Title
The use of Sodium Bicarbonate 1.4% for the prevention of contrast Induced Nephropathy
Authors
Mrs Sophie Riddell
Dr Rhymer / Authors’ job designations
  • Lead Surgical Pharmacist
  • Consultant Radiologist

Directorate
Pharmacy / Sub-directorate
Surgery/Radiology / Department
Pharmacy / Team/ Specialty
Surgery
Version / Date Issued / Status / Comment/ Changes
0.1 / Sept 2010 / Draft / First draft for consultation
0.2 / Sept 2010 / Draft / Amendments suggested by Dr Rhymer
0.3 / October 2010 / Draft / Amendments suggested by Dr Rhymer
0.4 / Nov 2010 / Final / Approval from DTG
Main Contact
Sophie Riddell
Lead Surgical Pharmacist
NorthDevonDistrictHospital
RaleighPark
Barnstaple, EX31 4JB / Tel: Direct Dial – 01271 311770
Tel: Internal – 3770 or bleep 813
Email:
Lead Director
Medical Director
Document Class
Clinical guideline / Target Audience (list all teams)
Surgical and Medical Staff
Medical staff
Nursing staff (all prescribing teams)
Pharmacists
Distribution List
Lead Clinicians
Senior Nurses
Senior Management / Distribution Method
TarkaNet
Superseded Documents
Not Applicable
Issue Date
November 2010 / Review Date
November 2011 / Review Cycle
Two Yearly
Consulted with the following stakeholders: (list all)
  • Surgical group
  • Drug & Therapeutics Group
/ Contact responsible for implementation and monitoring compliance:
Surgical Pharmacist
Education/ training will be provided by:
Radiology
Approval and Review Process
  • Drug & Therapeutics Group
/ Ratified by Trust Board?
No
Archive Reference
PathG:\PHARMACY\sophie Riddell\contrast induced nephropathy
FilenameSODIUM BICARBONATE.doc
Document Level (for Corporate Affairs use only):

TREATMENT PROTOCOL

SODIUM BICARBONATE 1.4% INFUSION FOR THE PREVENTION OF

CONTRASTINDUCEDNEPHROPATHY

Sodium Bicarbonate 1.4% is now to be used routinelyin patients with

eGFR less than 30mls/min (stage 4 cases).

Patients in CKD group 3, including diabetics, with an eGFR of 30-60mls/min

do not routinely need bicarbonate.

In all other patients undergoing contrast media scans ensure adequate hydration with IV 0.9% Sodium Chloride (superior to oral hydration)

The use of this infusion must be agreed with a consultant Radiologist before it is

Prescribed but can be written up by a junior doctor.

Prescription

Sodium Bicarbonate 1.4%(available from pharmacy in 500ml bottles)

Infusion rate

3ml / kg / hour for 1 hour prior to administration of the contrast

Then

1ml / kg / hour during contrast exposure and for 6 hours after the procedure.

There are no specific monitoring requirements related to the administration of this

Solution

If 1.4% sodium bicarbonate is unavailable, then 1.26% can be substituted or contactthe surgical pharmacist for advice. 1.26% can also be given peripherally.

References:

  • Prevention of Contrast-Induced Nephropathy. Uptodate.com 2010-08-18
  • Increasing evidence base for sodium bicarbonate therapy to prevent contrast media-induced acute kidney injury. Wiedermann et al. Nephrol Dial Transplant (2010) 25:650-654
  • Prevention of Contrast-Induced Nephropathy with Sodium Bicarbonate Merten et al; JAMA. 2004 May 19;291(19):2328-34.
  • Systematic Rv:Sodium bicarbonate treatment regimes for prevention of contrast induced nephropathy.

Produced September 2010 by:

Sophie Riddell Surgical Pharmacist ; Dr J RhymerConsultant Radiologist NDDH; Dr J. Moore consultant renal physician Exeter; Pat Backwell Renal Pharmacist Exeter

Approved by D&T group NDDH November 2010

G:\PHARMACY\sophie Riddell\contrast induced nephropathy.

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