Reducing Contrast Induced Nephropathy: Developing a Treatment Algorithm

Contrast induced nephropathy (CIN) is the result of acute renal impairment after the administration of IV radiocontrast medium. Because of the increasing age of our population as well as the increased incidence of chronic kidney disease, we can only expect to also see an increase number of patients who develop contrast induced nephropathy. Currently at Intermountain Medical Center (IMC) Emergency Department (ED) there are no treatment algorithms or consistent approaches to prevention of CIN in the ED. The purpose of this project was to develop a treatment algorithm to help reduce the incidence of CIN in the ED. Strategies for renal protection include: hydration, vasodilators, antioxidants, and sodium bicarbonate (Pannu, Wiebe, & Tonelli, 2006). There is general consensus in the literature that administration of intravenous fluids is important, however there is little consensus and some controversy about other optimal strategies to prevent contrast induced nephropathy such as intravenous Sodium Bicarbonate and N-acetylcysteine. Multiple studies, review, and meta-analysis have been completed on patients undergoing coronary angiography or percutaneous interventions. However, this patient population has different baseline characteristics then those of the typical ED patient. The ED patient population often times have more complicated risk factors, present in a more debilitated clinical condition, require different dosages of contrast medium, and may have untreated or undiagnosed hypertension resulting in different risk factors (Hsu et al., 2012; Mitchell, Jones, Tumlin, & Kline, 2010). The first objective of this project was to conduct a literature review, and using current research, create a treatment algorithm for the prevention of contrast induced nephropathy in the ED. The second was to collect and log feedback from content experts and the project chair and then alterations of the algorithm were done. The third objective was to present the algorithm along with nursing educational material to physicians, IMC ED nurse educator, and the Emergency Department Operations Governance for possible further implementation. Lastly, a manuscript regarding the appropriate preventative treatments for patients at risk for developing CIN was written and submitted to the Journal of the American Association of Nurse Practitioners for distribution to a wider audience. Contrast induced nephropathy is a clinically significant problem that can possibly be minimized with the appropriate use of preventative interventions. Creation of a treatment algorithm for the Intermountain Medical Center Emergency Department will help guide the prescriber to make informed research based decisions and to provide care that achieves the best possible patient outcomes for those patients at risk for developing CIN. Further study is needed to asses the reduction in the incidence of CIN with regards to its impact on reduced cost to the patient, reduced length of hospital stays, as well as decreased mortality and morbidity.