Statement from the ACR Committee on Drugs and Contrast Media | Imaging Technology News

ACR药物和造影剂委员会，隶属于ACR质量和安全委员会，is aware of the current global shortage of iodinated contrast media.

May 13, 2022 — The ACR Committee on Drugs and Contrast Media, within the ACR Commission on Quality and Safety, is aware of the currentglobal shortageofiodinated contrast media. The following statement offers some recommendations on how providers may address this emergency locally. The recommendations are not exhaustive or prescriptive. They are intended as a resource for imaging providers and their institutions to continue to provide high-quality patient care during times of shortage of contrast media. Providers and administrative leaders are encouraged to incorporate sound clinical judgment in all decisions affecting patient care.

The ACR recognizes that this is a rapidly evolving situation. Guidance may be revised as circumstances continue to change.

The ACR Committee on Drugs and Contrast Media recommends the following considerations for facilities operating during a time of iodinated contrast media shortages.

Risk mitigation strategies during an iodinated contrast shortage include:

Utilize alternative studies to answer the clinical question such as non-contrast CT, MR with or withoutgadolinium-based contrast media, ultrasound with or without ultrasound contrast agents,
nuclear medicine, or PET/CT, when feasible. Please refer to theACR Appropriateness Criteriaguidelines for indicated alternative studies as needed. (Scroll down to AC Portal and use the “Explore by scenario” icon.)
Look for alternative versions of contrast agents, which may be marketed under a different brand name or intended clinical use. (Note: US market availability may differ from global availability.)
Source contrast from other vendors, if able, and consider having at least two vendor products on formulary
如果您目前有更多的一次性小瓶，请联系您的机构药房，以确定是否有可能将小瓶重新包装成更小的等分，以减少浪费(机构级别)。
Minimize individual doses administered to reduce waste. Some options include:
- Weight-based dosing for CT in available aliquots/vial sizes to avoid waste
- Reducing dose in conjunction with low kVp protocols that improve contrast conspicuity
- Reducing dose and acquire studies with dual-energy protocols (where available) that improve contrast conspicuity
Reserve higher concentration (mg iodine / ml) agents for angiographic studies and multiphase studies, which require optimal vascular visualization.
口服、直肠、泌尿生殖系统使用非离子造影剂的替代品(例如:碘胺葡胺或散唑)。考虑在CT和PET/CT中用于口腔混浊的钡基产品，以及替代碘基制剂(离子剂)。(Please refer to the ACR Contrast ManualAPPENDIX A: Contrast Media Specifications Tablefor oral contrast agents).
Work with other departments, such as Urology, Radiation Oncology, Pain Management, Gastroenterology, Vascular Surgery and Cardiology, which utilize iodinated contrast to prioritize limited supply usage.

Considerations

Do not sacrifice image quality by using suboptimal doses; ensure enough contrast dose is used for diagnostic image quality.
美国疾病控制与预防中心和联合委员会的指导方针指出，被制造商标记为“单剂”或“单次使用”的小瓶只能用于单个患者，因为它们通常缺乏抗菌防腐剂，如果使用不当，可能会被污染并成为感染源。一些医源性感染的例子已经被报道为多个患者不当使用一次性小瓶，经常违反基本的感染控制技术。其中一些事件发生在药物短缺时期，以减少浪费。However, the CDC issued astatement in May of 2012that offered guidance for how contents fromunopenedsinge-dose/single-use vials can be repackaged for multiple patients but only performed by qualified healthcare personnel in accordance with standards in United States Pharmacopeia General Chapter <797> Pharmaceutical Compounding-Sterile Preparation. The ASHP, an organization representing pharmacists, postedtheir guidance也
- In the setting of severe shortage, institutions can explore developing their own guidelines for the safe use of single-use vials for more than one patient following proper infection control guidance and ensuring institution approval since this would deviate from medication and regulatory guidelines.

For more information:www.acr.org