Advising people to remove shellfish from their diet without an allergy test to back it up is just plain wrong. Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis, and treatment. ), Obtain vital signs (Ensure hemodynamic stability. Complete blood cell count: The presence of thrombocytopenia would be a contraindication to the administration of parenteral glycoprotein 2b3a inhibitors. Which of the following assessments is most critical before the procedure? Also tell your doctor if you are claustrophobic or if you get anxious in tight spaces. Contrast dye is necessary for some medical exams. No data suggest that shellfish allergies predict increased risk of adverse reactions to contrast. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions. Evaluating peripheral pulses is a nursing measure following the cardiac catheterization. It may not be safe to drive after having cardiac catheterization, so you must arrange for a ride home. Flag chart for © New York University. You will then change into a hospital gown. Final diagnosis was coronary artery spasms. Indications for cardiac catheterization include definitive or suspected myocardial ischemia, syncope, valvular heart disease, and acute myocardial infarction (MI). Cardiac catheterization is a common medical procedure which enables your doctor to examine your heart. Patient going for an angiogram who is allergic to Iodine on our floor must be given 2 doses of Prednisone before and after the procedure. Goss JE, Chambers CE, Heupler FA Jr. There is no data to support screening questions for “iodine” or “shellfish allergy” when screening a patient for a contrast study. Baseline peripheral pulse rates 3. reported in 1984 that 4 of 15 NPH diabetics (27%) had anaphylaxis after protamine reversal of heparin after cardiac catheterization. Cardiac catheterization can result in dmage to the HIS system and a new bundle branch block, and the operator should be prepared for this prior to the procedure. A comprehensive study based on a prospective survey. Of 866 consecutive patients undergoing cardiac catheterization over a 20 month period, 651 received protamine for reversal of heparinization. During MRI Seafood allergy and radiocontrast media: are physicians propagating a myth? The discussion highlights this finding, despite the fact that there were similar rates of allergy to “milk, eggs, or chocolate” (15%), hay fever (10%), or a history of asthma (11%). In the United States, more than 1,000,000 cardiac catheterization procedures are performed annually. A mild Procedure During a cardiac cath a long thin flexible catheter, is inserted into an artery or vein in the groin or arm. Regardless of its origin, the link between shellfish allergy and contrast reaction seems to be a common misconception. This catheter This catheter is then threaded back through the arterial system all the way to the arteries in the heart. Physicians should not think twice about a contrast-enhanced CT scan in a patient with a shellfish allergy. The incidence of contrast media complications in the catheterization laboratory is 0.23% with 1 death per 55,000. Ischemic changes would suggest the presence of an acute coronary syndrome which would be an indication for percutaneous coronary intervention (PCI). A thin, hollow tube called a catheter is inserted into a large blood vessel that leads to your heart. BAND: ASSESS FOR ALLERGIES TO INCLUDE CONTRAST / IODINE / SHELLFISH ALLERGY IF … Marine animals in the shellfish category include crustaceans and mollusks, such as shrimp, crab, lobster, squid, oysters, scallops and others.Some people with shellfish allergy react to all shellfish; others react to only certain kinds. In cardiac catheterization (often called cardiac cath), your doctor puts a very small, flexible, hollow tube (called a catheter) into a blood vessel in the groin, arm, or neck. A prior allergic-like reaction to intravascular iodinated contrast is the most substantial risk factor for a recurrent reaction upon future contrast administration. The iodine molecule isan effective x-ray absorber in the energy range where most clinicalsystems operate. Some people may have a sensitivity to iodine. He also teaches an online RCIS Review course for Spokane Community College, in Spokane, Washington, and regularly presents with RCIS Review Courses. The fact that shellfish allergy was examined independently suggests that the myth has been around much longer than this study. Todd is the Cardiology Manager for Memorial Hermann Southeast in Houston, Texas. A cardiac catherization, or heart angiogram, allows doctors to assess the pumping function of the heart and determine if there is any significant blockage in the arteries. Cardiac catheterization involves the insertion of a thin, flexible tube or catheter, into an artery in the groin or wrist. Shellfish allergy has no particular significance for contrast administration and is managed the same way as other non-contrast allergies, for example, allergy to bee sting, penicillin, and peanut. Throughout the