Kontrast Madde Nefropatisi ve Hemşirelik Girişimleri

Öz

Günümüzde tanı ve tedavi amaçlı, kontrast madde kullanılarak yapılan görüntüleme yöntemleri yaygın olarak kullanılmaktadır. Kontrast maddelerin kullanımı, akut böbrek hasarı (ABH) riskini beraberinde getirmektedir. Kontrast maddeye bağlı gelişen ABH, hastanede kalış süresinin uzamasına, mortalite, morbidite ve giderlerin artmasına neden olur. Kontrast madde nefropatisinde (KMN) hastaya bağlı riskler ve çeşitli korunma yöntemleri bulunmaktadır. Kontrast madde nefropatisini önlemede, en temel yaklaşım risklerin azaltılması ve hidrasyonun sağlanmasıdır. Riskli bireylerin hemşire tarafından izlenmesi, hemşirelerin önleme yöntemleri, tedavi ve sonuçlarını bilmesi KMN gelişim ve görülme sıklığını azaltacaktır. Bu derleme ile KMN’deki güncel uygulamalar, risk faktörleri, patofizyolojisi, hemşirelik tanı, uygulama ve eğitimleri sunulacaktır.  

Anahtar Kelimeler

• Kontrast madde nefropatisi,Akut böbrek hasarı,Hemşirelik,Hemşirelik bakımı

Contrast-Induced Nephropathy and Nursing Interventions

Öz

Nowadays radiographic imaging scans using contrast media for diagnosis and treatment are widely used. The use of contrast agents is associated with an acute renal failure risk. Acute kidney injury due to contrast agent can lead to prolongation of hospital stay, mortality, morbidity and costs. Contrast-induced nephropathy (CIN) has patient-related risks and various prevention methods. The basic approach for prevention CIN is to reduce risks and provide hydration. The nurses will reduce the incidence and development of CIN following-up of the risky individuals, having knowledge about the prevention methods, treatment and consequences. This review will present the current practices, risk factors, pathophysiology, nursing diagnosis, practice and training in CIN.

Anahtar Kelimeler

• Radiocontrast-induced nephropathy,Acute kidney injury,Nursing,Nursing care

Kaynakça

1. 1. Lambert P, Chaisson K, Horton S, Petrin C, Marshall E, et. all. Reducing Contrast-Induced Acute Kidney Injury: How Nurses Can Improve Patient Safety. Crit Care Nurse 2017; 37(1):13–26.
2. 2. Wood SP. Contrast-induced nephropathy in critical care. Crit Care Nurse 2012;32(6):15-23.
3. 3. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 2014;7(1):1-9.
4. 4. McCullough PA. Contrast-induced acute kidney injury. Journal of the American College of Cardiology 2008; 51(15):1419–1428.
5. 5. Lameire N, Kellum JA. Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2). Critical Care 2013; 17(1):205.
6. 6. Mehta RL, Kellum JA, Shah AV, Molitoris BA, Ronco C, et all. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care 2007; 11(2).
7. 7. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012; 2:69-88.
8. 8. Hatipoğlu E. Akut Böbrek Yetersizliği. Ecder, çev. ed. Böbrek Fizyopatolojisi: Temel Bilgiler. İstanbul: İstanbul Tıp Kitabevi; 2012. s. 291-310.

