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Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions

  • Minisymposium: Quality and safety
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Abstract

Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing “yes” responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.

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Acknowledgments

Dr. Maloney is supported in part through a National Institutes of Health, National Research Service Award training grant (grant number 2 T32 DK00742).

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Authors and Affiliations

  1. Department of Radiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Ezekiel Maloney, Ramesh S. Iyer & Grace S. Phillips

  2. Division of Nephrology, Seattle Children’s Hospital, Seattle, WA, USA

    Shina Menon

  3. Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, USA

    John J. Lee

  4. Department of Radiology, Boston Children’s Hospital, Boston, MA, USA

    Michael J. Callahan

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  1. Ezekiel Maloney
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  2. Ramesh S. Iyer
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Correspondence to Ezekiel Maloney.

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Maloney, E., Iyer, R.S., Phillips, G.S. et al. Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions. Pediatr Radiol 49, 433–447 (2019). https://doi.org/10.1007/s00247-018-4306-6

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  • DOI: https://doi.org/10.1007/s00247-018-4306-6

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