Pre-Treatment of Contrast Induced Nephropathy

Thursday, 10 July 2008: 10:30 AM
Holly Kirkland-Walsh, RN, FNP, MSN , Wound Care NP, University of California at Davis, Sacramento, CA
Bonnie Jean Raingruber, RN, PhD , Division of Nursing and Center for Nursing Research, California State University, Sacramento, and University of California Davis, Sacramento, CA

Learning Objective 1: define contrast induced nephropathy and list three vascular risk factors that contribute to contrast induced nephropathy.

Learning Objective 2: identify two interventions which will decrease patient risk for contrast induced nephropathy.

Objective The goal of this research is to provide evidenced based practice findings which will heighten awareness of the vascular risk factors contributing to contrast induced nephropathy and to describe interventions to decrease the incidence. Setting, Design, and Method At University of California Davis Medical Center, nursing staff assess all patients before angiographic procedures. Vascular risk factors along with pre-existing renal insufficiency contribute to the development of contrast induced nephropathy (CIN). In a study completed by this author 2006, patients with a Dangas risk score of 9.5 were found to be at higher risk for developing contrast induced nephropathy. This study was a retrospective chart and electronic medical record review on patients who had been identified as high risk for CIN, having angiographic procedures. 242 patients had a high risk score of 9.5 or greater. Further chart review was conducted on these patients to evaluate the effectiveness of infusion of sodium bicarbonate in dextrose infusion with oral mucomyst as a pretreatment. These results were compared to those high risk patients who received saline infusion as a pretreatment. Serum creatinine levels were available from one day post contrast exposure. Concept Targeted This research design was developed to provide evidenced-based interventions which will decrease the incidence of CIN in patients having angiographic procedures involving contrast. Findings Initial findings support the use of sodium bicarbonate infusion and oral mucomyst in providing peri-procedural prophylaxis in patients at high risk for CIN. An important finding suggests a greater incidence of CIN in females and the culturally diverse population. Conclusions Patients who have a Dangas risk score of 9.5 or above, should be considered at high risk for CIN. High risk patients should have pre-treatment of sodium bicarbonate infusion with oral mucomyst to provide the best possible outcome and to prevent CIN leading to dialysis.