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Copyright (c) 2024 Hani Abdulaziz Aleudwan Alzabn, Fatimah Hassan Mobarki, Mohammed Abdulrahman F Alkhalifah, Adel Mamdouh Hatab Alali, Abdulrahman Ibrahim Mohammed Alhaidari, Bander Yassin Guha, Saliha Qasem Abutaleb Masmali, Sabeal Heaa Sabeal Al Harby, Abdulrahman Mohammed Faleh Al Balawi, Tahani Ahmed Marey, Saad Qublan Khalaf Alsharari, Nadia Helal Almutairi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Interprofessional Management of Contrast-Induced Complications: A Narrative Review from Radiology to the Ward
Corresponding Author(s) : Hani Abdulaziz Aleudwan Alzabn
Saudi Journal of Medicine and Public Health,
Vol. 1 No. 2 (2024)
Abstract
Background: The administration of iodinated contrast media (ICM) is fundamental to diagnostic and interventional radiology but carries risks, notably contrast-induced nephropathy (CIN) and hypersensitivity reactions (HSRs). These complications span the care continuum, demanding coordinated efforts beyond radiology. Aim: This narrative review synthesizes evidence on interprofessional, systematic approaches to preventing and managing ICM-related complications, emphasizing roles across radiology, nursing, pharmacy, and health administration. Methods: A comprehensive literature search (2010-2024) was conducted across PubMed, CINAHL, and Scopus. Included studies and guidelines were analyzed thematically to map evidence-based strategies across pre-procedural, intra-procedural, and post-procedural phases. Results: Effective management is inherently collaborative. Key strategies include: risk stratification protocols; nurse-led pre-procedure hydration and screening; pharmacist-driven medication reconciliation; radiologist selection of low-osmolality/isosmolar agents; and standardized post-procedure monitoring coordinated by nursing with pharmacy and administrative support. System-level coordination, driven by health administration via clinical pathways and audit, is critical for adherence and outcomes. Conclusion: A siloed approach increases complication risks. An integrated interprofessional model, supported by standardized protocols and clear role delineation, significantly enhances patient safety and clinical outcomes across the care pathway.
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- Alausayni, F. A. M., Alshammari, A. F. K., Alzahrani, A. A., Al Zahrani, M. T., Al-Harthy, F. S. S., Alharthi, M. S. S., ... & Albarrak, M. M. A. (2024). Clinical Governance And Health System Resilience In Hospital-Based Diagnostic Services: Integrating Medical Secretarial Services, Nursing, Radiology, And Health Management. The Review of Diabetic Studies, 320-333. https://doi.org/10.70082/17rjpe84
- Alderson, S., Pillai, S., Manoras, A., Papanikitas, J., Lewis, D., & McKechnie, S. (2014). Incidence and outcomes of contrast-induced nephropathy in adult ICU patients. Critical Care, 18(Suppl 1), P374. https://doi.org/10.1186/cc13564
- Amin, H. P., Madsen, T. E., Bravata, D. M., Wira, C. R., Johnston, S. C., Ashcraft, S., ... & Esenwa, C. (2023). Diagnosis, workup, risk reduction of transient ischemic attack in the emergency department setting: a scientific statement from the American Heart Association. Stroke. https://doi.org/10.1161/STR.0000000000000418
- Bahrainwala, J. Z., Leonberg-Yoo, A. K., & Rudnick, M. R. (2020). Contrast-induced acute kidney injury: epidemiology, risk stratification, and prognosis. In Kidney Disease in the Cardiac Catheterization Laboratory: A Practical Approach (pp. 183-207). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-45414-2_11
- Barrett, T., Khwaja, A., Carmona, C., Martinez, Y., Nicholas, H., Rogers, G., ... & Spiers, S. (2021). Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media. Clinical radiology, 76(3), 193-199. https://doi.org/10.1016/j.crad.2020.08.039
- Cashion, W., & Weisbord, S. D. (2022). Radiographic contrast media and the kidney. Clinical Journal of the American Society of Nephrology, 17(8), 1234-1242. DOI: 10.2215/CJN.16311221
