Reducing Radiocontrast Use in the Cardiac Catheterization Laboratory—A Behavioral Modification Approach

Khawaja, Azimuddin Tareq; Srinivasan, Venkatraman; Hawa, Zafir; Gradman, Alan H.

doi:10.1097/00019514-200407000-00007

Cited by 4 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The contrast volume (CV) used during cardiac catheterization (CC) has been associated with acute kidney injury after CC. [1][2][3][4][5][6] The nephrotoxic effect of contrast media during CC leads to short-and long-term morbidity and mortality. 1,7 Contrast media-induced acute kidney injury, also referred to as contrast-induced nephropathy (CIN), is believed to be mediated by contrast-induced renal tubular cell injury, hypoxia, formation of free radicals, and vasoconstriction in the renal vasculature caused by elevated endothelin levels.…”

Section: Introductionmentioning

confidence: 99%

Do Cardiovascular Risk Factors and Coronary SYNTAX Score Predict Contrast Volume Use During Cardiac Catheterization?

et al. 2015

View full text Add to dashboard Cite

The association of cardiovascular risk factors and complexity and severity of coronary artery disease with contrast volume (CV) remains unknown. We assessed the predictive factors of CV use during elective and emergent cardiac catheterization (CC). Electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 708 patients were eligible. On multivariable regression analysis, the presence of obstructed coronary arteries was associated with CV (P = .01, β = -14.17), with greater CV used in patients with single or double vessel disease compared to those with triple vessel disease. The presence of lesions with >70% stenosis in major epicardial arteries (P = .019, β = 24.39) and ST-segment elevation myocardial infarction (P = .001, β = 36.14) was associated with increased CV use. Elevated B-type natriuretic peptide (P = .036, β = -17.23) and increase in Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (P = .024, β = -29.06) were associated with decreased CV use. These aforementioned associations were attenuated after adjusting for percutaneous coronary intervention. Our findings may help predict patient populations who could be exposed to increased CV during CC, thereby possibly increasing their risk of contrast-induced nephropathy.

show abstract

Section: Introductionmentioning

confidence: 99%

Do Cardiovascular Risk Factors and Coronary SYNTAX Score Predict Contrast Volume Use During Cardiac Catheterization?

et al. 2015

View full text Add to dashboard Cite

show abstract

“…CIN is a life-threatening dose-dependent reaction and is commonly defined as a decrease in renal function 24-48 hours after contrast media administration, with a rise in serum creatinine levels of more than 25% from the baseline (or an absolute increase greater than 0.5 mg/dL) three to five days after the procedure. [1][2][3][4][5][6][7][8][9] Preventative measures for CIN in cardiovascular procedures include pre-hydration, prophylactic administration of N-acetylcysteine and utilisation of iso-osmolar/hypo-osmolar contrast media. However, reducing the volume of contrast media within the procedure was found to be the most effective.…”