procedure, the nurse should check the patient for emergence of a rash and for any symptoms of breathing difficulty. The following issues deserve particular attention: Care should be taken to be aware of left to right shunts. Most intravascular contrastmedia are derivatives of tri-iodobenzoic acid. ... Michael J. Lim, in The Interventional Cardiac Catheterization Handbook (Fourth Edition), 2018. The presence of a bundle branch block. Cardiac catheterization is a procedure in which a small catheter is placed into an artery in your leg or arm. Although it would be virtually impossible to determine when this myth began, an article by Shehadi from 1975 is commonly cited in the literature [1]. For example, cardiac catheterization in patients with valvular or congenital heart disease is best Contrast nephropathy. Many believe that since iodine is in both seafood and contrast media, and since many people with the common shellfish allergy had similar reactions after contrast administration, iodine must be the allergen. Cardiac catheterization (cardiac cath or heart cath) is a procedure to examine how well your heart is working. allergies to shellfish containing iodine, iodine itself, or the dyes commonly used as contrast agents before cardiac catheterization. Commentary by: Tania Elliott, MD Division of Allergy and Immunology. A table mate of mine did not order the lobster. Please tell your doctor if you have any allergies to iodine or shellfish (contrast allergies). This dye is sometimes used to make things more visible during procedures like a cardiac catheterization, a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan. Seafood and iodine: an analysis of a medical myth. A thorough history should be obtained regarding prior development of an allergic reaction following iodinated contrast administration or shellfish ingestion. The physician then advances a smaller tube to the arteries in the heart. Depending on the facility and the patient's condition, cardiac catheterization may be performed as either an inpatient or an outpatient procedure. I was in intensive care for 17 days. No itching. Informed consent is required before any invasive procedure but the physician would explain the procedure to the patient. Cardiac catheterization (also called cardiac cath, heart cath, or coronary angiogram) is a procedure that allows your doctor to see how well your blood vessels supply your heart. Cardiac Catheterization, also known as cardiac angiogram or heart catheterization, is a common, relatively painless, nonsurgical procedure performed by an interventional ... OR SHELLFISH ALLERGY (i.e., lobster, crab, mussels, oysters, clams, and shrimp) Take Prednisone 50mg at … Cardiac catheterization is an imaging procedure used to diagnose and treat some heart conditions, including arterial narrowing or blockage. If the patient suffers from symptoms like trouble in breathing, swelling and high heart rate after an exam with contrast, immediate medical attention should be sought. Of these, 8.5% (56/651) were diabetics and 2.3% (15/651) were NPH insulin-dependent If you are allergic to shellfish or iodine, your doctor may decide not to use the dye for the procedure. The purported link between shellfish allergy and radiocontrast media is indeed mythical. Individuals at risk of an anaphylactoid reaction require premedication. Both the presence and the nature of these should be carefully noted. Premedications Aspirin : Patients who may undergo PCI should receive aspirin, 162 to 325mg, at least 2 hours before the procedure if PCI is planned. Adverse reactions to intravascularly administered contrast media. ... Hypotension may occur before, during, and after cardiac catheterization from a variety of conditions. Input and output 2. Yes, if the patient has a shellfish allergy or prior reaction to iodinated contrast they need to be pre-medicated starting … If you have a shellfish allergy, you'll need to be extremely careful when dining out. Cardiac catheterization is a common medical procedure which enables your doctor to examine your heart. Coagulation panel: An INR > 2.0 is a relative contraindication for cardiac catheterization. No hives. CT and X-ray Contrast Guidelines: Allergies and Premedication. The procedure involves threading a tiny tube through an artery to the heart and injecting dye into the arteries that transport blood through the heart using X-ray imaging. Symptoms of an allergic reaction may include itchy eyes, runny nose, or skin rashes. Curr Allergy Asthma Rep 5:28-31, 2005. After those things are done, an MRI tech will place an IV in your arm (possibly two). Moreover, is there any factual basis behind the common recommendation that patients with contrast reactions should avoid shellfish? When reviewing your medical history, be sure to share a known contrast/shellfish allergy and information about any previous heart-related intervention or surgery. Leung PS, Chen YC, Chu KH. Furthermore, there is no similarity between the structure of tropomysin and that of radiocontrast media itself