9. 9. Aoun J, Nicolas D, Brown JR, Jaber BL. Maximum allowable contrast dose and prevention of acute kidney injury following cardiovascular procedures. Curr Opin Nephrol Hypertens 2018, 27:121-129.
10. 10. Gallegos Y, Taha AA, Rutledge DN. CE: Preventing contrast-induced Acute kidney injury. Am J Nurs 2016 Dec;116(12):38-45.
11. 11. Susan I. Contrast-induced nephropathy: Nursing implications. Crit Care Nurse 2012 June; 32(3): 41-48.
12. 12. Lewington A, MacTier R, Hoefield R, Sutton A, Smith D, Downes M. Prevention of Contrast Induced Acute Kidney Injury (CI-AKI) In Adult Patients. The Renal Association, British Cardiovascular Intervention Society and The Royal College of Radiologists. https://www.bcis.org.uk/wp-content/uploads/2017/03/PSSB16_Renal_Association_Clinical_Practice_Guideline_on_Prevention_Final_Version.pdf Erişim tarihi: 23.04.2019.
13. 13. Owen RJ, Hiremath S, Myers A, Fraser-Hill M, Barrett B. Canadian association of radiologists consensus guidelines for the prevention of contrast-induced nephropathy: Update 2012. Can Assoc Radiol J 2014 May;65(2):96-105.
14. 14. Rolley JX, Salamonson Y, Wensley C, Dennison CR, Davidson PM. Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions. Aust Crit Care 2011 Feb;24(1):18-38.
15. 15. Jorgensen AL. Contrast-induced nephropathy: pathophysiology and preventive strategies. Crit Care Nurse 2013 Feb;33(1):37-46.
16. 16. Pakfetrat M, Nikoo MH, Malekmakan L, Tabande M, Roozbeh J, et al. Risk factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions. Iran J Kidney Dis 2010 Apr;4(2):116-22.
17. 17. Schweiger MJ, Chambers CE, Davidson CJ, Blankenship J, Bhalla NP, et al. Prevention of contrast induced nephropathy: recommendations for the high risk patient undergoing cardiovascular procedures. Catheter Cardiovasc Interv 2007 Jan;69(1):135-40.
18. 18. Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, et al. Prevention of contrast media–associated nephropathy randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002;162(3):329–33.
19. 19. Bangalore S, Briguori C. Preventive strategies for contrast-ınduced acute kidney ınjury and the winner Is… Circ Cardiovasc Interv. 2017 May;10(5).
20. 20. Berwanger O, Cavalcanti AB, Sousa AMG, Buehler A, Castello-JUnior HJ, et al. Acetylcysteine for the prevention of renal outcomes in patients with diabetes mellitus undergoing coronary and peripheral vascular angiography a substudy of the acetylcysteine for contrast-ınduced nephropathy trial. Circ Cardiovasc Interv 2013; 6:139-145.
21. 21. Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, at al. N-Acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 2006; 354:2773-2782.
22. 22. Merten GJ, Burgess WP, Gray LV, Holleman JH, Roush TS, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291(19):2328–2334.
23. 23. Tamura A, Goto Y, Miyamoto K, Naono S, Kawano Y, et al. Efficacy of single-bolus administration of sodium bicarbonate to prevent contrast-induced nephropathy in patients with mild renal insufficiency undergoing an elective coronary procedure. Am J Cardiol 2009;104(7):921-925.
24. 24. Valette X, Desmeulles I, Savary B, Masson R, Seguin A, et al. Sodium bicarbonate versus sodium chloride for preventing contrast-associated acute kidney injury in critically ill patients: a randomized controlled trial. Crit Care Med 2017 Apr;45(4):637-644.
25. 25. Brown JR, Robb JF, Block CA, Schoolwerth AC, Kaplan AV, et al. Does safe dosing of iodinated contrast prevent contrast-induced acute kidney injury? Circ Cardiovasc Interv 2010; 3(4):346-350.
26. 26. Deek H, Newton P, Sheerin N, Noureddine S, Davidson PM. Contrast media induced nephropathy: a literature review of the available evidence and recommendations for practice. Aust Crit Care 2014; 27(4):166-71.
27. 27. Wrobel W, Sinkiewicz W, Gordon M, Wozniak-Wisniewska A. Oral versus intravenous hydration and renal function in diabetic patients undergoing percutaneous coronary interventions. Kardiol Pol 2010; 68(9):1015–1020.
28. 28. Cheungpasitporn W, Thongprayoon C, Brabec BA, Edmonds PJ, O’Corragain OA, et al. Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological proce- dures: a systematic review and meta-analysis of randomized controlled trials. North Am J Med Sci 2014;6(12):618-624.
29. 29. Solomon R. Hydration to prevent acute kidney injury after angiography: the AMACING trial. Coronary Artery Disease 2017, 28:629–631.