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.
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.