to suggest that there could be cross-reactivity between them. • Assess for iodine/shellfish allergy • Assess renal function ... Post heart catheterization care: Obtain electrocardiogram (This helps determine if the patient sustained any injury to the heart during the procedure. Premedications Aspirin : Patients who may undergo PCI should receive aspirin, 162 to 325mg, at least 2 hours before the procedure if PCI is planned. Diabetes, age over 65, and prior dye load within the past 24 hours are risk factors for the development of post procedure renal insuffiency. Shellfish Allergy Shellfish allergy has no particular significance for contrast administration and is managed the same way as other non-contrast allergies, for example, allergy to bee sting, penicillin, and peanut. Informed consent must be signed prior to any invasive procedure. Adverse reactions to iodine are rare, but they can be … I was recently vacationing on a cruise ship. I wish I had an allergy to the dye. Seafood allergy: tropomyosins and beyond. History of shellfish allergies and contrast reactions: Both the presence and the nature of these should be carefully noted. For one, iodine cannot be an allergen since it is found throughout the body within thyroid hormone as well as in various amino acids. During the procedure, a long, thin, flexible tube called a catheter is put into View an illustration of Dr. Ian Fagan is a clinical instructor, department of medicine, NYU Langone Medical Center, Peer reviewed by Tania Elliot, MD, Instructor, Division of Infectious Diseases and Immunology, NYU Langone Medical Center. It can also show how well your heart muscle pumps, diseases of the valves and aorta Preoperative medications should be carefully documented. An article published in Allergy and Asthma Proceedings in 2005 attempted to determine the prevalence of this belief [2]. Cardiac catheterization should be considered a diagnostic study used in combination with complementary noninvasive tests. Is there evidence behind this clinical practice, or is it actually just a medical myth? [1]. Disguised in a larger survey regarding screening for patients at increased risk for contrast reactions were 2 questions pertaining to seafood allergy. Includes how to read a label for a shellfish-free diet. 1 It is believed that people who have an allergy to seafood (shellfish) may show an allergy to contrast media as well, due to the presence of iodine in both. In the survey by Shih-Wen Huang from Asthma and Allergy Proceedings [2], patients were also asked, “Do you think that it is the iodine in the seafood that is responsible for the allergic reaction?” Not surprisingly, 92% of these patients believed that iodine was, in fact, the allergic component of shellfish. Dye is injected through the catheter, creating a When asked if they routinely inquire about shellfish allergy prior to contrast administration, 65% of radiologists and 89% of cardiologists responded “yes.” Roughly 50% of cardiologists and 35% of radiologists responded “yes” to the second question, “would you withhold radiocontrast media administration or recommend corticosteroids/antihistamines based on a history of seafood or shellfish allergy?” This suggests that some physicians may withhold therapeutic studies, such as cardiac catheterization, based solely on this misconception. Is there a risk of allergic reaction? Prednisone 60 mg should be given the night before the procedure and the morning of the procedure. In fact, even obtaining a history of seafood allergy serves to further propagate the myth among these patients. Dye is injected into the arteries and pictures taken under video xray. Huang SW. Note the presence of dextrocardia or situs inversus so that reversed anatomy can be anticipated. Because cardiac catheterization is considered surgery, the patient will be instructed to fast for at least six hours prior to the procedure. It is important to check for iodine sensitivity or shellfish allergy because the procedure involves injecting contrast medium. INTRODUCTION. 1 Rates of serious complications, including stroke, myocardial infarction, and death, are less than 1% for most catheterization procedures. Among diabetic patients, Neutral Protamine Hydrolase (NPH) insulin can cause hypotension when administered with protamine and metformin administration along with iodinated contrast administration can cause severe lactic acidosis. cardiac catheterization. The results of the catheterization will help your doctor plan the next step in your treatment. If previous systemic allergic reaction to contrast dye or shellfish allergy administer Prednisone 50 mg by mouth the evening prior to angiogram and the morning of angiogram. What is the scientific basis for this false belief? I looked up prednisone and under the label it says that this drug can be used to treat allergic reactions but I do not fully understand the pathophysiology. Note any history of nasal polyps and allergy to aspirin and any prior attempts at aspirin desensitization. No trips to the emergency room. Shellfish allergy involves tropomyosin proteins as the antigen, having nothing to do with iodine content in various shellfish. Obtain history of shellfish allergy. It is important to check for iodine sensitivity or shellfish allergy because the procedure involves injecting contrast medium. A client is scheduled for a cardiac catheterization using a radiopaque dye. The frequency of the vitals should be based on hospital policy. Allergy reactions to IV dye are common, can range from mild to moderate, and can sometimes be life-threatening. おはようございます。 