🔹 1. General Principles
🔹 2. Contrast Dose Limits
🔹 3. Injection Rates and Volumes by Vessel
- Contrast volume should be minimized while achieving adequate opacification.
- Injection rate depends on vessel size, age/weight, catheter size, and modality (DSA vs CT angiography).
- Use nonionic, low-osmolar or iso-osmolar contrast agents (e.g., Iohexol, Iodixanol) to reduce nephrotoxicity and discomfort.
🔹 2. Contrast Dose Limits
- Using Omnipaque 300 - total of 6 ml/kg
🔹 3. Injection Rates and Volumes by Vessel
| Vessel | Injection Rate | Volume per Injection | Maximum Rate | Max Volume |
|---|---|---|---|---|
| Aortic Arch / Thoracic Aorta | 0.8–2.0 mL/sec | 1–2 mL/kg | 15 mL/sec | 30–40 mL |
| Abdominal Aorta | 1–2 mL/sec | 1–2 mL/kg | 10 mL/sec | 30 mL |
| Cerebral (ICA, Vertebral) | 0.5–1.5 mL/sec × 1–2 sec | 1–6 mL | 4 mL/sec | 8 mL |
| Pulmonary Artery | 1–2 mL/sec | 1–2 mL/kg (per side) | 10 mL/sec | 30 mL |
| Renal Artery | 0.5–1 mL/sec | 1–2 mL/kg | 4 mL/sec | 10 mL |
| SMA / Celiac | 1–2 mL/sec | 1–1.5 mL/kg | 5 mL/sec | 20 mL |
| Extremity Arteries | 0.5–1 mL/sec | 0.5–1 mL/kg | 3 mL/sec | 10 mL |
| Portal Vein (via transhepatic) | 0.5–1 mL/sec | 1–2 mL/kg | 4 mL/sec | 10–15 mL |
🔹 4. Safety and Monitoring
📚 References
- Hydration: Ensure IV hydration pre- and post-procedure (esp. in neonates and renal patients).
- Renal protection: Limit contrast to <3 g iodine/kg; avoid multiple studies in <24 hours.
- Allergy prophylaxis: Steroid + antihistamine protocol in known contrast allergy.
- Monitor: Creatinine (baseline and post-procedure if high-risk), urine output, hemodynamics.
📚 References
- Temple, Michael, and Francis E. Marshalleck. Pediatric Interventional Radiology: Handbook of Vascular and Non-Vascular Interventions. Springer, 2015.
- Towbin RB, et al. Interventional Radiology Techniques in Ablation. Springer, 2013.
➤ Pediatric contrast dose and injection tables. - Society for Pediatric Radiology (SPR) & SIR Guidelines:
Pediatric Interventional Radiology: Best Practices and Technical Guidelines. Available via SIR/SPI resources. - Restrepo R, et al. Contrast media use in children: a review. Radiol Clin North Am. 2011;49(1):45–71.
- Mayo JR, Aldrich J, Müller NL. Radiographic contrast material: nephrotoxicity and use in high-risk patients. AJR Am J Roentgenol. 1995;164(6):1251–1259.
- FDA Label Information for nonionic contrast agents (e.g., Omnipaque [iohexol], Visipaque [iodixanol]) – specific pediatric dosing guidance.