Rate of Contrast Material Extravasations and Allergic-like Reactions: Effect of Extrinsic Warming of Low-Osmolality Iodinated CT Contrast Material to 37°C

Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B2A209P, Ann Arbor, MI 48103, USA.
Radiology (Impact Factor: 6.87). 11/2011; 262(2):475-84. DOI: 10.1148/radiol.11111282
Source: PubMed


To retrospectively determine whether extrinsic warming of the low-osmolality contrast material iopamidol to 37°C prior to intravenous administration at computed tomography (CT) affects extravasation and allergic-like reaction rates.
The need to obtain informed patient consent was waived for this HIPAA-compliant and institutional review board-approved analysis. All adverse events related to the intravenous administration of iopamidol during CT examinations occurring 200 days before (period 1) and 200 days after (period 2) the cessation of extrinsic contrast material warming (37°C) for intravenous injections of less than 6 mL/sec at Duke University Medical Center (Durham, NC) were retrospectively reviewed. Adverse event rates were compared by using χ2 statistics.
There were 12,682 injections during period 1 (10,831 injections of iopamidol 300 and 1851 injections of iopamidol 370) and 12,138 injections (10, 064 injections of iopamidol 300 and 2074 injections of iopamidol 370) during period 2. Adverse event rates for iopamidol 300 were not affected by extrinsic warming (extravasation rates: 0.30% [32 of 10,831] in period 1 vs 0.23% [23 of 10,064] in period 2, P=.64; allergic-like reaction rates: 0.39% [42 of 10,831] in period 1 vs 0.46% [46 of 10,064] in period 2, P=.74; overall adverse events: 0.68% [74 of 10,831] in period 1 vs 0.69% [69 of 10,064] in period 2, P=.99). Discontinuation of extrinsic warming was associated with significantly increased extravasation and overall adverse event rates for iopamidol 370 (extravasation rates: 0.27% [five of 1851] vs 0.87% [18 of 2074], P=.05; allergic-like reaction rates: 0.16% [three of 1851] vs 0.39% [eight of 2074], P=.42; overall adverse events: 0.43% [eight of 1851] vs 1.25% [26 of 2074], P=.02).
Extrinsic warming (to 37°C) does not appear to affect adverse event rates for intravenous injections of iopamidol 300 of less than 6 mL/sec but is associated with a significant reduction in extravasation and overall adverse event rates for the more viscous iopamidol 370.

Download full-text


Available from: Carolyn L Wang,
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the safety of the universal use of the nonionic iodinated contrast agent iopromide in patients undergoing CT in a large urban teaching hospital. For 2 years, we prospectively recorded all adverse events temporally associated with the administration of iopromide in 29,508 consecutive patients undergoing contrast-enhanced CT at our institution. The types, intensities, treatments, and outcomes of adverse events were recorded along with relevant patient history, including risk factors. Descriptive analyses of the variables, comparisons of means, and proportions using Student's t and chi-square tests, and logistic regressions were conducted. Adverse events were observed in 211 patients (0.7%) and were categorized as follows: urticaria (n = 161), facial or laryngeal edema (n = 13), bronchospasm (n = 8), severe nausea or vomiting (n = 10), or other (n = 19). One hundred eighty-eight adverse events (89%) were rated mild, 19 moderate (9%), and four severe (2%), including one fatality. Adverse events required treatment in 89 patients (42%). A history of allergy was present in 92 patients (44%), and 29 (14%) had a prior contrast reaction. Other relevant risk factors were identified in 63 patients (30%). No relationship existed between the occurrence of adverse events and any of the following: patient age, dose of iodine administered, or time of study (i.e., month, season, and year). Women (p < 0.001) and outpatients (p < 0.001) had a statistically significant higher incidence of adverse events. The universal use of iopromide as an IV CT contrast agent has a favorable safety profile.
    American Journal of Roentgenology 02/2005; 184(1):31-4. DOI:10.2214/ajr.184.1.01840031 · 2.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to determine the frequency and characteristics of adverse effects of low-osmolar iodinated and gadolinium contrast agents in a single-center experience with a large number of cases. A retrospective review of all intravascular doses of low-osmolar iodinated and gadolinium contrast materials administered from 2002 through 2006 was conducted. Adverse effects were identified through the use of radiologist and nurse event recording. Adverse effects were examined for type and severity of reaction, treatment required, and outcome. A total of 456,930 contrast doses (298,491 low-osmolar iodinated, 158,439 gadolinium) were administered over the study period. A total of 522 cases of adverse effects (0.11% of total) were identified (458 low-osmolar iodinated, 64 gadolinium). The most common adverse effects were hives (274, 52.5%) and nausea (92, 17.6%). Of all adverse effects, 79 of low-osmolar iodinated and 15 of gadolinium contrast material necessitated treatment. Most treatments were performed in the radiology department alone. Only 16 cases of adverse effects necessitated transfer for further observation or treatment. Epinephrine was used to manage an adverse effect in nine instances. Thirty-two of the adverse effects of low-osmolar iodinated contrast material (6.9%) occurred in patients with a history of allergy who received premedication. Only two of these premedication reactions necessitated transfer to the emergency department. The one death in the study period occurred after administration of low-osmolar iodinated contrast material. The patient had no symptoms during the contrast administration or imaging but died suddenly within 30 minutes of receiving the dose. Both iodinated and gadolinium contrast agents are associated with a very low rate of adverse effects. Most adverse effects are mild and can be managed in the radiology department. Transfer for additional treatment or observation is rarely needed.
    American Journal of Roentgenology 10/2009; 193(4):1124-7. DOI:10.2214/AJR.09.2520 · 2.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Adverse reactions to radiopaque contrast media (RCM) are well documented with a wide range of incidences reported. The objective of this study was to determine how many patients in a sample of 200 who presents for interventional pain treatments report a history of adverse reactions to RCM. Methods: Data from 200 outpatients were collected using a self-administered questionnaire. The questionnaire was designed to obtain information about prior exposure to RCM and any adverse events plus other general information about allergic reactions including known risk factors for allergic reactions. Demographic data and information about past medical history were obtained from each patient. Results: Of the 200 patients surveyed, 16 reported having had an allergic reaction to RCM. The events met criteria for immediate hypersensitivity reaction. Chemotoxic reactions cannot be ruled out. Of factors associated with risk of allergic reaction, none were clearly more prevalent in subjects reporting an allergic reaction vs. subjects who did not. Atopic patients generally considered susceptible to contrast allergy reported no hypersensitivity reaction. The number of medications and foods the subjects reported caused them to have allergic reactions was extensive. Conclusion: Patients with a history suggestive of an immediate hypersensitivity reaction to RCM may report for interventional pain procedures normally performed with RCM. Patients who have experienced an immediate hypersensitivity reaction to RCM have increased risk for another reaction if injected again with contrast agent. Therefore, facilities should be prepared to implement measures to prevent recurrent reactions.
    Pain Practice 06/2012; 13(3). DOI:10.1111/j.1533-2500.2012.00571.x · 2.36 Impact Factor
Show more