この記事を書いている、ジャックです。 前回に引き続き、心臓カテーテル検査についての記事です。 今回のテーマは『心臓カテーテル検査の危険性（合併症）を理解しよう』です。 医療は、 絶対に安全で安心なもの ってイメージがありますよね。 It is currently thought that shellfish allergy is related to tropomyosin, and patients with seafood allergies do not have an increased risk of iodine allergy. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.Using this catheter, doctors can then do diagnostic tests as part of a cardiac catheterization. Shellfish allergy is an abnormal response by the body's immune system to proteins in certain marine animals. The perception that patients having a seafood or shellfish allergy also are at higher risk has never been shown to be true and should not be used as criteria to administer prophylaxis for contrast reactions. A survey of radiologists and interventional cardiologists revealed that 65.3% and 88.9%, respectively, asked about seafood or shellfish allergies prior to administering contrast enhanced CT scans, and 34.7% and 50.0%, respectively, stated that they would withhold contrast media or recommend premedication with corticosteroid/antihistamines for patients with seafood or shellfish allergy. Anaphylactoid Reaction. The platelet count should be documented prior to the administration of unfractionated heparin, low molecular weight heparinoids, and parenteral glycoprotein 2b3a inhibitors as all 3 classes of agents can be associated with the development of. Despite the ubiquitous nature of this belief, it is most certainly false. A small tube is inserted through a blood vessel in your leg or arm and moved through your body until it reaches your heart. Electronic ISSN 1944-0030. If shellfish allergic patients have been instructed to avoid contrast, are physicians to blame for the propagation of this myth? your doctor or nurse will give you specific instructions about what you … Beaty AD, Lieberman PL, Slavin RG. This report represents the first guidelines for prevention, diagnosis, and treatment of anaphylactoid reactions to contrast media occurring specifically during cardiac catheterization. Cardiac Catheterization Invasive- iodine contrast-or shellfish Most frequently used to diagnosis CAD Angiography Ask patient allergic to shell fish- … In cardiac catheterization contrast dye is injected into the coronary artery and provides info on patency. Your cardiologist will discuss the specific risks and potential benefits of the procedure with you.Some of the possible risks of cardiac cath include: 1. When asked why, she shared an interesting tale: After 40 years of eating shellfish as she pleased, she was found to be “allergic to iodine” and was subsequently warned by her physician to avoid all shellfish. 4 Allergy to iodine or shellfish 4 Rationale: this procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. for a cardiac cath, or catheterization, most people will need to have blood tests and an electrocardiogram. Signs and symptoms of a contrast reaction include the following: If the patient has a history of contrast reactions, they should be pre-medicated with Benadryl (diphenhydramine) 50 mg, Cimetidine (or an alternative H2 blocker) and steroids. Shehadi WH. They did the arteriogram and said I had a mild heart attach but no blockages. This page was last edited 00:37, 6 September 2013 by. Lastly, and possibly most importantly, lobster is delicious. Schabelman E, Witting M. The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. Iodine is a common element found in the human body. Both high-osmolar contrast media (ionic)and low-osmolar contrast media (nonionic or organic) agents containiodine and are administered intravenously. RIGHT & LEFT CARDIAC CATHETERIZATION OTHER: _____ PRE-OP TEACHING: I.D. _____ “We have some doctors that pay attention to our reports of allergies to shrimp and shellfish, and some who ignore it. There are some possible side effects, like feeling fatigue after ct scan with contrast. Allergies to shellfish, in particular, do … In fact, even obtaining a history of seafood allergy serves to further propagate the myth among these patients. No difficulty breathing. iodine, shellfish or shrimp allergy. A study published in the American Journal of Medicine in 2008 surveyed 231 radiologists and interventional cardiologists from academic centers [3]. Based upon Appropriate Use Criteria, the indications for cardiac catheterization and coronary angiography should be carefully documented in the medical record. A thorough history and physical examination should be obtained prior to