Article

Rate of contrast material extravasations and allergic-like reactions: effect of extrinsic warming of low-osmolality iodinated CT contrast material to 37 degrees C.

Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B2A209P, Ann Arbor, MI 48103, USA.
Radiology (Impact Factor: 6.34). 11/2011; 262(2):475-84. DOI: 10.1148/radiol.11111282
Source: PubMed

ABSTRACT 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.

0 Bookmarks
 · 
66 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Iodinated and gadolinium contrast agents pose some risk for certain pediatric patients, including allergic-like reactions, contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF). Digital flat-panel detectors enhance image quality during angiography and might allow use of more dilute contrast material to decrease risk of complications that might be dose-dependent, such as CIN and NSF. OBJECTIVE: To assess the maximum dilution factors for iodine- and gadolinium-based contrast agents suitable for vascular imaging with fluoroscopy and digital subtraction angiography (DSA) on digital flat-panel detectors in an animal model. MATERIALS AND METHODS: We performed selective catheterization of the abdominal aorta, renal artery and common carotid artery on a rabbit. In each vessel we performed fluoroscopy and DSA during contrast material injection using iodinated and gadolinium contrast material at 100%, 80%, 50%, 33% and 20% dilutions. An image quality score (0 to 3) was assigned by each of eight evaluators. Intracorrelation coefficient, paired t-test, one-way repeated analysis of variance, Spearman correlation and receiver operating characteristic curve analysis were applied to the data. RESULTS: Overall the image quality scores correlated linearly with dilution levels. For iodinated contrast material, the optimum cut-off level for DSA when a score of at least 2 is acceptable is above 33%; it is above 50% when a score of 3 is necessary. For gadolinium contrast material, the optimum cut-off for DSA images is above 50% when a score of at least 2 is acceptable and above 80% when a score of 3 is necessary. CONCLUSION: Knowledge of the relationship between image quality and contrast material dilution might allow a decrease in overall contrast load while maintaining appropriate image quality when using digital flat-panel detectors.
    Pediatric Radiology 06/2013; · 1.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective:To determine the incidence of immediate and delayed adverse drug reactions (ADRs) and to assess patient discomfort following administration of iodixanol during imaging examinations in routine clinical practice.Material and Methods:A total of 20,185 patients across 95 clinical centers were enrolled in a prospective postmarketing surveillance registry with iodixanol. Patients were monitored for occurrence of ADRs immediately following iodixanol administration and continued to 7 days after.Results:The overall rate of ADRs was 1.52%, of which 0.58% was immediate, and 0.97% was delayed onset. Two cases had non-fatal serious ADRs (0.01%). The ADRs were significantly more common in patients who underwent contrast-enhanced CT (CECT) / coronary CT angiography (CCTA) vs others (P<0.001), receiving pre-heated iodixanol vs non-heating (P<0.001), age=70 years (P<0.001), using a power injector for contrast delivery (p<0.001), with a history of an allergic reaction to contrast(P=0.024).Multivariate analysis showed that female gender, intravenous route of contrast injection, body weight =80 kg, age<65 years, contrast flow rate = 4 mL/sec and prior reaction to ICM were all significant independent contributors to ADRs. Pretreatment contrast volume and history of cardiac disease, gout, hypertension, diabetes mellitus or asthma did not affect the rate of ADRs. Discomfort was generally mild, with 94.8% of patients reporting a composite score of 0-3.Conclusions:The safety of iodixanol in routine clinical practice was shown to be similar to the published safety profiles of other nonionic iodinated contrast agents. Patient discomfort during administration was mild or absent in most patients.Advances in knowledge:The major strength of this study is that 20,185 patients were enrolled in various type of imaging examinations. The safety profile of iodixanol was comparable to previously published work.Clinical Trial Registration-URL:http://www.chictr.org; Unique identifier: ChiCTR-ONC (11003061).
    The British journal of radiology 12/2013; · 2.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE. The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for IV contrast infusion during MDCT. SUBJECTS AND METHODS. Two hundred five adult outpatients imaged on a dual-source 128-MDCT scanner with arterial phase body CT (flow rates, 5.0-7.5 mL/s) were randomized to either an 18-gauge nonfenestrated or 20-gauge fenestrated catheter. After randomization, any 18-gauge nonfenestrated subjects whose veins were deemed insufficient for that catheter gauge were assigned to a third cohort for placement of a 20-gauge fenestrated catheter. Catheter placement success, infusion rate, contrast volume, maximum pressure, complications, and aortic enhancement levels were recorded. RESULTS. Catheters were placed on the first attempt in 97% (100/103) for 18-gauge nonfenestrated and 94% (96/102) for 20-gauge fenestrated placements and in two or fewer attempts in 99% of both groups. Mean infusion rates (5.74 mL/s for 18-gauge nonfenestrated and 5.58 mL/s for 20-gauge fenestrated placements) and aortic enhancement levels were not significantly different. Maximum pressure was higher with 20-gauge fenestrated catheters (mean ± SD, 230.5 ± 27.6 pounds per square inch [psi]) than 18-gauge nonfenestrated catheters (mean ± SD 215.6 ± 32.8 psi) (p = 0.002). One subject with an 18-gauge nonfenestrated catheter had a high-pressure alarm. In the third cohort, a 20-gauge fenestrated catheter was successfully placed in two or fewer attempts in 85% (28/33), with one minor extravasation attributed to vein insufficiency. CONCLUSION. A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to IV contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.
    AJR. American journal of roentgenology. 06/2014; 202(6):1166-70.

Full-text (2 Sources)

View
11 Downloads
Available from
Jun 4, 2014