Preparing Clinicians for Managing Adverse Contrast Reaction

An educational module on contrast agent reaction management significantly improved clinician knowledge and comfort with managing adverse reactions to contrast media, according to the results of a single-center study.

But concerns over contrast reaction still lingered, researchers found. After completing the online module, nearly 20 percent of the technologists, nurses, and physicians still reported feeling uncomfortable managing an adverse contrast reaction, study author Bethany Niell, MD, PhD, director of Breast Magnetic Resonance Imaging, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital told Diagnostic Imaging.

“This result suggests that didactic instruction alone may be inadequate,” Niell said.

Adverse reactions to contrast media are rare, but can be life threatening. Prior research has shown that knowledge about managing these reactions is lacking among Canadian and U.S. board-certified radiologists.

At Niell’s institution, an online education module was developed to train appropriate personnel on the management of these adverse reactions. The one-hour module provided education on general concepts of emergency management and team dynamics, overview of the types of reactions to contrast media and the treatment algorithms for the most common adverse events, treatments of contrast media extravasations, and an overview on the use of contrast reaction kits.

To test the effect of these education modules, Niell and colleagues designed premodule and postmodule assessments of each person’s knowledge and comfort level with the treatment of adverse reactions to contrast media. All physicians and nurses, and subsets of technologists and other personnel involved in contrast administration were required to complete the assessments. The results of the study were published in the Journal of the American College of Radiology.

Overall, 571 personnel completed the premodule assessment; 12.8 percent were resident physicians, 12 percent were fellows, 21.9 percent were attending physicians, 34.9 percent were technologists and 13.3 percent were nurses. About 90 percent of personnel completed the postmodule assessment.

After completing the education module, physicians had significant improvements in selecting the correct medication for an adverse reaction (P<.01) and in their knowledge of the proper administration route, concentration and dose of intramuscular epinephrine (P<.01).

In addition to improved knowledge, participants reported a significant improvement in their comfort with the treatment of contrast extravasation and adverse reactions to contrast after having completed the module. Specifically, resident physicians, attending radiologists and nurses had significant improvements. In contrast, fellow physicians and technologists did not, with 14 percent of physicians still uncomfortable with managing adverse reactions, even after completing the module.

“Our study suggests that a successful educational curriculum for a Department of Radiology should include, but not be limited to, didactic instruction,” Niell said. “As a result of our study, the Massachusetts General Hospital Department of Radiology has implemented a medical simulation program for radiologic emergencies to enhance our educational curriculum for technologists, nurses and physicians.”