De afgelopen jaren is een reeks richtlijnen rondom veilig gebruik van contrastmiddelen binnen de radiologie ontwikkeld.
Onder voorzitterschap van dhr. A.J. (Aart) van der Molen zijn richtlijnen deel 1 (2017), deel 2 (2019) en deel 3 (2022) geschreven. In 2024 is onder voorzitterschap van dhr. N. (Nanko) de Graaf deel 4 gepubliceerd, waarin het gebruik van contrastmiddelen bij kinderen wordt behandeld. Zie voor de inhoud van de richtlijnen onderstaande links en toelichting.
Onderhoud en actualisatie van de modules uit de richtlijn Veilig gebruik van contrastmiddelen gebeurt volgens de methodiek van modulair richtlijnonderhoud. De richtlijn is onderdeel van het cluster "beeldvormende diagnostiek".
Richtlijn deel 1
Richtlijn Veilig Gebruik van Contrastmiddelen (Engels met Nederlandse samenvatting) - Deel 1, 2017
Nederlandse Samenvatting Aanbevelingen Richtlijn Veilig Gebruik van Contrastmiddelen - Deel 1, 2017
Richtlijn deel 2
Richtlijn Veilig Gebruik van Contrastmiddelen (Engels) - Deel 2, 2020
Nederlandse Samenvatting Aanbevelingen Richtlijn Veilig Gebruik van Contrastmiddelen - Deel 2, 2020
Richtlijn deel 3
Richtlijn Veilig gebruik van Contrastmiddelen - Deel 3, 2022
Bijlagen
Flowchart 1
Flowchart 2
Nederlandse Samenvatting Aanbevelingen Richtlijn Veilig Gebruik van Contrastmiddelen - Deel 3, 2022
Supplement Implementatie
Richtlijn deel 4
Richtlijn Veilig gebruik van Contrastmiddelen - Deel 4, kinderen 2024
Bijlage
Stroomschema
Aanvullende informatie
Flow diagram Preventie CA-AKI (LUMC, 2023)
Flow diagram Contrastmiddelinjectie CVC en poorten (LUMC, 2023)
Guidelines on Safe Use of Contrast Media
The NVvR deemed a set of new guidelines on the Safe Use of Contrast Media highly necessary and relevant, due to new publications and insights on topics concerning contrast safety. The patient population addressed are adults (>18 years) who receive intravascular, oral or intracavitary (intra-articular, intra-vesical, intra-cholangiographic) iodine-containing contrast media in a clinical or outpatient setting. The guidelines do not cover radioactive contrast media use in nuclear medicine. The three parts of the guidelines cover different topics regarding contrast media safety.
Guideline part 1 (published 2017)
- prevention of post-contrast acute kidney injury (PC-AKI) from iodine-containing contrast media;
- iodine-containing contrast media use in patients with type-2 diabetes taking metformin;
- iodine-containing contrast media use in patients on chronic dialysis.
links:
Guideline Safe Use of Contrast Media (full English) - Part 1, 2017
Appendices Safe Use of Contrast Media (full English) - Part 1, 2017
Summary Recommendations Guideline Safe Use of Contrast Media (full English) - Part 1, 2017
Guideline part 2 (published 2019)
- management of hypersensitivity reactions to contrast media;
- prophylaxis of hypersensitivity reactions to contrast media & the role of skin testing in patients with hypersensitivity reactions;
- contrast media injections with power injectors through (peripherally inserted) central venous lines and implantable ports;
- contrast media extravasation;
- nephrotoxicity of gadolinium-based contrast agents;
- prevention of nephrogenic systemic fibrosis (NSF);
- retention of gadolinium in the body after use of gadolinium-based contrast agents.
links:
Guideline Safe Use of Contrast Media (full English) - Part 2
Appendices Safe Use of Contrast Media (full English) - Part 2
Flowchart Safe Use of Contrast Media - Management Acute Reactions (full English) - Part 2
Summary Recommendations Guideline Safe Use of Contrast Media (English) - Part 2
Guideline part 3 (published 2022)
- Prevention of iodine-induced hyperthyroidism;
- Safety of liver-specific gadolinium-based contrast agents;
- Gadolinium deposition in the body and brain;
- Contrast media use in pregnancy and during lactation;
- Contrast media use in patients with multiple myeloma;
- Contrast media use in patients with pheochromocytoma;
- Contrast media use in patients with myasthenia gravis;
- Contrast media use in patients with mastocytosis;
- Pharmacokinetics of contrast media: how long to wait between 2 successive examinations;
- Contrast media induced encephalopathy in stroke treatment
- Weber and Lalli effects in using contrast media.
links:
Guideline Safe Use of Contrast Media (full English) - Part 3
Appendices Safe Use of Contrast Media (full English) - Part 3
Safe Use of Contrast Media - Flowchart 1 (full English) - Part 3
Safe Use of Contrast Media - Flowchart 2 (full English) - Part 3
Summary Recommendations Guideline Safe Use of Contrast Media (full English) - Part 3
Supplement: Barriers tot Implementation - Modules 7.2 and 7.4
Guideline part 4 Children (published 2024)
- Risk stratification in the Prevention of Post Contrast Acute Kidney Injury (PC-AKI)
- Hydration Strategies in the Prevention of PC-AKI
- Profylactic Measures for Hypersensitivity Reactions
- Treatment of Acute hypersensitivity reactions
- Monitoring of Thyroid Function after Administration of Iodine-based Contrast Media
links:
Guideline Safe Use of Contrast Media (full English) - Part 4
*Note: Post-contrast acute kidney injury is synonymous with contrast-associated acute kidney injury Guideline Safe Use of Contrast Media part 4 Guideline for Authorisation phase June 2024.