- Chalikias, G., Drosos, I., & Tziakas, D. N. (2016). Prevention of contrast-induced acute kidney injury: an update. Cardiovascular drugs and therapy, 30(5), 515-524. https://doi.org/10.1007/s10557-016-6683-0
- Cheng, F., Liu, Y., Li, Q., Mo, L., Zhang, W., Zhao, L., & Zhang, Y. (2023). Effects of ongoing nursing care on individuals with chronic heart failure's mental health and quality of life. Archives of Clinical Psychiatry, 50(6). DOI: 10.15761/0101-60830000000715
- Clements, W., & Koukounaras, J. (2023). Complications in Interventional Radiology: the role of clinical governance and iterative hospital systems in quality improvement. CVIR endovascular, 6(1), 38. https://doi.org/10.1186/s42155-023-00388-5
- Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668. https://doi.org/10.1148/radiol.2019192094
- de Laforcade, L., Bobot, M., Bellin, M. F., Clément, O., Grangé, S., Grenier, N., ... & Guerrot, D. (2021). Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging, 102(3), 131-139. https://doi.org/10.1016/j.diii.2021.01.007
- Donnelly, L. F., Lee, G. M., & Sharek, P. J. (2018). Costs of quality and safety in radiology. Radiographics, 38(6), 1682-1687. https://doi.org/10.1148/rg.2018180020
- Guo, L., Gao, W., Wang, T., & Shan, X. (2023). Effects of empowerment education on patients after percutaneous coronary intervention: A meta-analysis and systematic review. Medicine, 102(23), e33992. DOI: 10.1097/MD.0000000000033992
- Kang, H. R., Jeong, J., & Brockow, K. (2022). Diagnosis and prevention of hypersensitivity reactions to iodinated contrast media. Allergy, Asthma & Immunology Research, 14(4), 348. https://doi.org/10.4168/aair.2022.14.4.348
- Khan, F., Abbas, F., Hilal, K., Samad, M., Wahid, G., Ali, I., ... & Saeed, M. A. (2023). Knowledge assessment of radiologists, radiology residents, and radiographers regarding contrast materials and management of adverse drug reactions occurring due to contrast materials: a cross-sectional study. Annals of Medicine and Surgery, 85(7), 3347-3352. DOI: 10.1097/MS9.0000000000000465
- Khwaja, A. (2012). KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice, 120(4), c179-c184. https://doi.org/10.1159/000339789
- Lau, L., & Ng, K. H. (2013). Radiological safety and quality: paradigms in leadership and innovation. In Radiological safety and quality: Paradigms in leadership and innovation (pp. 3-33). Dordrecht: Springer Netherlands. https://doi.org/10.1007/978-94-007-7256-4_1
- Matari, N. H., Di Marco Serra, G., Beidas, A. K., Bruno, M. A., & Abujudeh, H. (2019). A Guided Survey Approach for Joint Commission Preparedness in Radiology. Current Radiology Reports, 7(10), 29. https://doi.org/10.1007/s40134-019-0339-3
- McCullough, P. A., Choi, J. P., Feghali, G. A., Schussler, J. M., Stoler, R. M., Vallabahn, R. C., & Mehta, A. (2016). Contrast-induced acute kidney injury. Journal of the American College of Cardiology, 68(13), 1465-1473. https://doi.org/10.1016/j.jacc.2016.05.099
- Mehran, R., Owen, R., Chiarito, M., Baber, U., Sartori, S., Cao, D., ... & Dangas, G. (2021). A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. The Lancet, 398(10315), 1974-1983. https://doi.org/10.1016/S0140-6736(21)02326-6
- Mossa-Basha, M., Meltzer, C. C., Kim, D. C., Tuite, M. J., Kolli, K. P., & Tan, B. S. (2020). Radiology department preparedness for COVID-19: radiology scientific expert review panel. Radiology, 296(2), E106-E112. https://doi.org/10.1148/radiol.2020200988
- Nijssen, E. C., Rennenberg, R. J., Nelemans, P. J., Essers, B. A., Janssen, M. M., Vermeeren, M. A., ... & Wildberger, J. E. (2017). Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. The Lancet, 389(10076), 1312-1322. https://doi.org/10.1016/S0140-6736(17)30057-0
- Ong, M. Y., Koh, J. J. H., Kothan, S., & Lai, C. (2022). The incidence and associated risk factors of contrast-induced nephropathy after contrast-enhanced computed tomography in the emergency setting: a systematic review. Life, 12(6), 826. https://doi.org/10.3390/life12060826