Section: Introductionmentioning

confidence: 99%

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

et al. 2008

View full text Add to dashboard Cite

IntroductionDiagnostic coronary angiography utilises radiographic contrast media to delineate epicardial coronary lesions and assess left ventricular function. While contrast media is essential for the radiographic visualisation of coronary vessels, there are certain risks and complications associated with its use. One such complication is contrast-induced nephropathy (CIN). CIN is a life-threatening dose-dependent reaction and is commonly defined as a decrease in renal function 24-48 hours after contrast media administration, with a rise in serum creatinine levels of more than 25% from the baseline (or an absolute increase greater than 0.5 mg/dL) three to five days after the procedure. [1][2][3][4][5][6][7][8][9] Preventative measures for CIN in cardiovascular procedures include pre-hydration, prophylactic administration of N-acetylcysteine and utilisation of iso-osmolar/hypo-osmolar contrast media. However, reducing the volume of contrast media within the procedure was found to be the most effective. [10][11][12][13][14] Cigarroa, et al. 15 and Freeman, et al. 16 both investigated the significance of an adjusted volume of contrast media to patient's body weight and serum creatinine level (maximum radiographic contrast dose (MRCD)) in relation to the occurrence of CIN. CIN developed in 2% of cases when the calculated MRCD for a group of patients was not exceeded, and a 15-fold increase in incidence for a group where MRCD was exceeded. Similarly Rihal, et al. 12 reported a 12% increase in the risk of nephropathy with each 100 mL administered to the patient. As CIN has been found to be the third leading cause of acute renal failure in patients (10% of all admitted cases), it is essential that contrast load is kept to a minimum in any examinations requiring contrast media. 3,17 Coronary angiography can be performed using either singleplane or biplane imaging equipment. Single-plane imaging involves the use of one x-ray tube to acquire images at different angles and requires a separate injection of contrast for each cine angiography run. Biplane imaging utilises two x-ray tubes and is capable of acquiring two simultaneous projections with a single contrast injection. Therefore, it is assumed that contrast load will not only be reduced, but screening time and overall procedural time will be shorter.In biplane imaging, the screening time is inclusive of the total fluoroscopy and cine angiography time for both planes. The screening time should therefore be shorter for biplane imaging than single-plane imaging as it acquires two images simultaneously. Additionally, as the setup of the two C-arms require less movement throughout the procedure, the use of biplane equipment would accordingly assist in reducing procedural time when compared to single-plane imaging. Furthermore, because the runs are calculated from each individual plane, biplane should result in a slightly greater number of cine angiography runs than single-plane imaging. Where single-plane will complete the nine standard projections, biplane will produce ...

show abstract

“…Khawaja et al [12] reported a physician behavioral modification study that included systematic monitoring of physicians and communications with physicians regarding total contrast used during catheterization cases. The results showed a significant reduction in contrast usage after the behavioral modification program was implemented.…”

Section: Introductionmentioning

confidence: 99%

Timeout for Contrast: Using Physician Behavior Modification to Reduce Contrast in the Catheterization Laboratory

Singh

Zughaib

2019

Cardiology Research and Practice

View full text Add to dashboard Cite

Background As the number of procedures using contrast media continues to rise, the ensuing complications place an ever increasing burden on the healthcare system. Contrast-induced nephropathy (CIN) is a common postprocedural complication after cardiac catheterization. Objectives The purpose of our study was to evaluate the impact of physician behavioral modification on reducing the amount of contrast used during the procedure. Methods All patients who underwent procedures in the cardiac catheterization laboratory from January 2013 to August 2016 were identified in addition to the total contrast used during the procedure, the type of procedure performed, and the operator performing the procedure. A new addition was made to the preprocedure checklist in September-October 2013 in the form of maximum allowed contrast for the patient. Results A total of 12,118 cases were identified. Across all procedures, the mean contrast used during the 8 months prior to the intervention was 118 ml per procedure. Mean contrast used per procedure for the first year after the revised timeout was 105 ml, for the second year was 106 ml, and for the third year was 99 ml. Conclusion A significant reduction in radiocontrast use across all operators and procedures after the introduction of a revised timeout procedure that was seen, which is a change that was sustained over a period of three years. With this straightforward intervention involving physician behavioral modification, patients were exposed to less of the nephrotoxic contrast and were consequently at a lower risk of developing dose-depended CIN and other associated complications.

show abstract

Reducing Radiocontrast Use in the Cardiac Catheterization Laboratory—A Behavioral Modification Approach

Cited by 4 publications

References 6 publications

Do Cardiovascular Risk Factors and Coronary SYNTAX Score Predict Contrast Volume Use During Cardiac Catheterization?

Do Cardiovascular Risk Factors and Coronary SYNTAX Score Predict Contrast Volume Use During Cardiac Catheterization?

Does biplane imaging reduce contrast load, procedural and screening time compared to single‐plane imaging in routine diagnostic coronary angiography?

Timeout for Contrast: Using Physician Behavior Modification to Reduce Contrast in the Catheterization Laboratory

Contact Info

Product

Resources

About