Objective

The goal of this research is to provide evidenced based practice findings that will improve assessment and outcomes for patients receiving radiographic contrast for procedures.

Setting, Design and Method

At University of California Davis Medical Center, nursing staff is responsible for pre-assessment of patients undergoing a radiographic procedure. Radiographic contrast must be used to perform these procedures, however, there is no standardization of peri-prophylaxis to prevent contrast-induced nephropathy (CIN). According to Persson, Hansell & Liss (2005), approximately 60 million doses of contrast are given for procedures each year. For patients with pre-existing renal insufficiency and other contributing factors, renal function deterioration after percutaneous coronary intervention is a marker for poorer outcomes.

A retrospective assessment of modalities used for cardiac angiograms as a prediction of contrast-induced nephropathy was undertaken to assess current practice. Data were collected to determine the most effective means for preventing contrast-induced nephropathy in patients undergoing angiographic procedures using a tool developed by Dr. G. Dangas (2001). Laboratory values including creatinine and hematocrit were collected on one hundred seventy patients before and after procedures. Using this tool, a score was calculated for each patient to determine the risk of developing contrast-induced nephropathy post-procedure.

Concept Targeted

The research design was developed to provide an evidenced-based method for nurses to identify the risk score of patient’s under going contrast procedures.

Findings

Initial findings indicate that sodium bicarbonate and mucomyst are effective in providing peri-procedure prophylaxis in high-risk patients.

Conclusions

Once a risk score has been assessed a nurse can advocate for prophylaxis or staged procedures in order to provide the best possible treatment for patients undergoing contrast procedures.