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
* [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]
*Data is sparse, however, and any guidelines should be utilized with that in mind, and in the context of local policies.
** '''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)


==Guideline==
ED patients do NOT require Cr 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==
Line 26: Line 12:


==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:Rads]]
[[Category:Radiology]]
[[Category:Nephro]]
[[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
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