Reducing radiocontrast use in the cardiac catheterization laboratory--a behavioral modification approach.
OBJECTIVE
This study assessed the impact of behavioral modification techniques on reducing the volume of contrast dye used during cardiac catheterization and percutaneous coronary intervention (PCI).


BACKGROUND
Excessive administration of radiocontrast agents in the catheterization laboratory is associated with numerous adverse effects including radiocontrast nephropathy. This may be precipitated by using large volumes of contrast dye, particularly in diabetic patients and those with pre-existing renal dysfunction.


METHODS
Data were prospectively collected on 20,322 consecutive patients undergoing cardiac catheterization and PCI between January 1997 and December 2001. A focused behavioral modification program was initiated in late 1998. The physician was informed verbally during the course of the procedure and by letter after the procedure regarding the volume of contrast dye used for cases in which the radiocontrast volume exceeded 300 mL. Data were analyzed using the Fischer's exact test.


RESULTS
In the prefeedback years (1997 and 1998), high contrast use occurred in 7.7% (n = 602) of the total cases (n = 7799). In the postfeedback years (1999, 2000, and 2001), this declined to 3.6% (n = 445) of the total cases (n = 12,523), representing a 53% reduction (P < .001). The effect was most pronounced in PCI, with the percentage of high contrast cases decreasing from 24% (n = 563) of the total PCI cases (n = 2348) to 10.6% (n = 359) of the total PCI cases (n = 3386), representing a 56% reduction (P < .001).


CONCLUSIONS
Our study demonstrates the effectiveness of behavioral modification and the contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce costs.
Khawaja
Azimuddin Tareq
AT
Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, Pittsburgh, PA 15224, USA. TKhawaja@msn.com
Srinivasan
Venkatraman
V
Hawa
Zafir
Z
Gradman
Alan H
AH
D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012449:Safety; D014481:United States
D003287:Contrast Media