Prevention of contrast medium reaction

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Author: Mikael Häggström [notes 1]

Prevention of contrast medium reaction for CT with IV contrast:

Pre-medication

Indication

Before a contrast CT of a patient with known allergic-like or unknown-type of contrast reaction to the same class of contrast medium (such as iodinated), the American College of of Radiology recommends premedication.

Asthma, atopy, and drug or food allergy have been regarded as generally not conferring enough risk to motivate glucocorticiod premedication.[1]

Medication

Preferably a glucocorticoid, preferably starting 12 or 13 hours before contrast administration.[2]

In emergent situations in adults and children over the age of 6, Swedish guidelines recommend the following pre-medication:[3]

  • IV hydrokortisone, 200mg, immediately and then every 4 hours until the CT is done.
  • Peroral desloratadine, 10 mg, 1 hour before IV contrast injection, if possible.

Other measures

Swedish guidelines recommend:[3]

  • Having an adrenaline shot available in case of contrast medium reaction
  • Switching to other contrast formula, although cross-reaction can still occur.
  • Presence of an anesthesiologist if known severe reaction previously.
  • Observation and remaining intravenous access at least 30 minutes after injection.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. . Guidelines for contrast media pre-medication. Nova Scotia Department of Health and Wellness. Retrieved on 2018-08-25. October 2014
  2. Error on call to Template:cite web: Parameters url and title must be specified. . American College of Radiology, Committee on Drugs and Contrast Media. Retrieved on 2018-08-25. Version 10.3. 2018. ACR
  3. 3.0 3.1 At NU Hospital Group, local guideline approved from May 4, 2018