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Publication Type: Patient Safety Alert
Single or Multiple Incident: Multiple
Date: 5/7/2019 12:00:00 AM
Country: South Korea
This alert discusses hypersensitivity reactions after patients were administered contrast agents. Two cases are described where a severe reaction resulted in hypoxic brain damage in one case; in the other case a hypersensitivity reaction requiring cardiopulmonary resuscitation occurred despite a negative skin reaction test. Recommendations addressing pre-inspection cautions, post-examination observation and process for responding to hypersensitivity reactions are provided. In addition a treatment algorithm for outpatient and radiology treatment of mild and severe hypersensitivity cases is provided.

Additional Details

Device:
intravenous injection equipment, airway maintenance equipment
Medication/Gas/Fluid:
radiocontrast agents, antihistamine, chlorpheniramine, epinephrine, epinephrine self-injection kit, steroids, prednisone, methylprednisolone, hydrocortisone injectable, fast actine bronchial dilators, normal saline, oxygen
Medication/IV List:
adrenergic agonists, IV (e.g., epinephrine, phenylephrine, norepinephrine, dopamine), radiocontrast agents, IV

Rules / Policies / Procedures
  1. Pre-inspection Cautions and Confirmations: Prepare emergency medication and medical devices: - Epinephrine, antihistamines, steroids, fast-acting bronchial dilators (inhalation), etc. - Intravenous injection equipment, airway maintenance equipment, etc.
  2. Check the history of patient hypersensitivity reaction to contrast agents,
  3. Consider skin tests to select safe contrast agents for patients who have experienced hypersensitivity reaction contrast agents in the past - It is not recommended to conduct a skin test for screening purposes on a screening test for all patients scheduled to use contrast agent.
  4. Premedication in patients with a history of contrast agent hypersensitivity reaction. - Pre-treatment of scheduled examinations - Pre-treatment in first aid (See full alert for complete listing of dosing times and recommended medications for each of the above pre-treatment protocols)
  5. Observe the presence of hypersensitive reactions for a certain period of time after the contrast agent examination.
  6. Process for responding to contrast agent hypersensitivity reaction: Pre-preparation of the examination room and medical staff - Preparing medicines and equipment for emergency situations and checking supplies once a week - Establishing processes and regular training for immediate first aid in case of side effects of contrast agent - Medical staff should be able to recognize early signs of contrast agent side effects
  7. Process for responding to contrast agent hypersensitivity reaction: Initial First Aid - Immediate injection of contrast agent(if any contrast agent is in the process of injection) - Evaluation of blood circulation, airway, breathing, consciousness, skin, etc.
  8. Process for responding to contrast agent hypersensitivity reaction: Immediate and Simultaneous Measures - Ask for help. - Epinephrine muscle injection(based on 1mg/1mL/amp), medial anterolateral administration of the thigh. (See full alert for dosage recommendations.) - Posture adjustment: Raise the legs in a lying position(a comfortable position for the patient when dyspnea or vomiting).
  9. Process for responding to contrast agent hypersensitivity reaction: Action taken when necessary - Rapid administration of 1-2 L normal saline, oxygen supply (6-8L/min), and cardiopulmonary resuscitation are performed.

Hypersensitivity reaction after administration of contrast agent