Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety

Abstract

BACKGROUND Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. OBJECTIVE To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. METHODS Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. RESULTS Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m2. Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. CONCLUSIONS Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material.

Comparison the Effect of Organized education by Group discussion and film screening on Anxiety and Contrast-induced nephropathy in Coronary catheterization Patients; A Randomized Clinical Trial

“…A study by Lambert et al (2017) titled "reducing contrast-induced acute kidney injury: how nurses can improve patient safety?" during 2007 to 2012 to improve quality and reduce the incidence of contrast-induced nephropathy on 20147 patient candidates for angioplasty in 10 centers in the north of England indicated that the standardization of the best evidence-based practices in nursing care could reduce the incidence of contrast-induced acute kidney injury (38).…”

Cuidados de enfermagem ao cliente pós-angioplastia transluminal coronariana

“…15,17,24 In this sense, the role of the nurse is highlighted, in which the authors seem unanimous in affirming their importance, mainly in the recognition of possible complications. 16,20,24,19 In addition, nurses need to be updated on the guidelines for the treatment of this clientele and must be able to identify the associated risk factors, such as the use of anticoagulants and antiplatelet agents associated with the risk of bleeding after the procedure. 18,20 In the context of basic human needs, the elimination of body waste as a concern was addressed in addressing the prevention of CIN in an experimental study.…”

Effects and Mechanism of Salvianolic Acid B on the Injury of Human Renal Tubular Epithelial Cells Induced by Iopromide

“…Iopromide, a new nonionic hypotonic contrast agent commonly used in PCI, has a direct toxic effect on renal tubular epithelial cells, such as the vacuolation of proximal tubules, interstitial edema, and renal tubular degeneration (Tan et al, 2017). The cytotoxic mechanisms induced by contrast agents include apoptosis, cell inflammation, and calcium homeostasis damage (Rear et al, 2016;Lambert et al, 2017). The flow resistance in the renal tubules increases after renal tubular epithelial cells are injured, and the renal interstitial pressure can reach up to 50 mmHg.…”