Emergence Teleradiology Gadolinium Recommendations

Stage 1                      GFR >90        Normal filtration, slight kidney damage

Stage 2                      GFR 60-89     Mild decrease in kidney function

Stage 3                      GFR 30-59     Moderate decrease in kidney function

Stage 4                      GFR 15-29     Severe decrease in kidney function

Stage 5                      GFR <15        Kidney Failure, dialysis

 

Stage 1 and 2                        Adults             OptiMark 0.1mmol/kg

                                                Peds               Magnevist 0.1mmol/kg

Stage 3                                  Adults             Multihance 0.1mmol/kg

                                                Peds               Magnevist 0.1mmol/kg

Stage 4 and 5                        Adults             No Gadolinium unless ***

                                                Peds               No Gadolinium unless ***

 

*** Use gad only in life threatening situations where value of gadolinium outweighs risk of developing NSF.

  • Avoid contrast with Dialysis patients unless emergency then use 0.05mmol/kg (half dose) Multihance
  • Neonates and Infants 0-2 avoid contrast.  Accepted uses is tumor or infection and then use Magnevist 0.1mmol/kg.
  • Serum Creatinine for calculating GFR should be less than 30 days old.
  • Calculate the GFR on patients with abnormal Serum Creatinine.
  • Serum creatinine results performed for all patients over age of 60 years or with any of following risk factors.

-Current chemotherapy or know nephrotoxic medications

-Collagen vascular disease

-Diabetes Mellitus

-Debilitated state such as AIDS or advanced Malignancy

-Liver Disease

-Muscular dystrophy

-Paraproteinemia syndrome, Multiple Myeloma

-Renal disease or transplant

-Renal failure, known renal insufficiency

 

GFR > 60No Significant RiskNo action needed, use LOCM
GFR 59-45Low RiskUse Visipaque or other LOCM with oral hydration of 250 ml before and after.
GFR 44-30Moderate RiskConsider no contrast, if need contrast then hydrate 500 ml NS before and additional 500 after exam IV, Visipaque, may limit contrast at radiologist discretion
GFR < 30High RiskNo Contrast