Preventing contrast media-induced nephrotoxicity
Wendi Rank MSN, RN, CNRN, CRNP

$7.95 		Nursing2013
April 2013 
Volume 43  Number 4
Pages 48 - 51
 
  PDF Version Available!

ABSTRACT
NURSES KNOW that patients' renal status must be assessed before they receive intravascular contrast media for radiologic imaging. But what exactly is the risk, what information about the patient's renal status is needed, and how can nurses help prevent or minimize complications? This article discusses how intravascular contrast media affect renal function and what nurses need to assess and monitor to keep patients safe.Nephrotoxicity resulting from the administration of intravascular contrast media is termed contrast-induced nephrotoxicity (CIN) or contrast-induced nephropathy. Although no standard diagnostic criteria for CIN have been agreed upon, it's generally diagnosed when renal function abruptly declines in the wake of contrast media administration when no other cause can be determined. One of the most commonly used criteria is an absolute increase in serum creatinine of 0.5 mg/dL.1,2CIN is usually self-limiting; most patients return to their baseline kidney function without any treatment within 7 to 10 days after contrast media administration. Longer recovery times are associated with poorer prognoses, but it's very rare for patients with CIN to develop lasting renal dysfunction.2,3Intravascular iodinated contrast media are pharmaceuticals used to improve medical imaging. Used in diagnostic imaging such as computed tomography and angiography, they improve the visibility of structures that otherwise would be difficult to see and are most commonly administered I.V or intra-arterially. In studies, CIN seems to develop at a higher rate in patients who have received contrast intra-arterially rather than I.V.1,2,4,5Iodinated contrast media are classified by their osmolality compared with plasma. (See Sorting out contrast media by osmolality.) The osmolality of contrast media is related to the development of contrast media reactions; high-osmolality contrast media (HOCM) are more nephrotoxic than low-osmolality contrast media (LOCM) or isoosmolar contrast media (IOCM).4Iodinated

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