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Pre-Medication Guideline (112.007)

Pre-Medication Guideline (112.007) - Policies, Clinical, UWMF Clinical, UWMF-wide, Medical Imaging

112.007

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL GUIDELINE

TITLE: PRE-MEDICATION GUIDELINE
For patients with a history of reactions to iodinated contrast material

Effective Date: May, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Medical Imaging

Reviewed May 2010 Sept 2012 Jan 2014


PURPOSE: The primary indication for premedication is pretreatment of “at risk” patients who require contrast
media. These guidelines will identify patients at risk for a contrast reaction prior to the day of contrast
administration so pre-medication can be ordered by the referring provider.

GUIDELINE STATEMENT:
• At the time the exam is ordered, patients who will be receiving intravenous contrast will have their
allergy history reviewed.
• Any history of allergic reaction to intravenous contrast or other severe allergic reaction will be noted on
the order.
• Patients with history of allergic reaction to intravenous contrast should be pre-medicated prior to
intravenous contrast administration or imaged using alternate methods depending on the severity of the
prior reaction. (See chart below)
• In general, premedication is not necessary for patients with food allergies or allergies to medications
other than iodinated contrast. If patient or referring provider is concerned based on severity of prior
allergic reactions, premedication could be considered.
• The referring provider is responsible for ordering the pre-medication regimen.

GUIDELINES:
1. Referring provider will verify the patient’s allergy to intravenous contrast material by reviewing the
patient’s medical record and by questioning the patient. (See chart below)
2. Confirm the time of the appointment and the actual time of the exam.
3. Referring provider orders the medications as needed based on patients past medical history.

Prior Contrast Reaction Type Treatment
Severe
hypotension, unresponsive, severe bronchospasm, laryngeal edema
No contrast; consider other
imaging modality (US or MRI)
Mild or Moderate
urticaria, diaphoresis, mild bronchospasm or dyspnea, facial edema,
nausea, vomiting, abdominal pain, chest or throat tightness

Pre medicate

ASTHMA/ALLERGIES/FOOD ALLERGIES:
• In general, premedication is not necessary. If patient or referring provider is concerned based on
severity of prior allergic reactions, premedication could be considered.






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ORAL PREMEDICATION REGIMEN:
1) Methylprednisolone (Medrol)
a. 32 mg by mouth at 12 and 2 hours before contrast injection, plus
2) Benadryl
a. 50 mg intramuscular or oral - 1 hr. pre-contrast OR
b. 50 mg (or 25 mg per height/weight indication) intravenously 15-20 min. pre-contrast.

Note: The time of medication administration is in relation to the time of the procedure, NOT the time the
patient arrives in radiology to drink oral contrast.

Note: The Benedryl must be used with the proviso that the patient does not drive a car or operative heavy
machinery 4-6 hrs after the Benadryl is administered.

Guidelines for Patients with Prior Reaction to Gadolinium Contrast:

Prevention of Contrast Reactions
Allergic-type reactions to gadolinium-based contrast are rare and severe or anaphylactic reactions are extremely
rare. In patients who have previously reacted to a gadolinium agent, there are no definitive studies to support
the efficacy of premedication in reducing the incidence of subsequent reactions. Nonetheless, in the absence of
such data, it is reasonable to follow a common sense approach.

1) Use a different gadolinium-based agent
2) Premedication of the patient with steroids and antihistamine in accordance with the policy for
iodinated contrast is considered prudent. (See Chart below)


Prior Contrast Reaction Type Treatment
Severe
hypotension, unresponsive, severe bronchospasm, laryngeal edema
No contrast; consider other
imaging modality. If CE MRI
essential, use alternative agent
and pre medicate.
Mild or Moderate
urticaria, diaphoresis, mild bronchospasm or dyspnea, facial edema,
nausea, vomiting, abdominal pain, chest or throat tightness

Pre medicate and use alternative
agent.

Asthma/Allergies/Food Allergies:
• In general, premedication is not necessary. If patient or referring provider is concerned based on
severity of prior allergic reactions, premedication could be considered.

Oral Premedication Regimen:
3) Methylprednisolone (Medrol)
a. 32 mg by mouth at 12 and 2 hours before contrast injection, plus
4) Benadryl
a. 50 mg intramuscular or oral - 1 hr. pre-contrast OR
b. 50 mg (or 25 mg per height/weight indication) intravenously 15-20 min. pre-contrast.



New Engl J Med 1987;317:845-849

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WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
Kari Pulfer, RT (R), CT, BS, Medical Imaging Manager
Brian Sparland, RT (R), MR, AS, Medical Imaging Manager

REVIEWED BY: Dr. Peter Chase, Modality Chief Radiologist – CT, University of Wisconsin Department
of Radiology Community Section
Dr. Frank Thornton, Modality Chief Radiologist – MR, University of Wisconsin
Department of Radiology Community Section
Dr. Lynn Broderick, Modality Chief Radiologist – DR, University of Wisconsin
Department of Radiology Community Section

REFERENCES: American College of Radiology, Manual on Contrast Media –Version 8, 2012

AUTHORIZED BY: Richard Welnick, MD, Medical Director, Ambulatory Clinic Operations, UWMF
Samuel Charles, M.D., Medical Director, UWMF Radiology

______________________________________________________________________________
Medical Director, UWMF Date


______________________________________________________________________________
Medical Director, UWMF Radiology Date