Patient Care

Contrast Issues and Policies

Yale-New Haven Hospital Non-ionic Contrast Pre-medication Policy

• A patient with a history of anaphylactoid reaction to allergens other than iodinated contrast does NOT need to be pre-medicated.
• A patient should not receive contrast (iodinated oral or IV) if they have previously had an anaphylactoid reaction to non-ionic contrast unless, in the opinion of the physician, the procedure is needed as an emergency. Anaphylactoid reactions would include the following:
  
     - Difficulty breathing
     - Unconciousness
     - Convulsions

• A patient may benefit from pre-medication if they have had a significant reaction to non-ionic contrast in the past. Significant reactions would include the following:
  
     - Urticaria/Hives
     - Bronchospasm
     - Rash  

Significant reactions would NOT include the following:

- Nausea/Vomiting
- Metal taste in mouth
- Flushing   

• The radiologist should discuss pre-treatment in these situations with the referring clinician.
• If the referring clinician wishes the study to continue without pre-treatment this must be documented in the report.
  
• If the referring clinician agrees that pre-treatment is warranted they should be advised to prescribe:
     - 50mg Prednisone PO 13, 7 and 1 hour before the injection.
     - 50mg Benadryl (Diphenhydramine) IV/PO within 1 hour of the injection.

In an emergency setting an alternative faster (but less proven) regime is: 

   - 200mg Hydrocortisone IV 4 hours before injection.
   - 50mg Benadryl (Diphenhydramine) IV/PO within 1 hour of the injection.

Pediatric Patients: (For patients less than 50kg):

• Prednisone 0.7mg/kg (not to exceed 50mg) PO 13, 7 and 1 hour before the injection.
• Benadryl (Diphenhydramine) 1mg/kg IV/PO (not to exceed 50mg) within 1 hour of the injection.

In an emergency setting an alternative faster (but less proven) regime is: 

   - Hydrocortisone 1mg/kg (not to exceed 200mg) IV 4 hours before injection.
   - Benadryl (Diphenhydramine) 1mg/kg IV/PO (not to exceed 50mg) within 1 hour of the injection.