Patient Safety Topics
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Contrast-Induced Nephropathy
Overview

Contrast-induced nephropathy (CIN) cannot be viewed as a treatable or acceptable complication of iodinated contrast-related procedures, because it is associated with serious short-term and long-term consequences. Yet, fear of renal failure should not dictate avoidance of diagnostic studies using iodinated contrast. As in all clinical situations, the decision to administer iodinated contrast is based upon clinical judgment about the clinical status of the patient, knowledge of the risks and effective prophylactic measures, and the expected benefits of the procedure.

Key Data and Statistics

Event Reports

As of a March 2007 published analysis, at least 70 events have been reported through the Pennsylvania Patient Safety Reporting System concerning occurrences that reflect system/process issues related to renal function and contrast media. About 10% of the reports are categorized as Serious Events, compared to 4% of submitted PA-PSRS reports overall. Five percent of the reports indicated that the patient required dialysis after a contrast-related procedure. Some of the patterns and examples include:

  • Good news
    • Imaging study was cancelled because of elevated creatinine
    • Contrast study was delayed until creatinine results were available
  • Opportunities for improvement
    • Creatinine level was not checked prior to study
    • Wrong laboratory results were checked prior to study
    • A contrast-related study was performed in a patient with cin risk factors
    • Order entry error
    • Contrast administered despite order for study without contrast
    • Multiple contrast-related studies

Lessons Learned from Reports

  • Reporting facilities use creatinine levels, rather than eGFR to evaluate renal function. 
  • Having the most recent renal function study available and reviewed immediately before contrast administration may prevent untoward patient outcomes.
  • Physicians ordering contrast-related studies may not always consider contrast-induced nephropathy (CIN) risk factors. 
  • Delaying studies until renal function studies are reviewed may prevent untoward outcomes. 
  • Implementing standard CIN prevention strategies prior to contrast-related study in high-risk patients reduces reliance on memory. 
  • Written guidelines and standing orders help standardize care given, but are effective only if the healthcare team is aware of such tools and fully implements them. 
  • Double checking order entries may prevent high-risk patients from receiving contrast. 
  • If medically feasible, spacing multiple contrast-related studies will allow the patient's creatinine level to return to baseline before the next study is  performed. 
  • Conducting a full risk assessment and history may identify patients at CIN risk. 
  • Heightening awareness of the long-term sequelae of CIN may help the healthcare team understand that CIN is not an acceptable complication, and that its prevention must be taken seriously.

Figures 1 and 2 depict the structure and function of the various components of the kidney.

Figure 1. Internal Structure of the Kidney Figure 2. The Nephrons

 

Excerpted from: Contrast-induced nephropathy: can this iatrogenic complication of iodinated contrast be prevented? PA PSRS Patient Saf Advis 2007 Mar 30. http://patientsafety.pa.gov/ADVISORIES/Pages/2007sup1_01.aspx.

Educational Tools

Management of Patients Undergoing Iodinated Contrast-Related Procedures
This stand-alone algorithm can help institutions to identify patients with risk factors for contrast-induced nephropathy.

Management of Patients Undergoing Iodinated Contrast-Related Procedures
This educational poster includes an algorithm to identify patients with risk factors for contrast-induced nephropathy, premedication regimen information, and reference tables for calculating estimated glomerular filtration rates.

Multimedia
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