I work out of the Radiology dept. and recently discovered all the Contrast warmers off and empty. When I asked about why we are NOT administering warm contrast I was told that it was no longer necessary. Any one know anything about this?

Check your IFU

The person who told you it was not necessary has never received cold contrast.  It is a shock not only to the body but to the vessels.   I have heard anecdotally that some radiology departments feel warming contrast reduces complications, such as patient nausea, vomiting and extravasations.   No published literature, but it seems logical to me. 

The blood vessels will constrict when cold contrast (not body temp) hits the veins at 5cc/second (18000 cc/hr) this vasoconstriction can lead to a vasovagal response, extravasation and other complications. 

There are steps involved in keeping contrast warm, like keeping a log of temps and discarding open contrast after 24 hrs, that is why some want to get away from it. 

If you read the Instructions for use of any central line (PICC, Port, CVC) approved for use with power injection, they state to use contrast warmed to body temp.  It is less viscous, therefore less stressful to the catheter and will need less pressure to push.   A power injector only pushes at the psi needed to reach the speed set, if the contrast is warm it can use less psi to push it.

 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

 I would want to have a

 I would want to have a policy and practice to use warmed contrast. Contrast should be considered as a medication. There are 2 issues - growth of organisms in warmed solution and stability of the drug. Warmers must be maintained at 37 degrees C and checked daily. An unopened fluid container can remain in the warmer for up to 30 days however an opened one must be discarded at the end of each day. This study shows a reduction in contrast extravasation when the contrast is warmed:

1. Davenport MS, Wang CL, Bashir MR, Neville AM, Paulson EK. Rate of Contrast Material Extravasations and Allergic-like Reactions: Effect of Extrinsic Warming of Low-Osmolality Iodinated CT Contrast Material to 37° C. Radiology 2012;262:475-84.

Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861