Harbor:Creatinine screening prior to IV contrast: Difference between revisions

 
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==Background==
* ED patients do NOT require creatinine measurement prior to IV contrast if the study is immediately necessary to prevent life-threatening decompensation or delay in emergent treatment (e.g., trauma patients, dissection r/o)
*It may be possible to reduce the use of creatinine screening in ED patients requiring IV contrast for CT or other radiographic evaluation
*Data is sparse, however, and any guidelines should be utilized with that in mind, and in the context of local policies.
 
==Guideline==
* [https://lacounty-my.sharepoint.com/personal/jshim_dhs_lacounty_gov/_layouts/15/onedrive.aspx?FolderCTID=0x01200042EAB0B5A27C63468CDB5666D0718199&id=%2Fpersonal%2Fjshim%5Fdhs%5Flacounty%5Fgov%2FDocuments%2FMicrosoft%20Teams%20Chat%20Files%2FUse%20of%20IV%2 DHS IV Contrast Expected Practices 10-2022]
* [https://lacounty-my.sharepoint.com/personal/jshim_dhs_lacounty_gov/_layouts/15/onedrive.aspx?FolderCTID=0x01200042EAB0B5A27C63468CDB5666D0718199&id=%2Fpersonal%2Fjshim%5Fdhs%5Flacounty%5Fgov%2FDocuments%2FMicrosoft%20Teams%20Chat%20Files%2FUse%20of%20IV%2 DHS IV Contrast Expected Practices 10-2022]
** No need for screening
** '''Ok to give IV contrast if GFR>30'''
*** GFR>30
** '''No need for GFR screening if age <60 with no pertinent history''' (AKI, CKD, HD with urine output, renal transplant, Metformin use)
** If the GFR<30, ER physician should state in the CT order “Clinical History” or document in the chart that IV contrast is necessary and authorized.
*** Alternately, the '''CT tech may call the physician to confirm IV contrast is necessary and authorized, and CT tech should document this communication in the chart.'''
** Screening for MRI contrast is unnecessary unless using  Eovist for liver mets study (all ED Emergent studies should use Dotarem or Gadavist)


ED patients do NOT require creatinine measurement prior to IV contrast:
*If the study is immediately necessary to prevent life-threatening decompensation or delay in emergent treatment (e.g. trauma patients)
*If they do not meet any of the following criteria<ref>Tippins RB, Torres WE, Baumgartner BR, Baumgarten DA. Are screening serum creatinine levels necessary prior to outpatient CT examinations? Radiology. 2000 Aug;216(2):481-4.</ref><ref>ACR Manual on Contrast Media – Version 10, 2015. [http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2015_Contrast_Media.pdf PDF] Accessed 08/10/15</ref>:
**Age >60
**History of kidney disease
***[[Kidney transplant]]
***[[Dialysis]]
***Single kidney
***Renal cancer
***Kidney surgery
**Family history of kidney failure
**[[Diabetes]]
**Hypertension
**[[Collagen vascular disease]] (e.g. [[SLE]], [[scleroderma]], [[rheumatoid arthritis]])
**Paraproteinemia (e.g. [[multiple myeloma]])
**Recent use of nephrotoxic medication (eg, [[metformin]], [[aminoglycosides]])


==See Also==
==See Also==
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==References==
==References==
<References/>
<ref>Tippins RB, Torres WE, Baumgartner BR, Baumgarten DA. Are screening serum creatinine levels necessary prior to outpatient CT examinations? Radiology. 2000 Aug;216(2):481-4.</ref><ref>ACR Manual on Contrast Media – Version 10, 2015. [http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2015_Contrast_Media.pdf PDF] Accessed 08/10/15</ref>:
 


[[Category:Radiology]]
[[Category:Radiology]]
[[Category:Renal]]
[[Category:Renal]]

Latest revision as of 16:34, 22 March 2023

  • ED patients do NOT require creatinine measurement prior to IV contrast if the study is immediately necessary to prevent life-threatening decompensation or delay in emergent treatment (e.g., trauma patients, dissection r/o)
  • DHS IV Contrast Expected Practices 10-2022
    • Ok to give IV contrast if GFR>30
    • No need for GFR screening if age <60 with no pertinent history (AKI, CKD, HD with urine output, renal transplant, Metformin use)
    • If the GFR<30, ER physician should state in the CT order “Clinical History” or document in the chart that IV contrast is necessary and authorized.
      • Alternately, the CT tech may call the physician to confirm IV contrast is necessary and authorized, and CT tech should document this communication in the chart.
    • Screening for MRI contrast is unnecessary unless using Eovist for liver mets study (all ED Emergent studies should use Dotarem or Gadavist)


See Also

References

[1][2]:

  1. Tippins RB, Torres WE, Baumgartner BR, Baumgarten DA. Are screening serum creatinine levels necessary prior to outpatient CT examinations? Radiology. 2000 Aug;216(2):481-4.
  2. ACR Manual on Contrast Media – Version 10, 2015. PDF Accessed 08/10/15