Recognition and Management of IV Contrast Reactions : A re-audit

By Dr M. Millar-Mills, Dr C. Filippini, Dr R. Carter, Dr H. Elhassan, Dr J. Chen

Introduction

• Using iodinated IV contrast is vital to enhance radiological imaging

• Over 60,000 contrast enhanced diagnostic CTs are performed per annum at Oxford University Hospitals

• There have been 14 documented contrast reactions in the past 5 years

• Risks associated with iodinated contrast use remain low:

• 0.15% rate of adverse/mild events

• 0.04% risk of moderate reactions

• 0.004% risk of severe reactions

• However, life threatening reactions, as well as anaphylaxis, can and do occur

• Are we, as radiologists, confident at recognising and managing these reactions?

Discussion:

There has been a general improvement since the 2015 audit, however we still not meeting the RCR standard – that 100% of radiologists in the department are able to confidently recognise and manage a contrast reaction or anaphylaxis. This includes how to treat a reaction, and where in the department can you locate the appropriate medications or resources.

The 2019 re-audit found:

• We are not all confident in managing all aspect of contrast reactions, including how to identify them as mild, moderate or severe, and when to intervene with treatment

• Most people knew about the contrast reaction e-learning module produced in 2015 but haven’t necessarily completed it (or had subsequently forgotten what to do!)

• Many knew there were posters inside the contrast reaction box or in CT suites which can be used as a reference on how to manage reactions, but hadn’t necessarily seen one of these

Specifically, radiologists were unsure of how to manage more mild reactions that did not necessarily require administration of adrenaline, and were keen to be reminded of the following (in line with RCR guidance):

• Treatment of N&V is supportive

• Treatment of isolated urticaria is with antihistamines – if urticaria is severe, intramuscular adrenaline can be given

• Treatment of isolated laryngeal oedema is with oxygen and intramuscular adrenaline, repeated as necessary

• Treatment of isolated hypotension is to elevate legs and give oxygen and fluids. If the patient looses consciousness then intramuscular adrenaline can be given

Method:

The following questionnaire was distributed among the radiology consultant and registrar body (correct answers in red)

This questionnaire and audit was first performed in 2015, and then again in 2019, to see whether any improvement in knowledge had been achieved following delivery of an online e-learning packing on managing anaphylaxis.

Results from the 2019 audit:

Recommendations:

• Encourage completion of the

e-learning module annually.

• Creation of lanyard cards for

a quick reference guide that

is accessible wherever you

may be

References:The Royal College of Radiologist. Standards for intravascular contrast agent administration to adult patients, Third edition. London: The Royal College of Radiologist, 2015. Resuscitation Council UK. Emergency treatment of anaphylactic reactions: guidelines for healthcare providers. 2008.

The largest improvement between the 2015 audit and the 2019 audit was in the awareness of preventative strategies and in the appropriate identification and treatment of an isolated bronchospasm:

47%correctly answered

2015 audit

64%correctly answered

2019 audit