Administration and supply of contrast media
For general principles of legal mechanisms, including PGDs, for the administration and supply of contrast agents refer to Legal mechanisms and contrast media (SPS page).
Parental (injected) contrast media
All parenteral (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 (SPS page).
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 accordance with local policy and governance requirements. 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 authorised to work under the relevant PGD takes over administration while a multi-injector device remains loaded, they must verify that the correct contrast media and/or sodium chloride have been loaded, are within the permitted period for use, and that infection prevention and control requirements have been followed. Before administering contrast media, the radiographer assuming responsibility must confirm patient eligibility, obtain consent in accordance with local policy, and ensure all PGD, governance and record-keeping requirements have been met.
Non-parenteral (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. The PGD must clearly state that it can be used for supply of the contrast media.
Once it has been supplied under the PGD, the contrast media 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).
Organisations should ensure that dilution, thickening and administration processes are governed by approved local protocols and that staff undertaking these activities are appropriately trained and deemed competent.
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. Please refer to the advice published by the Medicines and Healthcare products Regulatory Authority (MHRA).
Update history
- Republished
- Page contents fully reviewed. No changes made to content but formatting revised to improve flow. Contrast agent changed to contrast media throughout to reflect wording now used by professional bodies.
- Minor clarification of wording
- Published