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8/13/2019 CM Urogram
http://slidepdf.com/reader/full/cm-urogram 1/19
Contrast media for urography and
IVU
8/13/2019 CM Urogram
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IODINE
• Only element for intravascular radiological
contrast
• Packaged to be delivered safely
• Fully substituted benzoic acid molecule
• First used 1928 Swick
8/13/2019 CM Urogram
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Radiographic contrast media
• Imaging not therapeutic agents
• Hydrophilic , low lipid soluability, low
binding affinity
• Following IV injection enter extravascular
and extracellular space [ not CNS] , they do
not enter cells and 90% eliminated viakidneys in 12 hours.
8/13/2019 CM Urogram
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RCM – HOCM
• Ionic monomers-
urograffin
• Ionic dimers – hexabrix
8/13/2019 CM Urogram
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RCM – LOCM/IOCM
• Non ionic monomer –
omnipaque
• Non ionic dimer – visipaque
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8/13/2019 CM Urogram
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8/13/2019 CM Urogram
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Adverse reactions
RCM are drugs and are liable to occasional
and unpredictable ADR.
They are administered in enormous doses
compared with other drugs
It is essential to have a sound and defensible
indication for their use
Deaths USA 500/year
8/13/2019 CM Urogram
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Adverse contrast reaction
prevalence
8/13/2019 CM Urogram
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Risk factors
8/13/2019 CM Urogram
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Other risk factors
• Severe cardiac disease
• Sickle cell disease
• Myeloma
• Phaeochromocytoma
• Renal disease
• Anxiety and apprehension20 – 40% of the population are at increased risk
8/13/2019 CM Urogram
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Adverse contrast reactions
Non idiosyncratic [ dose related]
Cause – direct chemotoxic/hyperosmolar
- nausea and vomiting
- Cardiac arrhythmia
- Renal failure
- Pulmonary oedema
8/13/2019 CM Urogram
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Adverse contrast reactions
idiosyncratic - anaphylactoid
Occur unpredictably, independent of dose
Not a true IgE mediated reactionCause – unknown
- hives, itching
- Facial, laryngeal oedema
- Bronchospasm,respiratory collapse
- Circulatory collapse
8/13/2019 CM Urogram
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Adverse contrast reactions
delayed
- Erythematous rashes
- Fever, chills, flu like symptoms
- Joint pain
- Headache fatigue
- Abdominal pain , diarrhoea
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Treatment 1
• 95% of serious reactions occur within
15minutes of injection
• Maintain IV access
• All IVU/CT rooms have emergency drugs
box.
• All rooms have contrast reaction poster
• Low theshold for calling crash team.
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Treatment 2
ESUR guidelines• Crash trolley
• Airway + O2
• IM adrenaline 1:1000 0.5ml and repeat
• IV fluid
• H1- blocker diphenhydramine 25- 50 mg IV
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ESUR guidelines for prevention of reactions
• Identify risk factors- think about otherimaging techniques
• Use LOCM for all IV/IA injections• Premedicate at risk patients 30mg Pred 12
and 2 hrs pre injection
• Observe all patients for 20 mins post IV• Have emergency drugs and personnel
available.
8/13/2019 CM Urogram
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Other guidelines
• All patients should be well hydrated
• Stop metformin at the time of injection for
48hours and then restart
• High doses of contrast impair renal function
This will be more severe and may be
irreversible in those with preexisting renal
impairment – creat >150
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Urography and IVU
• Always use LOCM
• 2 hours NBM only
• 50 – 100mls 300/350
• ‘half strength’ contrast if injected directly
via antegrade or retrograde.