CM Urogram

8/13/2019 CM Urogram

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Contrast media for urography and

IVU



IODINE

• Only element for intravascular radiological

contrast

• Packaged to be delivered safely

• Fully substituted benzoic acid molecule

• First used 1928 Swick



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.



RCM – HOCM

• Ionic monomers-

urograffin

• Ionic dimers – hexabrix



RCM – LOCM/IOCM

• Non ionic monomer –

omnipaque

• Non ionic dimer – visipaque



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



Adverse contrast reaction

prevalence



Risk factors



Other risk factors

• Severe cardiac disease

• Sickle cell disease

• Myeloma

• Phaeochromocytoma

• Renal disease

• Anxiety and apprehension20 – 40% of the population are at increased risk



Adverse contrast reactions

Non idiosyncratic [ dose related]

Cause – direct chemotoxic/hyperosmolar

- nausea and vomiting

- Cardiac arrhythmia

- Renal failure

- Pulmonary oedema




idiosyncratic - anaphylactoid

Occur unpredictably, independent of dose

Not a true IgE mediated reactionCause – unknown

- hives, itching

- Facial, laryngeal oedema

- Bronchospasm,respiratory collapse

- Circulatory collapse




delayed

- Erythematous rashes

- Fever, chills, flu like symptoms

- Joint pain

- Headache fatigue

- Abdominal pain , diarrhoea



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.



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



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.



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



Urography and IVU

• Always use LOCM

• 2 hours NBM only

• 50 – 100mls 300/350

• ‘half strength’ contrast if injected directly

via antegrade or retrograde.

CM Urogram

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