The Central Role of the Radiology Nurse in Ensuring Safe Administration and Handling of Contrast Media: Systematic Review
Abstract
Background: Contrast media administration is a pillar of current diagnostic and interventional radiology to maximize image quality and diagnostic information. It is associated with a variety of risks, from harmless side effects to life-threatening emergencies. Within the multimodal imaging team, the radiology nurse has evolved into a pivotal player, acting as the patient safety key throughout the periprocedural path.
Aim: This systematic review claims to synthesize available evidence and formulate guidelines to outline the radiology nurse's multifaceted role in the safe administration and management of contrast media. It claims to write about the underlying tasks that define this role and highlight the nurse's vital role in minimizing risk and improving patient outcomes.
Methods: A systematic integration and synthesis of evidence from a wide range of peer-reviewed literature, including professional guidelines from associations such as the American College of Radiology and the European Society of Urogenital Radiology, was conducted. The review systematically reviews the evidence-based practices that apply to each aspect of the role of the radiology nurse.
Results: The review details and summarizes the key responsibilities of the radiology nurse, which form a cohesive framework for maintaining patient safety. They include pre-procedure patient evaluation and screening, knowledge of pharmacology related to contrast medium administration, application of accurate administration methods, careful patient monitoring, and management of emergent adverse effects. Additionally, the results highlight the nurse's key roles of patient education, advocacy, and facilitating a culture of safety and interprofessional communication within the radiology department.
Conclusion: The radiology nurse is crucial to effective and safe administration of contrast media. Expertise from the initial risk assessment and prevention all the way to emergency handling by the radiology nurse significantly decreases the intrinsic risks of contrast administration. By guaranteeing safety measures are being obeyed and patient care is being considered as a whole, the radiology nurse is part of the successful patient outcomes in modern radiological practice.
Full text article
References
Aggarwal, B. (2023). Textbook of Radiology And Imaging, Volume 1-E-Book. Elsevier Health Sciences.
American College of Radiology. (2021). ACR manual on contrast media. ACR Committee on Drugs and Contrast Media. https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Contrast-Manual
Beckett, K. R., Moriarity, A. K., & Langer, J. M. (2015). Safe use of contrast media: what the radiologist needs to know. Radiographics, 35(6), 1738-1750. https://doi.org/10.1148/rg.2015150033
Behzadi, A. H., Zhao, Y., Farooq, Z., & Prince, M. R. (2018). Immediate allergic reactions to gadolinium-based contrast agents: a systematic review and meta-analysis. Radiology, 286(2), 471-482. https://doi.org/10.1148/radiol.2017162740
Brant, W. E., & Helms, C. A. (Eds.). (2007). Fundamentals of diagnostic radiology.
Brockow, K. (2005). Contrast media hypersensitivity–scope of the problem. Toxicology, 209(2), 189-192. https://doi.org/10.1016/j.tox.2004.12.032
Brockow, K. (2021). Diagnosing and managing patients with reactions to radiocontrast media. Current Treatment Options in Allergy, 8(3), 210-221. https://doi.org/10.1007/s40521-021-00287-x
Bush, W. H. (1990). Treatment of systemic reactions to contrast media. Urology, 35(2), 145-150. https://doi.org/10.1016/0090-4295(90)80064-T
Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668. https://doi.org/10.1148/radiol.2019192094
de Santa María, R. S., Labella, M., Bogas, G., Doña, I., & Torres, M. J. (2023). Hypersensitivity to gadolinium-based contrast. Current opinion in allergy and clinical immunology, 23(4), 300-306. DOI: 10.1097/ACI.0000000000000911
Ding, S., Meystre, N. R., Campeanu, C., & Gullo, G. (2018). Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions. JBI Evidence Synthesis, 16(1), 87-116. DOI: 10.11124/JBISRIR-2017-003348
Doudenkova, V., & Bélisle Pipon, J. C. (2016, March). Duty to inform and informed consent in diagnostic radiology: how ethics and law can better guide practice. In Hec forum (Vol. 28, No. 1, pp. 75-94). Dordrecht: Springer Netherlands. https://doi.org/10.1007/s10730-015-9275-7
European Society of Urogenital Radiology. (2022). ESUR contrast media guidelines, version 11.0. https://www.esur.org/esur-guidelines-on-contrast-agents/
Hecht, E. M., Holland, A. E., Israel, G. M., Hahn, W. Y., Kim, D. C., West, A. B., ... & Krinsky, G. A. (2006). Hepatocellular carcinoma in the cirrhotic liver: gadolinium-enhanced 3D T1-weighted MR imaging as a stand-alone sequence for diagnosis. Radiology, 239(2), 438-447. https://doi.org/10.1148/radiol.2392050551
Hsieh, C., Wu, S. C., Kosik, R. O., Huang, Y. C., & Chan, W. P. (2022). Pharmacological prevention of hypersensitivity reactions caused by iodinated contrast media: a systematic review and meta-analysis. Diagnostics, 12(7), 1673. https://doi.org/10.3390/diagnostics12071673