- Stacul, F., van der Molen, A. J., Reimer, P., Webb, J. A., Thomsen, H. S., Morcos, S. K., ... & Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR) www. esur. org. (2011). Contrast induced nephropathy: updated ESUR contrast media safety committee guidelines. European radiology, 21(12), 2527-2541. https://doi.org/10.1007/s00330-011-2225-0
- Starekova, J., Pirasteh, A., & Reeder, S. B. (2024). Update on gadolinium-based contrast agent safety, from the AJR special series on contrast media. American Journal of Roentgenology, 223(3), e2330036. https://doi.org/10.2214/AJR.23.30036
- Stewart, S., Carrington, M. J., Goldstein, S., & Scuffham, P. (2013). Differential impact of a nurse-led, home-based intervention for optimal secondary cardiac prevention on recurrent hospitalization in men and women: the Young@ Heart multicentre, randomized trial. European Heart Journal, 34(suppl_1), P3359. https://doi.org/10.1093/eurheartj/eht309.P3359
- Stocker, T. J., Massberg, S., & Hausleiter, J. (2022). Reduction of contrast agent volume utilization for cardiac catheterization in current clinical practice. International Journal of Cardiology, 366, 82-87. https://doi.org/10.1016/j.ijcard.2022.07.011
- van der Molen, A. J., Reimer, P., Dekkers, I. A., Bongartz, G., Bellin, M. F., Bertolotto, M., ... & Thomsen, H. S. (2018). Post-contrast acute kidney injury–Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. European radiology, 28(7), 2845-2855. https://doi.org/10.1007/s00330-017-5246-5
- Walker, H., Guthrie, G. D., Lambourg, E., Traill, P., Zealley, I., Plumb, A., & Bell, S. (2022). Systematic review and meta-analysis of prophylaxis use with intravenous contrast exposure to prevent contrast-induced nephropathy. European Journal of Radiology, 153, 110368. https://doi.org/10.1016/j.ejrad.2022.110368
- Weinreb, J. C., Rodby, R. A., Yee, J., Wang, C. L., Fine, D., McDonald, R. J., ... & Davenport, M. S. (2021). Use of intravenous gadolinium-based contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 298(1), 28-35. https://doi.org/10.1148/radiol.2020202903
- Weisbord, S. D., Gallagher, M., Jneid, H., Garcia, S., Cass, A., Thwin, S. S., ... & Palevsky, P. M. (2018). Outcomes after angiography with sodium bicarbonate and acetylcysteine. New England Journal of Medicine, 378(7), 603-614. DOI: 10.1056/NEJMoa1710933
- Wu, M. Y., Lo, W. C., Wu, Y. C., Lin, T. C., Lin, C. H., Wu, M. S., & Tu, Y. K. (2022). The incidence of contrast-induced nephropathy and the need of dialysis in patients receiving angiography: a systematic review and meta-analysis. Frontiers in Medicine, 9, 862534. https://doi.org/10.3389/fmed.2022.862534
- Yao, Z. F., Shen, H., Tang, M. N., Yan, Y., & Ge, J. B. (2021). A novel risk assessment model of contrast‐induced nephropathy after percutaneous coronary intervention in patients with diabetes. Basic & clinical pharmacology & toxicology, 128(2), 305-314. https://doi.org/10.1111/bcpt.13501
- Zygmont, M. E., Itri, J. N., Rosenkrantz, A. B., Duong, P. A. T., Gettle, L. M., Mendiratta-Lala, M., ... & Kadom, N. (2017). Radiology research in quality and safety: current trends and future needs. Academic radiology, 24(3), 263-272. https://doi.org/10.1016/j.acra.2016.07.021
References
Alausayni, F. A. M., Alshammari, A. F. K., Alzahrani, A. A., Al Zahrani, M. T., Al-Harthy, F. S. S., Alharthi, M. S. S., ... & Albarrak, M. M. A. (2024). Clinical Governance And Health System Resilience In Hospital-Based Diagnostic Services: Integrating Medical Secretarial Services, Nursing, Radiology, And Health Management. The Review of Diabetic Studies, 320-333. https://doi.org/10.70082/17rjpe84
Alderson, S., Pillai, S., Manoras, A., Papanikitas, J., Lewis, D., & McKechnie, S. (2014). Incidence and outcomes of contrast-induced nephropathy in adult ICU patients. Critical Care, 18(Suppl 1), P374. https://doi.org/10.1186/cc13564
Amin, H. P., Madsen, T. E., Bravata, D. M., Wira, C. R., Johnston, S. C., Ashcraft, S., ... & Esenwa, C. (2023). Diagnosis, workup, risk reduction of transient ischemic attack in the emergency department setting: a scientific statement from the American Heart Association. Stroke. https://doi.org/10.1161/STR.0000000000000418
