Risk for adverse reaction to iodinated contrast media: a validation study

Juchem, Beatriz Cavalcanti; Almeida, Miriam de Abreu

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Revista Gaúcha de Enfermagem

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Sumário

Original Articles • Rev. Gaúcha Enferm. (Online) 38 (2) • 2017 • https://doi.org/10.1590/1983-1447.2017.02.68449 copy

Risk for adverse reaction to iodinated contrast media: a validation study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives

To validate the content of the nursing diagnosis, Risk for adverse reaction to iodinated contrast media, and its nursing interventions and outcomes according to standardized terminologies.

Method

Fehring’s (1987) model of diagnosis content validation was used, with the participation of experts including registered nurses and physicians.

Results

Seventy-four experts validated the title and the definition of the diagnosis, and assessed 28 risk factors, five of which were validated as primary, 22 as secondary, and one was discarded. The inclusion of the diagnosis in the NANDA International Taxonomy II was evaluated by 41 registered nurses and validated for Area II – Safety/ Protection and Class 2 – Physical Injury. Sixty-three experts validated seven nursing interventions as primary and one as secondary, and seven nursing outcomes as principal and one as minor.

Conclusion

The title, definition, and risk factors of the diagnosis were validated, in addition to eight interventions and eight nursing outcomes.

Diagnostic imaging; Contrast media; Nursing diagnosis; Nursing process; Validation studies

Risk Factors	Weighted average

	(n = 74)
Validated as primary
History of previous adverse reaction to iodinated contrast media	0.92
Renal disease	0.91
Dehydration	0.86
Concurrent use of nephrotoxic medications	0.82
Intravascular injection of iodinated contrast media	0.81
Validated as secondary
Physical and chemical properties of iodinated contrast media (concentration. viscosity. high osmolality and ion toxicity)	0.79
Extremes of age	0.77
Pulmonary disease	0.75
Concurrent use of metformin	0.75
Prior or actual chemotherapy treatment	0.71
Generalized debilitation	0.71
Previous axillary lymph node dissection in the limb to be injected	0.70
Endocrine disease	0.69
Pheochromocytoma	0.69
Distal intravenous access sites: hand, wrist, foot, ankle	0.67
Use of pump injector with high flow rates	0.66
Multiple attempts to obtain intravenous access	0.65
History of allergies	0.64
Prior or actual radiation in the limb to be injected	0.64
Sensory limitation	0.64
Blood dyscrasias	0.63
Autoimmune disease	0.62
Indwelling intravenous lines in place for more than 24 hours	0.58
Heart disease	0.57
Concurrent use of interleukin-2	0.56
Concurrent use of beta-blockers	0.55
Anxiety	0.52
Not validated
Female sex	0.31

Nursing interventions	Weighted average

	(n = 63)
Validated as primary
Examination assistance	0.93
Documentation	0.92
Allergy management	0.91
Intravenous (IV) insertion	0.89
Vital signs monitoring	0.87
Respiratory monitoring	0.87
Decision-making support	0.86
Validated as secondary
Fluid management	0.74

Nursing outcomes	Weighted average

	(n = 63)
Validated as primary
Respiratory status: airway patency	0.88
Knowledge: medication	0.88
Allergic response: systemic	0.86
Allergic response: localized	0.84
Kidney function	0.82
Hydration	0.81
Knowledge: treatment procedure	0.80
Validated as secondary
Tissue perfusion: peripheral	0.79

Title: Risk of adverse reaction to iodinated contrast media
Domain II: Safety/protection
Class 2: Physical Injury
Definition: At risk for any harmful or undesirable reaction associated with the use of iodinated contrast, which can occur during or up to seven days after the injection of contrast agent.
Primary risk factors
◾ History of previous adverse reaction to iodinated contrast media
◾ Renal disease
◾ Dehydration
◾ Concurrent use of nephrotoxic medications
◾ Intravascular injection of iodinated contrast media
Secondary risk factors
◾ Risk of any harmful or undesirable reaction associated with the use of iodinated contrast, which can occur during or up to seven days after the injection of contrast agent
◾ Extremes of age
◾ Asthma
◾ Concomitant use of metformin
◾ Fragile veins (e.g. prior or actual chemotherapy treatment; previous lymph node dissection in the limb to be injected; distal intravenous access sites: hand, wrist, foot, ankle; multiple attempts to obtain intravenous access; prior or actual radiation in the limb to be injected; indwelling intravenous lines in place for more than 24 hours)
◾ Generalized debilitation
◾ Diabetes mellitus
◾ Use of pump injector with high flow rates
◾ History of multiple allergies with need for treatment
◾ Sensory limitation
◾ Other concomitant pathologies (e.g.: pheochromocytoma, multiple myeloma, sickle cell disease, autoimmune disease, cardiac disorders)
◾ Use of other concomitant medications (e.g.: interleukin-2, betablockers)
◾ Anxiety

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Autor correspondente: Beatriz Cavalcanti Juchem. E-mail: bcjuchem@hotmail.com