Kaliyaperumal, Y., Sivadasan, S., & Aiyalu, R. (2023). Contrast-induced nephropathy: an overview. Dr. Sulaiman Al Habib Medical Journal, 5(4), 118-127. DOI: 10.1007/s44229-023-00040-3
Khan, F., Abbas, F., Hilal, K., Samad, M., Wahid, G., Ali, I., ... & Saeed, M. A. (2023). Knowledge assessment of radiologists, radiology residents, and radiographers regarding contrast materials and management of adverse drug reactions occurring due to contrast materials: a cross-sectional study. Annals of Medicine and Surgery, 85(7), 3347-3352. DOI: 10.1097/MS9.0000000000000465
Lehmann, S. L. (2019). Role of the Clinical Nurse Specialist in Radiology. In Advanced Practice and Leadership in Radiology Nursing (pp. 15-24). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-32679-1_2
Lightfoot, C. B., Abraham, R. J., Mammen, T., Abdolell, M., Kapur, S., & Abraham, R. J. (2009). Survey of radiologists' knowledge regarding the management of severe contrast material–induced allergic reactions. Radiology, 251(3), 691-696. https://doi.org/10.1148/radiol.2513081651
Mehran, R., & Nikolsky, E. (2006). Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney international, 69, S11-S15. https://doi.org/10.1038/sj.ki.5000368
Murugan, R., Boudreaux-Kelly, M. Y., Kellum, J. A., Palevsky, P. M., & Weisbord, S. (2023). Contrast-associated acute kidney injury and cardiovascular events: a secondary analysis of the PRESERVE cohort. Clinical Kidney Journal, 16(12), 2626-2638. https://doi.org/10.1093/ckj/sfad214
Park, H. J., Shin, K., You, M. W., Kyung, S. G., Kim, S. Y., Park, S. H., ... & Kim, H. J. (2023). Deep learning–based detection of solid and cystic pancreatic neoplasms at contrast-enhanced CT. Radiology, 306(1), 140-149. https://doi.org/10.1148/radiol.220171
Petrov, V. I., Kudasheva, A. A., & Frolov, D. V. (2022). Contrast-induced nephropathy: prevalence, diagnosis, prevention and treatment. Journal of Volgograd State Medical University, 19(2), 7-18. https://doi.org/10.19163/1994-9480-2022-19-2-7-18
Roditi, G., Khan, N., van Der Molen, A. J., Bellin, M. F., Bertolotto, M., Brismar, T., ... & Clément, O. (2022). Intravenous contrast medium extravasation: systematic review and updated ESUR Contrast Media Safety Committee Guidelines. European Radiology, 32(5), 3056-3066. https://doi.org/10.1007/s00330-021-08433-4
Thim, S., Henriksen, T. B., Laursen, H., Schram, A. L., Paltved, C., & Lindhard, M. S. (2022). Simulation-based emergency team training in pediatrics: a systematic review. Pediatrics, 149(4), e2021054305. https://doi.org/10.1542/peds.2021-054305
Tourgeman-Bashkin, O., Shinar, D., Donchin, Y., Zmora, E., Velleman, N., & Libson, E. (2013). Radiology department, human factors and organizational perspectives: using action research to improve patient safety. Israel Journal of health policy research, 2(1), 40. https://doi.org/10.1186/2045-4015-2-40
Wahl, A. D., Saini, N., Trinh, K., Patel, S., Lobner, K., Huang, J., & Deng, F. (2023). Simulation training in the management of adverse contrast reactions: A systematic review. Journal of the American College of Radiology, 20(11), 1110-1120. https://doi.org/10.1016/j.jacr.2023.07.013
Wang, C. L., Chinnugounder, S., Hippe, D. S., Zaidi, S., O'Malley, R. B., Bhargava, P., & Bush, W. H. (2017). Comparative effectiveness of hands-on versus computer simulation–based training for contrast media reactions and teamwork skills. Journal of the American College of Radiology, 14(1), 103-110. https://doi.org/10.1016/j.jacr.2016.07.013
Wang, C. L., Cohan, R. H., Ellis, J. H., Caoili, E. M., Wang, G., & Francis, I. R. (2008). Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. American Journal of Roentgenology, 191(2), 409-415. https://doi.org/10.2214/AJR.07.3421
Weisbord, S. D. (2018). Contrast-associated acute kidney injury. Core Concepts in Acute Kidney Injury, 95-112. https://doi.org/10.1007/978-1-4939-8628-6_6
Weisbord, S. D., Palevsky, P. M., Kaufman, J. S., Wu, H., Androsenko, M., Ferguson, R. E., ... & Gallagher, M. (2020). Contrast-associated acute kidney injury and serious adverse outcomes following angiography. Journal of the American College of Cardiology, 75(11), 1311-1320. https://doi.org/10.1016/j.jacc.2020.01.023
Werthman, J. A. (2019). An integrative review of outcomes and radiology nursing. Journal of Radiology Nursing, 38(1), 47-52. https://doi.org/10.1016/j.jradnu.2018.10.004
Werthman, J. A., Maxwell, C. A., Dietrich, M. S., Jordan, L. M., & Minnick, A. F. (2021). Moderate sedation education for nurses in interventional radiology to promote patient safety: results of a national survey. Journal of Radiology Nursing, 40(1), 49-55. https://doi.org/10.1016/j.jradnu.2020.10.007
Zamora, C. A., & Castillo, M. (2017). Historical perspective of imaging contrast agents. Magnetic Resonance Imaging Clinics, 25(4), 685-696. https://doi.org/10.1016/j.mric.2017.06.002
Authors
Copyright (c) 2024 Yasser Said Alzahrani, Zainab Abdullah Saleh Albishi, Majeb Mubark Aldosari, Zahra Ahmed Aysh Alsmaeil, Ahmed Ibrahim Ibrahim Jarrah, Haya Saad Said Aldossari, Abdullah Hamood Alazmy, Ibtesam Ali Alwan, Majed Kasab Shlman Alanazi, Mody Nasser Alkhamiss, Latifa Abdullah Al-Jouraid, Abdullah Fahad Alntaifat, Sawsan Hussain Mohammed Alawad

This work is licensed under a Creative Commons Attribution 4.0 International License.