Administration and supply of contrast agents

For general principles of legal mechanisms, including PGDs, for the administration and supply of contrast agents refer to Legal mechanisms and contrast agents.

Injected contrast

All injected contrast agents, such as intravenous (IV) contrast, are prescription only medicines (POMs).

No delegation of administration of an injectable medicine supplied under a Patient Group Direction (PGD) is permissible under the legislation.

Therefore, injected contrast must be supplied and administered by the registered radiographer approved to operate under the PGD. This includes all preparation and any required manipulation of the contrast (e.g. dilution) and/or loading of pre-filled syringes into injectors. No part of the process can be delegated to another registered or unregistered HCP (e.g. healthcare assistant, radiographic assistant, nurse or another radiographer).

For further information refer to Delegation of roles under a PGD.

Multi-injector devices

Where multi-injector devices are used to administer contrast under a PGD, these must be set up by a radiographer who will be administering under the relevant contrast PGD.

At the time of set up, appropriate records (e.g. details of the contrast/sodium chloride loaded, date and time of loading, batch numbers and expiry, confirmation that infection prevention and control (IPC) procedures have been followed) must be completed in line with local guidance. No other person (e.g. a radiography assistant) can be involved in the setup of the multi-injector device where a PGD is being used to administer the contrast.

If, during the imaging session, another radiographer, also approved to work under the relevant PGD, takes over administration whilst the multi-injector device is still loaded (i.e. they do not load the contrast/sodium chloride themselves) they must check all the appropriate records to ensure the appropriate contrast/sodium chloride has been loaded and is within the permitted timeframe for the contrast/sodium chloride to be used, IPC procedures have been followed, appropriate patient consent gained and records completed. If they are assured that processes have been adhered to, they can then administer the contrast/sodium chloride to individuals under the relevant PGD.

Non-injected contrast

The following advice is provided in relation to prescription only contrast administered/supplied under a PGD that is not injected (i.e. it is administered by routes such as oral, rectal or vaginal) and requires manipulation prior to administration which may result in the use being unlicensed.

Diluting or thickening before administration

The contrast must first be supplied to the patient by the registered radiographer (or speech and language therapist) approved to operate under the PGD.

Once it has been supplied, the contrast agent can then be diluted/thickened and administered by the same registered healthcare professional who has made the supply under the PGD or another registered or unregistered HCP (e.g. healthcare assistant, radiographic assistant, nurse or another radiographer) under a locally approved protocol/standard operating procedure.

Governance

The process of dilution/thickening and/or administration should follow a locally approved protocol/standard operating procedure. This should include the required training and competence of the HCP undertaking the dilution/thickening and/or administration.

Labelling

Single dose medicines which are not injected and which are supplied by a registered HCP under a PGD and then immediately administered by another person, such as a non-registered HCP, in the same examination room or clinic do not require labelling. This has been confirmed by the Medicines and Healthcare products Regulatory Authority (MHRA) and Care Quality Commission (CQC).

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