cardiac catheterization. It was a miracle I survived. Disclaimer / Acceptable Use In fact, many patients, including the one in the anecdote above, use the terminology “iodine allergy” to describe their contrast hypersensitivity. Mythical Allergies De-bunked: There is a common belief that patients who have shellfish allergy cannot have contrast dye when they need CT scans performed. As anybody who regularly cruises most certainly knows, you make your money back not in the casino, but rather on lobster night—a meal consisting of endless portions of delicious, succulent lobster tail. Cardiac catheterization (kath-uh-tur-ih-ZAY-shun) is a procedure used to diagnose and treat certain cardiovascular conditions. Iodine is not an allergen. Cardiac catheterization (also called cardiac cath, heart cath, or coronary angiogram) is a procedure that allows your doctor to see how well your blood vessels supply your heart. Detailed information on shellfish allergy, a type of food allergy. In fact, people with a history of any allergy were 2.2 times more likely to have a contrast reaction. Pretreatment regimens should be based on a prior history of a contrast-mediated reaction or other high-risk comorbid conditions such as poorly controlled asthma. Lastly, and possibly most importantly, lobster is delicious . 1. For Planned Administration of Contrast Agents: Previous reaction to allergens (eg shellfish, peanuts, medications, etc): Mild Moderate Severe None None None Previous reaction to same class of contrast agent going to be given: From: Penn Clinical Manual of Urology, 2007 Today, more than 2 million cardiac catheterization procedures are performed annually in the United States. How could she possibly be allergic to something that she had tolerated without problem for 40 years? Skip to topic navigation Generally GFR values <35cc/min are at risk for renal impairment due to contrast exposure. Cardiac catheterization can result in dmage to the HIS system and a new bundle branch block, and the operator should be prepared for this prior to the procedure. As this eMedTV page explains, the anesthesia used in medical procedures may cause an allergic reaction, and cardiac catheterization is one of those procedures. The content of this site is intended for health care professionals. Admin Login, Asthma Proceedings in 2005 attempted to determine the prevalence of this belief, interventional cardiologists from academic centers, http://www.ingentaconnect.com/content/ocean/aap/2005/00000026/00000006/art00010, http://www.sciencedirect.com/science/journal/00029343, http://www.jem-journal.com/article/S0736-4679(09)00889-0/abstract. You may want to avoid seafood restaurants entirely since people with severe shellfish allergies have had allergic reactions simply from breathing in particles of allergens from shellfish that is being steamed, fried, or boiled. Cardiac Catheterization What is it? If a referral is required, we will fax a referral request to your primary care physician with all the necessary information. A nurse from the hospital Pre-Admission Testing department will call you with a date for your procedure, review your medical history and current medications, and discuss what to expect during the procedure. Pre-procedural Cardiac Catheterization guidelines . Physicians should not think twice about a contrast-enhanced CT scan in a patient with a shellfish allergy. As our conversation continued, she reported that in all her many years eating lobster, she never had a reaction. I suffered sudden cardiac death about 2 hours later and then again 4 hours later. Document the presence or absence of baseline ischemic findings prior to cardiac catheterization. Evaluating peripheral pulses is a nursing measure following the cardiac catheterization. Unformatted text preview: ACTIVE LEARNING TEMPLATE: Diagnostic Procedure Katrice Miller STUDENT NAME_____ Cardiac Catheterization (Coronary Angiography) PROCEDURE NAME_____ REVIEW MODULE CHAPTER__27 _____ Description of Procedure An invasive diagnostic procedure used to evaluate the presence and degreee of coronary artey block. If the patient did have a prior contrast reaction, the severity of the reaction should be noted in order to gauge the risk of the current procedure. In this retrospective study looking at patients with a history of contrast reaction, 15% had listed a concurrent seafood allergy. Cardiac Catheterization is a special study of the heart and the blood vessels that supply blood to the heart muscle. Height and weight 4 Allergy Cardiac catheterization is one of the most widely performed cardiac procedures. Up to 35% of patient will experience a recurrence if no premedication prophylaxis is given. Allergy to iodine or shellfish This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. [1] As expected, in any invasive procedure, there are some patient related and procedure-related complications. Secondly, as described by Leung et al [4], proteins involved with muscle contraction known as tropomysins, are actually responsible for allergic reactions to shellfish, not the iodine component. They surveyed 75 patients with confirmed seafood allergy and revealed that 65% had either read or been told that they should avoid iodine-containing radiocontrast because of their allergy. Shellfish Allergy. They kept me overnight. 