Bahrainwala, J. Z., Leonberg-Yoo, A. K., & Rudnick, M. R. (2020). Contrast-induced acute kidney injury: epidemiology, risk stratification, and prognosis. In Kidney Disease in the Cardiac Catheterization Laboratory: A Practical Approach (pp. 183-207). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-45414-2_11
Barrett, T., Khwaja, A., Carmona, C., Martinez, Y., Nicholas, H., Rogers, G., ... & Spiers, S. (2021). Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media. Clinical radiology, 76(3), 193-199. https://doi.org/10.1016/j.crad.2020.08.039
Cashion, W., & Weisbord, S. D. (2022). Radiographic contrast media and the kidney. Clinical Journal of the American Society of Nephrology, 17(8), 1234-1242. DOI: 10.2215/CJN.16311221
Chalikias, G., Drosos, I., & Tziakas, D. N. (2016). Prevention of contrast-induced acute kidney injury: an update. Cardiovascular drugs and therapy, 30(5), 515-524. https://doi.org/10.1007/s10557-016-6683-0
Cheng, F., Liu, Y., Li, Q., Mo, L., Zhang, W., Zhao, L., & Zhang, Y. (2023). Effects of ongoing nursing care on individuals with chronic heart failure's mental health and quality of life. Archives of Clinical Psychiatry, 50(6). DOI: 10.15761/0101-60830000000715
Clements, W., & Koukounaras, J. (2023). Complications in Interventional Radiology: the role of clinical governance and iterative hospital systems in quality improvement. CVIR endovascular, 6(1), 38. https://doi.org/10.1186/s42155-023-00388-5
Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668. https://doi.org/10.1148/radiol.2019192094
de Laforcade, L., Bobot, M., Bellin, M. F., Clément, O., Grangé, S., Grenier, N., ... & Guerrot, D. (2021). Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging, 102(3), 131-139. https://doi.org/10.1016/j.diii.2021.01.007
Donnelly, L. F., Lee, G. M., & Sharek, P. J. (2018). Costs of quality and safety in radiology. Radiographics, 38(6), 1682-1687. https://doi.org/10.1148/rg.2018180020
Guo, L., Gao, W., Wang, T., & Shan, X. (2023). Effects of empowerment education on patients after percutaneous coronary intervention: A meta-analysis and systematic review. Medicine, 102(23), e33992. DOI: 10.1097/MD.0000000000033992
Kang, H. R., Jeong, J., & Brockow, K. (2022). Diagnosis and prevention of hypersensitivity reactions to iodinated contrast media. Allergy, Asthma & Immunology Research, 14(4), 348. https://doi.org/10.4168/aair.2022.14.4.348
Khan, F., Abbas, F., Hilal, K., Samad, M., Wahid, G., Ali, I., ... & Saeed, M. A. (2023). Knowledge assessment of radiologists, radiology residents, and radiographers regarding contrast materials and management of adverse drug reactions occurring due to contrast materials: a cross-sectional study. Annals of Medicine and Surgery, 85(7), 3347-3352. DOI: 10.1097/MS9.0000000000000465
Khwaja, A. (2012). KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice, 120(4), c179-c184. https://doi.org/10.1159/000339789
Lau, L., & Ng, K. H. (2013). Radiological safety and quality: paradigms in leadership and innovation. In Radiological safety and quality: Paradigms in leadership and innovation (pp. 3-33). Dordrecht: Springer Netherlands. https://doi.org/10.1007/978-94-007-7256-4_1
Matari, N. H., Di Marco Serra, G., Beidas, A. K., Bruno, M. A., & Abujudeh, H. (2019). A Guided Survey Approach for Joint Commission Preparedness in Radiology. Current Radiology Reports, 7(10), 29. https://doi.org/10.1007/s40134-019-0339-3
McCullough, P. A., Choi, J. P., Feghali, G. A., Schussler, J. M., Stoler, R. M., Vallabahn, R. C., & Mehta, A. (2016). Contrast-induced acute kidney injury. Journal of the American College of Cardiology, 68(13), 1465-1473. https://doi.org/10.1016/j.jacc.2016.05.099
Mehran, R., Owen, R., Chiarito, M., Baber, U., Sartori, S., Cao, D., ... & Dangas, G. (2021). A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. The Lancet, 398(10315), 1974-1983. https://doi.org/10.1016/S0140-6736(21)02326-6
