Richtlijnen Veilig Gebruik van Contrastmiddelen
Tijdens de AV van 16 november 2017 is de nieuwe richtlijn Veilig Gebruik van Contrastmiddelen - deel 1 geautoriseerd. Deze richtlijn, onder voorzitterschap van dhr. A.J. van der Molen, is een eerste deel in een reeks richtlijnen over veilig gebruik van contrastmiddelen binnen de radiologie.
Deel 2 van deze richtlijnenreeks ligt voor ter becommentariëring tot 20 juni 2019. In 2020 zal een start gemaakt worden met de ontwikkeling van deel 3.
Background: new set of guidelines on safe use of contrast media
The NVvR deemed a set of new guidelines on the Safe Use of Contrast Media (CM) highly necessary and relevant, due to recent publications on many topics concerning contrast safety. Because of recent scientific developments, the recommendations of the most recent CM guideline (NVvR/CBO, 2007) were in conflict with what should be considered best clinical practice. In order to update this guideline, which only covered selected topics on the use of iodine-containing CM, a plan has been developed to make a set of 3 new guidelines covering the safe use of all types of CM in adults.
The patient population for which these guidelines are meant consists of adult patients (>18 years) who receive intravascular, oral or intracavitary (intra-articular, intra-vesical, intra-cholangiographic) iodine-containing contrast media both in the clinical setting, as well as for outpatients. The guidelines do not cover radioactive contrast media use in nuclear medicine.
The three parts of the Safe Use of Contrast Media guidelines are produced in consecutive projects and cover the following topics regarding CM safety:
Safe Use of Contrast Media - Part 1 (published 2017):
- prevention of post-contrast acute kidney injury (PC-AKI) from iodine-containing contrast media;
- iodine-containing contrast media use in patients with type-2 diabetes taking metformin;
- iodine-containing contrast media use in patients on chronic dialysis.
Safe Use of Contrast Media - Part 2 (published end 2019):
- management of hypersensitivity reactions to contrast media;
- prophylaxis of hypersensitivity reactions to contrast media & the role of skin testing in patients with hypersensitivity reactions;
- contrast media injections with power injectors through (peripherally inserted) central venous lines and implantable ports;
- contrast media extravasation;
- nephrotoxicity of gadolinium-based contrast agents;
- prevention of nephrogenic systemic fibrosis (NSF);
- retention of gadolinium in the body after use of gadolinium-based contrast agents.
Safe Use of Contrast Media - Part 3 (in development >2019):
- prevention of iodine-induced hyperthyroidism;
- safety of organ-specific gadolinium-based contrast agents;
- contrast media use in pregnancy and during lactation;
- contrast media use in patients with pheochromocytoma;
- contrast media use in patients with myasthenia gravis;
- contrast media use in patients with mastocytosis;
- the Weber and Lalli effects in using contrast media.