Reactions and Precautions

What will the patient experience during contrast media application? Barium sulfate contrast media

If possible, exams with barium sulfate contrast media are performed on sober patients. Therefore, the patient will be asked not to eat for several hours before the exam begins. If the contrast media will be applied rectally, patients may be requested to have a special diet and medication prior to the exam.

Since this contrast medium will be expelled from the body with feces, white feces for a few days are expected. Some patients experience changes in their normal bowel movement during the first 12–24 hours after swallowing the medium.

Iodine-based contrast media

After intravenous injections of iodine-based media some patients have a warm, flushed sensation and a metallic taste in their mouth which lasts for a few minutes.

MR-Gadolinium

It is normal to feel coolness at the injection site, usually lasting for less than two minutes.

It is important to increase your fluid intake after any of the imaging examinations involving all contrast materials (especially the iodine-based one). Drinking water supports removal of the contrast material from the patient’s body.

Are there any allergic reactions or side effects? Barium sulfate contrast media

Some patients experience mild side effects. Very few patients encounter more serious effects such as: nausea , vomiting , constipation , diarrhea , stomach cramps , hives, red skin, itching , swelling of the throat, difficulty with breathing or swallowing, hoarseness , confusion, fast heartbeat or bluish skin color. In these cases they should inform their physician immediately.

If patients have a history of asthma, hay fever , or other allergies they are at greater risk of an adverse ungünstig, nachteilig reaction to barium sulfate contrast media. Also cystic fibrosis patients have an increased risk of blockage in the small bowel. Constipation is common after the patient is dehydrated. Intestinal blockage may get worse after getting a barium-sulfate agent .

Iodine-based contrast media

Some patients experience mild to severe reactions. They should see their physician only if they experience one of these symptoms: itching, headache , flushing, skin rash or hives, nausea and vomiting, wheezing abnormal heart rhythms, increased or decreased blood pressure, shortness of breath or difficulty breathing, cardiac arrest, swelling of the throat or other parts of the body, convulsion or profound low blood pressure.

Hours to days after an imaging examination, very few patients may develop delayed reactions. Patients should also inform their physicians.

Medication is indicated for “at-risk patients”. These are people who suffer from nephropathy, heart disease, sickle cell anemia, polycythemia and myeloma or renal disease as well as showed previous adverse reactions to iodine-based contrast materials, have a history of asthma or severe allergies, or are dehydrated. The use of medica-tions such as beta blockers, interleukin 2, or having received a large amount of contrast material within the past 24 hours are further risk factors that need to be considered.

MR-Gadolinium

MR-Gadolinium is even less likely to induce an allergic reaction than the iodine-based materials. Severe reactions are rare. In some cases patients experience hives and itchy eyes.

Are there any precautions during pregnancy and breast-feeding? The use of gadolinium-based contrast material is avoided during pregnancy or breast feeding due to unknown risks to the baby. Intravenous contrast material producers indicate that mothers should not breast-feed their babies for 24–48 hours after contrast medium is given. However, the “Manual on Contrast Media” from the ACR states:

“Review of the literature shows no evidence to suggest that oral ingestion by an infant of the tiny amount of gadolinium contrast medium excreted into breast milk would cause toxic effects. We believe, therefore, that the available data suggest that it is safe for the mother and infant to continue breast-feeding after receiving such an agent.

If the mother remains concerned about any potential ill effects, she should be given the opportunity to make an informed decision as to whether to continue or temporarily obstain from breast-feeding after receiving a gadolinium contrast medium. If the mother so desires , she may obstain from breast-feeding for 24 hours with active expression and discarding of breast milk from both breasts during that period. In anticipation of this, she may wish to use a breast pump to obtain milk before the contrast study to feed the infant during the 24-hour period following the examination.”

Bibliography 1. Thomsen HS, Muller RN, Mattrey R F: Trends in contrast Media. Springer Verlag Berlin Heidelberg, 1999. 2. www.acr.org 3. http://dict.leo.org 4. www.dict.cc 5. www.webster-dictionary.org

EXERCISE: 1. Which of the these contrast media is a nonionic one?* a) Diatrizoate b) Iohexol c) Iodamide

2. _______________ and barium are the most common types of contrast medium for enhancing x-ray based imaging methods. a) Chlorine b) Uranium c) Iodine

3. Which of the following is a common patient reaction to IV contrast media? 1. warmth at the injection site, 2. headache, 3. nausea a) 1 only b) 2 only c) 3 only d) 1, 2 & 3

* If you will have a look into the “ACR Manual on Contrast Media” you will find the answer for the following question.

Die Autorin: Carmen Lobitz mail@lobitz-seminare.de www.lobitz-seminare.de Carmen Lobitz ist freie Trainerin, Lehrerin und MTA. Sie gründete 1998 in Berlin lobitz seminare, die u.a. Englischseminare für Health Professionals anbieten.

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Lösung für Exercise:

Answer: 1. b) Answer: 2. c) Answer: 3. d)

Reactions and Precautions

What will the patient experience during contrast media application?

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