1. Purpose
This policy sets out how the Service screens patients before contrast administration, obtains and records consent, administers contrast safely and responds to contrast-media adverse reactions.
It covers iodinated contrast, gadolinium-based contrast and ultrasound contrast where used by the Service.
2. Sources to verify before adoption
- RCR guidance on gadolinium-based contrast agent administration to adult patients: https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/guidance-on-gadolinium-based-contrast-agent-administration-to-adult-patients/
- RCR standards and guidance publications: https://www.rcr.ac.uk/our-services/all-our-publications/standards/
- Resuscitation Council UK emergency treatment of anaphylactic reactions: https://www.resus.org.uk/library/additional-guidance/guidance-anaphylaxis/emergency-treatment
- MHRA Yellow Card reporting site: https://yellowcard.mhra.gov.uk/
- Human Medicines Regulations 2012: https://www.legislation.gov.uk/uksi/2012/1916/contents
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12: https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- Current contrast agent Summary of Product Characteristics and manufacturer safety information.
3. Scope
This policy applies to:
- contrast-enhanced CT
- contrast-enhanced MRI
- interventional radiology where contrast is administered
- ultrasound contrast where used
- patient screening before contrast
- renal-function and prior-reaction checks
- diabetes and metformin considerations
- pregnancy and breastfeeding considerations
- consent for contrast
- IV access and injection
- post-administration observation
- contrast reaction management
- Yellow Card reporting decisions
The policy applies to employed staff, contractors and visiting clinicians who administer contrast under the Service's governance.
4. Contrast safety process
The Service does not administer contrast until a competent role holder has completed and recorded the contrast safety checks.
4.1 Request and protocol review
The Radiologist or authorised practitioner reviews the request and confirms whether contrast is clinically justified.
The review considers:
- clinical question
- modality and protocol
- contrast type and route
- previous imaging
- renal-risk information where relevant
- pregnancy or breastfeeding status where relevant
- previous contrast reaction
- known allergy history
- diabetes and metformin considerations
- urgency and alternatives
Where the contrast risk is uncertain, Staff escalate to the Radiologist before administration.
4.2 Patient screening
Staff complete screening before contrast is prepared.
The screening record includes:
- patient identity
- examination requested
- contrast type proposed
- previous contrast reaction
- asthma or significant allergy history where relevant
- renal disease or dialysis
- current renal-function information where required by local protocol
- diabetes and metformin status where relevant
- pregnancy or breastfeeding status where relevant
- current medication relevant to the protocol
- patient questions and consent
The Service uses current source material and local clinical governance to decide which patients require renal-function testing. Staff do not apply informal deadlines or thresholds from memory.
4.3 Consent and information
Staff give the patient information about why contrast is proposed and what to report during or after administration.
The conversation covers:
- reason for contrast
- expected benefit
- common effects, such as warmth or taste change
- warning symptoms to report immediately
- alternative route where clinically available
- post-scan advice
- who to contact after leaving the Imaging Centre
Consent is recorded in the patient record or examination record.
4.4 Preparation and IV access
Staff prepare contrast according to local protocol and manufacturer information.
The preparation record includes:
- contrast agent name
- batch number where required by local protocol
- dose or volume
- expiry check
- route
- cannula site and gauge
- injector or manual administration
- operator
- time administered
The Service checks emergency equipment and medicines before contrast sessions begin.
4.5 Post-administration observation
Staff observe the patient according to local protocol and current source material.
Observation includes:
- immediate symptoms
- rash, itch or swelling
- breathing difficulty
- nausea or vomiting
- dizziness or collapse
- extravasation or injection-site pain
- delayed symptoms advice
The Service records early departure against advice and any safety-netting advice given.
5. Reaction management
The Service classifies contrast reactions according to local clinical protocol and current professional guidance.
5.1 Mild reaction
For mild symptoms, Staff:
- stop or pause administration where appropriate
- assess airway, breathing, circulation and conscious level
- inform the Radiologist or senior clinician
- monitor symptoms
- record the reaction and treatment
- give post-event advice
5.2 Moderate or severe reaction
For moderate, severe or rapidly progressing symptoms, Staff:
- call for immediate clinical help
- follow the local emergency algorithm
- call 999 where required
- use emergency medicines and equipment only within competence
- monitor and record observations
- preserve contrast and batch information
- record decisions, treatment and outcome
- complete an incident record
The Service aligns the emergency algorithm with current Resuscitation Council UK guidance and local prescriber arrangements.
5.3 Extravasation
If contrast extravasation is suspected, Staff:
- stop injection
- assess the site
- record contrast type and volume
- escalate for clinical review
- give patient advice
- record follow-up plan
- complete an incident record where harm, delay or complaint may result
5.4 Reporting and learning
The Service assesses whether the reaction or device issue should be reported through the MHRA Yellow Card scheme.
The review checks:
- reaction severity
- contrast agent involved
- device or injector issue
- batch or product concern
- patient harm
- recurrence pattern
- duty of candour requirement
- update needed to the contrast protocol
6. Repeat contrast and high-risk patients
The Radiologist reviews repeat contrast in the same patient where local policy or patient risk requires senior review.
High-risk cases may include:
- previous moderate or severe contrast reaction
- renal impairment or dialysis
- pregnancy or breastfeeding
- complex diabetes or metformin decision
- repeated CT or MRI contrast within a short clinical episode
- contrast needed despite incomplete information
The decision record states the rationale, precautions and patient advice.
7. Responsibilities
- Registered Manager: owns this policy, ensures governance review and signs off annual review.
- Radiologist: owns clinical protocol, high-risk contrast decisions and reaction review.
- Radiographer: completes screening, checks contrast preparation, administers contrast within competence and records the examination.
- Lead Clinician: assures emergency response arrangements, training and post-event review.
- Operations Manager: ensures emergency equipment, contrast stock control and session readiness checks are in place.
- All staff: escalate uncertainty before contrast is administered and record incidents promptly.
8. Recording requirements
The Service keeps the following records:
- contrast protocol
- patient screening record
- consent record
- renal-function decision where applicable
- contrast agent, dose, route and batch where required
- IV access record
- observation record
- reaction record
- emergency treatment record
- extravasation record
- Yellow Card decision
- duty of candour decision
- training and competency records
- improvement action record
Records are kept in the Service governance records and linked to the patient record where relevant.
9. Audit cadence
The Service uses the following Verivius default audit rhythm unless current RCR, Resuscitation Council UK, MHRA, CQC or local source material requires a different rhythm:
- Per contrast examination: Staff record screening, consent, contrast agent and operator details.
- Monthly: the Lead Clinician checks contrast incidents, stock exceptions and emergency equipment checks.
- Quarterly: the Radiologist reviews reaction themes, high-risk decisions and repeat contrast cases.
- Annually: the Registered Manager audits the protocol against current source material and training records.
- After any moderate or severe reaction: the Service reviews screening, emergency response, product reporting and learning.
Audit findings are recorded as improvement actions with an owner and review date.
10. Version control and review date
The Service keeps a controlled copy of this policy. The footer or document-control table records:
- policy owner
- version number
- date approved
- next review date
- changes made since the last version
- source material checked during the review
11. Related records
- Contrast protocol
- Patient screening form
- Consent record
- Examination record
- Emergency drugs and equipment checklist
- Incident register
- Yellow Card decision record
- Duty of candour policy
- Training matrix
- Improvement action register
Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.