1. When used for intravenous and other forms of parenteral injection, contrast media infrequently cause adverse drug reactions and very rarely cause patient death.

2. In determining the need for contrast media in the circumstances of the examination, specific risk factors can be identified, including:

   1. previous reactions to contrast media;

   2. asthma;

   3. significant allergic disease;

   4. cardiac disease;

   5. renal insufficiency particularly associated with insulin dependent diabetes;

   6. sickle cell disease, polycythemia and myeloma;

   7. phaeochromocytoma

      The practice must have a clear protocol for each of these conditions.

3. Severe hypotension, bronchospasm, cardiac arrhythmia, even anaphylaxis may occur. Staff should be trained and equipped to recognise and deal with all these problems which may require different forms of therapy.

4. Before injecting contrast material, the person performing the injection must check the name of the agent, its concentration and its expiry date. Additional measures to ensure injection of the correct material must be in place. These may include checking of the same details by another person or the implementation of systematic measures to prevent inappropriate injections.

5. A practice or department may decide whether appropriately trained radiographers, nurses and/or non-radiologist doctors may administer intravenous injection of contrast media, taking full consideration of relevant state and territory legislation and any implications for medical malpractice, medical negligence or professional indemnity insurance cover.

   Radiographers, nurses and/or non-radiologist doctors must not be compelled to perform this procedure.

   Any liability for an adverse event arising from an intravenous injection of contrast media lies with the radiologist as the employer and/or as the supervising specialist.

   Documented procedures for the administration of contrast media by radiographers, nurses and/or non-radiologist doctors must be included in the practice procedures manual and must include the following minimum requirements:

   Radiographers and Nurses

   • radiographers and nurses must be trained in venepuncture and resuscitation and receive certification of their competence from the practice;
   • protocols must be confirmed by the radiologist prior to each injection; the practice should limit the number of unsuccessful venepuncture attempts allowed per examination;
   • the practice must identify those patients who are not suitable for injection by radiographers and nurses, eg children, patients with a history of difficult injections or contrast reactions;
   • the supervising radiologist must remain immediately available for 20 minutes following injection in case of any subsequent reactions.

   Non-radiologist Doctors

   • protocols must be confirmed by the radiologist prior to each injection;
   • non-radiologist doctors injecting patients must remain immediately available for 20 minutes following injection in case of any subsequent reactions.

Adopted by Council: August 2001

[ References ]