Echo Lab Contrast Reaction Protocol
PRE
Echo Lab Contrast Reaction Protocol
PREventClinic, Inc. | Sandy Springs, Georgia
Based on ASE Guidelines (2014/2018)
Effective: ___/___/______
Approved: D. Montgomery, MD
Effective: ___/___/______
Approved: D. Montgomery, MD
Pre-Administration Requirements
Confirm no known hypersensitivity to UCA components (perflutren, PEG, albumin/blood products for Optison)
Confirm no right-to-left, bidirectional, or transient R→L cardiac shunt
IV access verified with good blood return (≥22-gauge cannula)
Resuscitation equipment & crash cart accessible
Allergy/anaphylaxis kit present and checked for expiration
Physician available on-site during contrast administration
Reaction Classification & Management
MILD |
Signs & Symptoms | Immediate Actions |
|---|---|---|
| Nausea • Flushing/warmth • Headache • Dizziness • Altered taste • Mild urticaria (limited, scattered hives) • Transient back pain • Injection-site discomfort |
1. Pause or stop contrast infusion
2. Monitor vitals (HR, BP, SpO₂)
3. Most symptoms self-limiting — observe
4. If urticaria persists: Diphenhydramine 25–50 mg IV/PO
5. Observe ≥10 min post-resolution before discharge
|
|
MODERATE |
Signs & Symptoms | Immediate Actions |
| Diffuse urticaria/erythema • Bronchospasm (wheezing, dyspnea) • Facial/laryngeal edema without respiratory failure • Tachycardia (HR>100) • Mild hypotension (SBP 80–100) |
1. STOP contrast immediately
2. Supplemental O₂ & continuous vitals monitoring
3. Bronchospasm → Inhaled β₂-agonist (albuterol 2.5 mg neb)
4. Diphenhydramine 50 mg IV
5. Hydrocortisone 200 mg IV —OR— Solu-Medrol 125 mg IV
6. If progressing → treat as SEVERE
7. Notify supervising physician immediately
|
|
SEVERE |
Signs & Symptoms | Immediate Actions |
| Anaphylaxis/anaphylactoid shock • Severe bronchospasm / respiratory failure • Laryngeal edema with stridor • Cardiovascular collapse (SBP<80) • Loss of consciousness • Seizure • Cardiac arrest |
1. STOP contrast — ACTIVATE CODE / CALL 911
2. Epinephrine 0.3 mg IM (1:1,000; anterolateral thigh) — may repeat q5–15 min
3. Position supine, elevate legs (unless respiratory distress)
4. High-flow O₂ (100% non-rebreather)
5. NS bolus wide open for hypotension
6. Diphenhydramine 50 mg IV
7. Hydrocortisone 200 mg IV —OR— Solu-Medrol 125 mg IV
8. If cardiac arrest → initiate CPR / AED per ACLS
|
Key Medications — Quick Reference
Epinephrine
0.3 mg IM (1:1,000)Anterolateral thigh
Repeat q5–15 min PRN
First-line for anaphylaxis
Diphenhydramine
25–50 mg IV or POH₁-blocker
Urticaria, pruritus, mild–moderate allergic sx
Hydrocortisone / Solu-Medrol
Hydrocortisone 200 mg IV—OR— Methylprednisolone 125 mg IV
Adjunct for mod–severe; prevents biphasic response
Albuterol
2.5 mg via nebulizerBronchospasm / wheezing
Normal Saline
Bolus 500–1000 mL IVWide open for hypotension
Volume resuscitation
Supplemental O₂
Nasal cannula → non-rebreatherTarget SpO₂ ≥94%
Titrate to clinical response
Current Contraindications to UCA Administration:
(1) Known hypersensitivity to perflutren or UCA components (albumin/blood products for Optison; PEG for Definity)
(2) Right-to-left, bidirectional, or transient R→L cardiac shunt
Post-Reaction Requirements
- Document reaction type, severity, timing relative to contrast administration, and all interventions in the medical record
- Record the specific UCA agent, lot number, dose administered, and route (bolus vs. infusion)
- Observe patient for minimum 30 minutes post-resolution (watch for biphasic reaction)
- Update the patient’s allergy list in the EMR with the specific agent and reaction details
- Complete institutional adverse event / incident report
- Communicate reaction to the ordering/referring physician
