What should I do if my patient has a contrast reaction? Guidelines for contrast reactions

What should I do if my patient has a contrast reaction?

These are symptom-dependent guidelines for treatment of patients who suffer a reaction to intravenous contrast material.

Urticaria

In asymptomatic patients, no treatment is needed.

In patient with symptomatic urticaria that is mild or moderate, diphenhydramine 50 mg may be administered orally, intramuscularly, or intravenously.

In severe cases, treatment is as above; consider adding cimetidine 300 mg by slow intravenous injection or ranitidine 50 mg by slow intravenous injection.

Bronchospasm

For mild bronchospasm, treatment includes oxygen 10-12 L by face mask, close observation, and/or 2 puffs of an albuterol or metaproterenol inhaler.

For moderate cases without hypotension, treatment is as above, with epinephrine 1:1000, 0.1-0.3 mL given subcutaneously, repeated every 10-15 minutes as needed until 1 mL is administered.

In patients with severe bronchospasm, administer epinephrine 1:10,000 1 mL slow intravenous injection over approximately 5 minutes, repeated every 5-10 minutes as needed.

Laryngeal edema

For mild to moderate laryngeal edema, treatment includes oxygen 10-12 L by face mask and epinephrine 1:1000 0.1-0.3 mL given subcutaneously, repeated every 10-15 minutes as needed until 1 mL is administered.

In moderate to severe cases, consider calling a code or intubating the patient. Consider adding diphenhydramine 50 mg slow intravenous injection and cimetidine 300 mg slow intravenous injection or ranitidine 50 mg slow intravenous injection.

Isolated hypotension

Raise the patient's legs as much as possible while preparing to administer intravenous fluids. The Trendelenburg position can also be effective, but many radiographic tables do not tilt. Oxygen should be administered in high doses.

Hypotension with tachycardia

In mild to moderate cases, elevate the patient's legs. Administer oxygen 10-12 L by face mask, and intravenous isotonic fluid (eg, 0.9% isotonic sodium chloride solution, Ringer lactate solution).

For patients with severe hypotension with tachycardia or patients who are unresponsive, treatment is as above, with dopamine 2-20 mcg/kg/min. Call a code if no response occurs.

Vasovagal reaction

In cases of mild to moderate vasovagal reactions, elevate the patient's legs. Administer oxygen 10-12 L by face mask, and intravenous isotonic fluid (eg, 0.9% isotonic sodium chloride solution, Ringer lactate solution).

For severe reactions or unresponsive patients, administer intravenous atropine 0.6-1 mg, repeated every 3-5 minutes as needed until a total of 3 mg is administered.