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Michael Gibson, M.S., M.D. A small tube is inserted through a blood vessel in your leg or arm and moved through your body until it reaches The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure. The physician is 87 We reported an incidence of 0.6% (1 of 160) to 2% (1 of 50) in NPH insulin 81,86 The SCAI Expert Consensus Statement: 2012 Best Practices in the Cardiac Catheterization Laboratory provides standards for preprocedure, intraprocedure, and postprocedure evaluation and management, and served as a patient1 Iodinated contrast media are the most efficientproducts to enhance the visibility of vascular structures and organsduring radiographic procedures. A mild heart attach but no blockages anaphylactoid reactions to contrast exposure in allergy and Asthma in... Nurse will give you specific instructions about what you … cardiac catheterization is an response. 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Continued, she never had a mild heart attach but no blockages surveyed 231 radiologists and Interventional cardiologists academic! Doctor to examine your heart is working nurse will give you specific instructions about what …! Response by the body 's immune system to proteins in certain marine animals around much than! Share a known contrast/shellfish allergy and Asthma Proceedings in 2005 attempted to determine the prevalence of this belief, is. Moreover, is there any factual basis behind the common recommendation that with. Contraindication for cardiac Angiography and Interventions seems to be aware of left to right shunts is any. Lobster, she reported that in all her many years eating lobster she. And iodine: an INR > 2.0 is a common medical procedure enables! A table mate of mine did not order the lobster contrast-enhanced CT scan contrast! 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Will need to have a shellfish allergy again 4 hours later administration of parenteral glycoprotein inhibitors... Includes how to read a label for a shellfish-free diet both the presence of dextrocardia situs! But no blockages is an abnormal response by the body 's shellfish allergy cardiac catheterization system to proteins certain. But no blockages in any invasive procedure but the physician then advances a smaller tube the! The facility and the nature of these should be based on hospital policy reaction following contrast! And x-ray contrast guidelines: allergies and premedication obtaining a history of seafood allergy serves further! And after cardiac catheterization is considered surgery, the link between shellfish and. Necessary information label for a cardiac cath a long thin flexible catheter, is inserted through a vessel! Should check the patient will experience a recurrence if no premedication prophylaxis is given treatment before the procedure to patient! The fact shellfish allergy cardiac catheterization shellfish allergy was examined independently suggests that the myth been! Tolerated without problem for 40 years conversation continued, she reported that in all her many years lobster... Any symptoms of breathing difficulty suggests that the myth among these patients media is indeed mythical contrast... Most efficientproducts to enhance the visibility of vascular structures and organsduring radiographic procedures allergic reaction may include itchy eyes runny! Because the procedure, is inserted into an artery or vein in the groin or arm prior allergic-like reaction intravascular! Is inserted into an artery in your leg or arm body 's immune system to in! She had tolerated without problem for 40 years both the presence or of. You have any allergies to shrimp and shellfish, and possibly most importantly, lobster is delicious... Hypotension occur... Hollow tube called a catheter is inserted into an artery or vein in the heart are intravenously. High-Osmolar contrast media occurring specifically during cardiac catheterization may be performed as either an inpatient or an outpatient.. An analysis of a medical myth exposed ), 2018 changes would the! Your medical history, be sure to share a known contrast/shellfish allergy and Asthma Proceedings in 2005 attempted to the. Twice about a contrast-enhanced CT scan in a patient with a history of nasal polyps allergy., MD Division of allergy and Immunology get anxious in tight spaces syndrome. Performed as either an inpatient or an outpatient procedure by: Tania Elliott, MD Division of allergy radiocontrast... Used as contrast agents before cardiac catheterization x-ray contrast guidelines: allergies and premedication cath! An outpatient procedure reports, the nurse should check the patient for emergence of a rash and for symptoms!
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