Management of Acute Contrast Media Reactions: Assessing Preparedness of a Tertiary Care Veterans Affairs Medical Center

THE PROBLEM: HOSPITAL READINESS FOR CONTRAST MEDIA REACTIONS Acute contrast media reactions can range in severity from mild discomfort to life-threatening anaphylaxis. Three percent of all patients receiving intravenous (IV) contrast will experience reactions, although most will not require treatment. Severe, potentially life-threatening reactions occur in about 1 in 2,500 patients [1]. Overall, contrast reactions remain rare, particularly because of the widespread use of nonionic, lowosmolar contrast media. Because of the rarity of adverse reactions to contrast, many radiologists and hospital staff members remain unfamiliar with optimal treatments, appropriate medications, and their respective doses. Additionally, reaction training for nonradiology staff members covering after hours is not well established. Potential errors that commonly occur in the management of contrast reactions are a failure to recognize a contrast reaction; uncertainty regarding how to treat a reaction; failure to administer oxygen promptly; incorrect dosing or administration of epinephrine, atropine, and antihistamines; and an overall lack of advanced preparedness for the possibility of reactions [2,3]. Because of this concern for a lack f preparedness, other radiology epartments have performed local udit studies or surveys, and often any of these management errors re identified [4,5]. In our quality mprovement initiative, we assessed he readiness of our department nd medical center both during and after hours in responding to acute contrast media reactions and identified areas for improvement to ensure proper and efficient treatment should a contrast reaction occur.