Mossa-Basha, M., Meltzer, C. C., Kim, D. C., Tuite, M. J., Kolli, K. P., & Tan, B. S. (2020). Radiology department preparedness for COVID-19: radiology scientific expert review panel. Radiology, 296(2), E106-E112. https://doi.org/10.1148/radiol.2020200988
Nijssen, E. C., Rennenberg, R. J., Nelemans, P. J., Essers, B. A., Janssen, M. M., Vermeeren, M. A., ... & Wildberger, J. E. (2017). Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. The Lancet, 389(10076), 1312-1322. https://doi.org/10.1016/S0140-6736(17)30057-0
Ong, M. Y., Koh, J. J. H., Kothan, S., & Lai, C. (2022). The incidence and associated risk factors of contrast-induced nephropathy after contrast-enhanced computed tomography in the emergency setting: a systematic review. Life, 12(6), 826. https://doi.org/10.3390/life12060826
Stacul, F., van der Molen, A. J., Reimer, P., Webb, J. A., Thomsen, H. S., Morcos, S. K., ... & Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR) www. esur. org. (2011). Contrast induced nephropathy: updated ESUR contrast media safety committee guidelines. European radiology, 21(12), 2527-2541. https://doi.org/10.1007/s00330-011-2225-0
Starekova, J., Pirasteh, A., & Reeder, S. B. (2024). Update on gadolinium-based contrast agent safety, from the AJR special series on contrast media. American Journal of Roentgenology, 223(3), e2330036. https://doi.org/10.2214/AJR.23.30036
Stewart, S., Carrington, M. J., Goldstein, S., & Scuffham, P. (2013). Differential impact of a nurse-led, home-based intervention for optimal secondary cardiac prevention on recurrent hospitalization in men and women: the Young@ Heart multicentre, randomized trial. European Heart Journal, 34(suppl_1), P3359. https://doi.org/10.1093/eurheartj/eht309.P3359
Stocker, T. J., Massberg, S., & Hausleiter, J. (2022). Reduction of contrast agent volume utilization for cardiac catheterization in current clinical practice. International Journal of Cardiology, 366, 82-87. https://doi.org/10.1016/j.ijcard.2022.07.011
van der Molen, A. J., Reimer, P., Dekkers, I. A., Bongartz, G., Bellin, M. F., Bertolotto, M., ... & Thomsen, H. S. (2018). Post-contrast acute kidney injury–Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. European radiology, 28(7), 2845-2855. https://doi.org/10.1007/s00330-017-5246-5
Walker, H., Guthrie, G. D., Lambourg, E., Traill, P., Zealley, I., Plumb, A., & Bell, S. (2022). Systematic review and meta-analysis of prophylaxis use with intravenous contrast exposure to prevent contrast-induced nephropathy. European Journal of Radiology, 153, 110368. https://doi.org/10.1016/j.ejrad.2022.110368
Weinreb, J. C., Rodby, R. A., Yee, J., Wang, C. L., Fine, D., McDonald, R. J., ... & Davenport, M. S. (2021). Use of intravenous gadolinium-based contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 298(1), 28-35. https://doi.org/10.1148/radiol.2020202903
Weisbord, S. D., Gallagher, M., Jneid, H., Garcia, S., Cass, A., Thwin, S. S., ... & Palevsky, P. M. (2018). Outcomes after angiography with sodium bicarbonate and acetylcysteine. New England Journal of Medicine, 378(7), 603-614. DOI: 10.1056/NEJMoa1710933
Wu, M. Y., Lo, W. C., Wu, Y. C., Lin, T. C., Lin, C. H., Wu, M. S., & Tu, Y. K. (2022). The incidence of contrast-induced nephropathy and the need of dialysis in patients receiving angiography: a systematic review and meta-analysis. Frontiers in Medicine, 9, 862534. https://doi.org/10.3389/fmed.2022.862534
Yao, Z. F., Shen, H., Tang, M. N., Yan, Y., & Ge, J. B. (2021). A novel risk assessment model of contrast‐induced nephropathy after percutaneous coronary intervention in patients with diabetes. Basic & clinical pharmacology & toxicology, 128(2), 305-314. https://doi.org/10.1111/bcpt.13501
Zygmont, M. E., Itri, J. N., Rosenkrantz, A. B., Duong, P. A. T., Gettle, L. M., Mendiratta-Lala, M., ... & Kadom, N. (2017). Radiology research in quality and safety: current trends and future needs. Academic radiology, 24(3), 263-272. https://doi.org/10.1016/j.acra.2016.07.021