increased risk of adverse reactions to ICM. Riassunto

Iodinated contrast media and their effect on thyroid function – Routines and practices among diagnostic imaging departments in Norway

“…The findings of the current study indicate the need for optimising the practice related to ICM administration in risk patients. Previous results show that implementation of guidelines for ICM use is essential and feasible despite the challenges, such as increased workload and logistical difficulties in rescheduling the examinations to a date compatible with the patient’s condition and other planned examinations 18 . The reported workload directly related to the use of a written checklist is 2 min and 40 sec per patient (which includes explaining the questions to the patient) 19 .…”

“…The reported workload directly related to the use of a written checklist is 2 min and 40 sec per patient (which includes explaining the questions to the patient) 19 . One unwanted consequence of implementing guidelines regarding thyroid‐related risk was a transient increase of requests for T3, T4 and TSH determinations not justified by the patients’ clinical situations 18 . Previous studies have found that implementing of guidelines included a concise checklist covering all risk factors can get positive reactions from both radiographers and radiologists 19 …”

“…Evidence shows that training courses for personnel are imperative to ensure proper implementation of guidelines and might be more effective than sending out formal and informal reminders about using various checklists 18 . Interprofessional collaboration and awareness of each other’s routines and responsibilities might be improved by activities that increase interprofessional interaction.…”

“…To our knowledge, no literature exists on how guidelines regarding management of patients at risk due to thyroid conditions are implemented in Norway or elsewhere. Previous studies on implementing and compliance of guidelines for safe administration of ICM 18,19 do not focus on thyroid‐related aspects. There is a significant gap between the amount of studies analysing the effect of ICM on thyroid function and those that investigate how this knowledge is reflected in practices at radiology departments.…”