Renal Function Scheduling Protocols for Contrast Exams

1. This protocol applies to the following exams: CT scan requiring IV contrast, IVP, CT Urogram with contrast, Venogram, and Arteriogram.
2. The following patients do not require pre-procedure renal function labs (Creatinine, BUN) prior to intravenous or intra-arterial contrast studies:
   • Patients under 70 years old and without history of chronic renal disease, renal artery stenosis, or diabetes. Any patient who is currently on dialysis.
   • The following patients do require pre-procedure renal function labs: All patients over age 70 (except patients on dialysis), and
   • any patient with suspected renal artery stenosis, known chronic renal disease, or diabetes.
3. When a patient requires pre-procedure renal function labs (Creatinine, BUN), lab results dated within the prior 12 months are acceptable. Schedulers should document any pertinent clinical information from the referring physician in the on-line scheduling notes.
4. Most patients with serum Creatinine of 1.8 or below can safely receive the standard intravenous dose of non-ionic low osmolar contrast material (100-120 cc).
5. Upon request by the referring physician, patients with serum Creatinine above 1.8 (including diabetics) may benefit from Mucomyst prophylaxis (see below), which needs to be prescribed by the referring physician. Consultation with an RMG physician may be necessary. Patients undergoing angiographic procedures don’t usually require Mucomyst prophylaxis, as the radiologist will often use alternative contrast agents such as carbon dioxide and gadolinium.

Mucomyst Contrast Prophylaxis Protocol

The following is the standard Mucomyst prophylaxis protocol used in some patients with chronic renal insufficiency and in whom an intra-venous or intra-arterial contrast exam is required. The referring physician, who may wish to consult with an RMG physician, must prescribe Mucomyst. After the contrast exam is complete, the patient should be hydrated (oral or intravenous) and should have renal function follow-up by the referring physician.

The pre-treatment protocol (Reference: NEJM 2000; 343: 180-184) is as follows:

Mucomyst (Acetylcysteine) solution 600 mg orally twice a day for four (4) doses beginning the day before the contrast exam.

Mucomyst (Acetylcysteine) solution comes in 10% (100mg/ml) and 20% (200mg/ml) concentrations in 4, 15, or 30 ml vials. Most pharmacists dispense the doses in individual dose syringes and have patients squirt each dose into a glass of soda.

Pharmacies listed below are familiar with this protocol:

• Hillcrest area—University Compounding Pharmacy (619-683-2005)
• Encinitas area—North Coast Health Center Medical Pharmacy (760-943-1191)
• San Clemente area—Sea View Pharmacy (949-496-0123)