Contrast

Kenneth C. Wang

PREMEDICATION PROTOCOL FOR HISTORY OF INTRAVENOUS CONTRAST REACTION

Please note: Premedication is indicated in patients who have had a history of mild/moderate contrast reactions (urticaria/pruritus/erythema). Patients who have had prior severe contrast reaction (bronchospasm/hypotension/anaphylaxis) do not receive contrast at our institution, as prophylaxis has not been shown to be effective.

Prednisone 40 mg PO per protocol, for premedication before IV contrast examination; two-dose protocol: one dose 12-18 hours and one dose 2 hours before examination; three-dose protocol: 24, 12, and 2 hours before examination.
Optional: Benadryl 50 mg PO 1 hour before examination (no proven benefit).
Use nonionic contrast.

CUSTOMARY CONTRAST DOSES FOR COMPUTED TOMOGRAPHY

Body or Head Computed Tomography

1 mL/lb or 2 mL/kg up to 100 mL IV.

Myelography

3 g iodine intrathecal, such as:

10 mL Omnipaque 300 (cervical puncture) or

12 mL Omnipaque 240 (thoracic puncture) or

16 mL Omnipaque 180 (lumbar puncture).

TABLE 64-1 Intravenous Contrast Dosages, Formulations, and Premedications

Tradename	Iodine Content (mg/mL)	Comments
Angiovist 282, 292, 370	282, 292, 370
Conray 30, 43, 325, 400	141, 202, 325, 400
Conray (plain), Cysto, Angio	282, 81, 480
Diatrizoate meglumine 76%	358
Gastroview	367
Hexabrix	320	Low osmolality, but ionic
Hypaque meglumine 30%, 60%	141, 282
Hypaque sodium 25%, 50%	150, 300
Hypaque 76	370
Hypaque-M 75%, 90%	385, 462
Imagopaque 150, 200, 250, 300, 350	150, 200, 250, 300, 350	Nonionic
Isovue 128, 200, 300, 370	128, 200, 300, 370	Nonionic
MD 60, 76	292, 370
Omnipaque 180, 240, 300, 350	180, 240, 300, 350	Nonionic
Optiray 160, 240, 300, 320, 350	160, 240, 300, 320, 350	Nonionic
Osmovist	240	Nonionic
Oxilan 300, 350	300, 350	Nonionic
Renografin 60, 76	292, 370
Reno-M DIP, 60	141, 282
Renovue DIP, 65	111, 300
Renovist II	309
Renovist	370
Ultravist 150, 240, 300, 370	150, 240, 300, 370	Nonionic
Urovist meglumine (Cysto-141)	141
Urovist sodium 300	300
Vascoray	400
Visipaque 270, 320	270, 320	Nonionic, isosmolar