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Contrast induced nephropathy (CIN) is a common post-procedural complication after cardiac catheterization with total volume of contrast administered directly associated with the incidence of CIN. The purpose of our study was to evaluate the effect of physician behavioral modification in the form of informing the operating physician of the calculated maximum allowed dose of contrast during the pre-procedure timeout, on reducing the amount of contrast used during the procedure.
Using the hospital database, all patients who underwent procedures in the cardiac catheterization lab from January 2013 to August 2016 were identified. In addition to total contrast used, type of procedure performed and operator performing the procedure were also identified. During September and October 2013, an intervention in the form of new timeout procedure was implemented in catheterization lab, in which operating physician was informed about the calculated maximum allowed dose of the contrast. Overall mean contrast use was determined for 8 months prior to the intervention and for one, two and three years after the intervention. Mean contrast used for top three most frequently performed procedures and top three most frequent operators was also analyzed.
A total of 13,000 cases were included in the study. Across all procedures, mean contrast used during the 8 months prior to intervention was 118 ml. Mean contrast use for the first year after the intervention was 105 ml and for second year was 106 ml. For the third year, mean contrast used decreased further to 99 ml per case. Contrast use decreased significantly for top three institutional operators as well as for top three procedures.
Analysis revealed a significant reduction in radiocontrast use across operators and procedures after a simple intervention in the form of timeout procedure that included informing the physicians of the maximum allowed dose of contrast for each patient. Decrease in mean contrast used was sustained over a period of three years. With this straightforward and easy to implement intervention, patients were exposed to less of the nephrotoxic contrast thus reducing the risk of developing dose dependent CIN.