Medicolegal responsibilities for the administration of intravenous contrast media by radiographers: Radiologists' perspectives

Background. Global trends in the delivery of healthcare services have placed tremendous strain on resources, among them human and capital. With this has emerged the need to revisit the job requirements and/or scope of practice of cadres within a profession, to ensure adequate training where needed. The administration of intravenous contrast media (IVCM), a fundamental element of expertise within the radiology field, is an example of such evolution in South Africa (SA). Currently falling within radiologists' scope of practice, it has become necessary for radiographers to extend their own scope to include this skill, owing to the national shortage of radiologists and subsequent service delivery constraints, as well as the need to close the gap with international trends.Objective. To provide a synopsis of the perspectives of radiologists on the medicolegal responsibilities related to the administration of IVCM by radiographers.Methods. A quantitative, descriptive, cross-sectional research design was conducted, targeting qualified radiologists in KwaZulu-Natal Province (KZN). An online questionnaire was administered through SurveyMonkey that provided information on the medicolegal responsibilities associated with the administration of IVCM.Results. Of a total of 97 qualified radiologists in KZN, a response rate of 48.5% (n=47) was obtained. The majority of respondents felt that radiographers should be responsible for obtaining informed patient consent (66.0%), and deciding on the site of IVCM administration (72.3%). It was also felt that the radiologists should remain responsible for decisions regarding the type and dose of IVCM (87.2%) and managing the possible complications and adverse reactions due to the administration of IVCM (78.7%).Conclusion. Evidence-based research provides a contextualised approach towards addressing transformation in service delivery and training needs. This study, in demonstrating the importance of appropriate medicolegal responsibilities in the extension of a professional role, forms a basis for informing the future training of radiographers in SA

Training requirements for the administration of intravenous contrast media by radiographers: Radiologists' perspective

Background. The administration of intravenous contrast media (IVCM) is one of the key areas currently under investigation for inclusion in the South African (SA) radiographers' scope of practice. However, for the radiographers to legally administer IVCM, training guidelines must first be identified, developed and accredited by the Health Professions Council of SA.Objective. To investigate the radiologists' perspective of the knowledge, skills and medicolegal training required of radiographers for the administration of IVCM to provide input for the development of national training guidelines. Methods. A quantitative, cross-sectional research study using an online survey, administered by SurveyMonkey, was conducted. The target population included all radiologists residing and practising in the province of KwaZulu-Natal, SA.Results. Fifty-nine participants (60.8%) completed the online survey. Twelve were excluded owing to incomplete surveys, resulting in a final response rate of 48.5% (n=47). The study revealed that various theoretical, clinical/practical and medicolegal study units should be included in the training, i.e. the study of the pharmacology of contrast media, practical training on cardiopulmonary resuscitation and basic life support, as well as the rights and responsibilities of a healthcare professional. In addition, both theory and practical/clinical assessments need to be included.Conclusion. Key data have been provided for the development of national training guidelines for radiographers to administer IVCM, based on scientific evidence that is relevant to the SA context. The study may be of value to other related health professions where scopes of practice are expanded through transforming the education and training curricula

Nephropathie au cours d'une extravasation de produit de contraste iode : quel lien ? a propos d'un cas

Introduction. L'extravasation d'un produit de contraste injecte par voie intraveineuse est rare en pratique clinique courante. Son incidence est relativement faible. Cas clinique. Nous rapportons ici l'observation d'un adulte jeune de 40 ans; obese; qui a la suite d'une extravasation de 50 ml de produit de contraste iode dans l'avant-bras droit; a presente des reactions locoregionales immediates accompagnees d'une insuffisance renale aigue. Un traitement symptomatique institue sur la base d'une rehydratation adaptee a ameliore les signes cliniques apres 48 heures avec secondairement normalisation de la fonction renale. Conclusion. La toxicite des produits de contraste iode est connue et liee a leur osmolarite elevee et a l'importance de la quantite extravasee dans le tissu sous cutane

Nephropathie au cours d'une extravasation de produit de contraste iode : quel lien ? a propos d'un cas

Introduction. L'extravasation d'un produit de contraste injecte par voie intraveineuse est rare en pratique clinique courante. Son incidence est relativement faible. Cas clinique. Nous rapportons ici l'observation d'un adulte jeune de 40 ans; obese; qui a la suite d'une extravasation de 50 ml de produit de contraste iode dans l'avant-bras droit; a presente des reactions locoregionales immediates accompagnees d'une insuffisance renale aigue. Un traitement symptomatique institue sur la base d'une rehydratation adaptee a ameliore les signes cliniques apres 48 heures avec secondairement normalisation de la fonction renale. Conclusion. La toxicite des produits de contraste iode est connue et liee a leur osmolarite elevee et a l'importance de la quantite extravasee dans le tissu sous cutane

Contrast Medium-induced Nephropathy. Aspects on Incidence; Consequences; Risk Factors; and Prevention

"Contrast media-induced nephropathy (CIN) is a well-known complication of radiological examinations employing iodine contrast media (I-CM). The rapid development and frequent use of coronary interventions and multi-channel detector computed tomography with concomitant administration of relatively large doses of I-CM has contributed to an increasing number of CIN cases during the last few years. Reduced renal function; especially when caused by diabetic nephropathy or renal arteriosclerosis; in combination with dehydration; congestive heart failure; hypotension; and administration of nephrotoxic drugs are risk factors for the development of CIN. When CM-based examinations cannot be replaced by other techniques in patients at risk of CIN; focus should be directed towards analysis of number and type of risk factors; adequate estimation of GFR; institution of proper preventive measures including hydration and post-procedural observation combined with surveillance of serum creatinine for 1-3 days. For the radiologist; there are several steps to consider in order to minimise the risk for CIN: use of ""low-"" or ""iso-osmolar"" I-CM and dosing the I-CM in relation to GFR and body weight being the most important as well as utilizing radiographic techniques to keep the I-CM dose in gram iodine as low as possible below the numerical value of estimated GFR. There is as yet no pharmacological prevention that has been proven to be effective."

Informed consent: the radiologist administering radiological contrast media

This study represents the understanding and practice of radiologists in Nigeria in obtaining informed consent from patients before administering radiological contrast media. 120 questionnaires were sent to radiologists practicing in Nigeria. 78(65%) responded, 60(76.9%) of the respondents understood informed consent to mean informing a patient about a procedure and obtaining consent to carry out the procedure. Whereas for consent to be informed it must include the nature of the procedure, purpose, risks and benefits. 52(66.7%) obtained either written or verbal consent while 26(33.3%) neither informed patient nor obtained consent. However, all respondents understood that failure to obtain consent may result in possible litigation by patient or relative while 69(88.5%) requested for a specific policy regarding informed consent. It is concluded that the radiologist in Nigeria does not fully understand the concept of informed consent. A specific policy should be made by the appropriate professional body in Nigeria as to what constitutes the requirements of a truly informed consent since there are simply no guidelines for now. Also informed consent forms, simple enough for patients to understand should be designed. These will assist the individual specialist in the conduct of their practice