Adequate hydration is a particular concern because most patients are asked to avoid oral intake starting the night before their procedure. They can easily present to the catheterization laboratory in a relatively dehydrated state. It is important to initiate intravenous fluid early in these cases, while carefully monitoring patients with heart failure who may be sensitive to rapid volume changes. The most well-studied fluid regimen in clinical trials has been 0.45%

Table 5-4. Strategies to Minimize Contrast-Induced Nephropathy in At-Risk Patients

Periprocedural strategies


N-Acetylcysteine Ascorbic acid Hemofiltration

Intraprocedural strategies

Avoid nephrotoxic medications (e.g., NSAIDs)

Minimize use of contrast agents

Use low- or iso-osmolar contrast agents

0.9 NS 1 mL/kg/hr starting 6 to 12 hr before and after procedure or D5W with sodium bicarbonate 154 mEq/L at 3 mL/kg/hr starting 1 hr before procedure and continuing at 1 mL/kg/hr for 6 hr after procedure 600-1200 mg orally twice daily starting the day before the procedure for 2 days 3 g orally 2 hr before procedure and 2 g orally two times the next day Starting 4-6 hr before the procedure and continued for 18-24 hr after

Selective left ventriculography, smaller catheters, biplane coronary angiography

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