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Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety
Peggy Lambert1,2,3,4,5,6,7,8,9, Kristine Chaisson1,2,3,4,5,6,7,8,9, Susan Horton1,2,3,4,5,6,7,8,9
1Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire.
Critical Care Nurse
|February 3, 2017
Summary
Implementing standardized nursing care significantly reduced contrast-induced acute kidney injury (AKI) in cardiac procedures. This quality improvement initiative demonstrated a notable decrease in AKI rates, particularly in high-risk patients.
Area of Science:
- Nephrology
- Cardiology
- Quality Improvement
Background:
- Acute kidney injury (AKI) affects 3-15% of patients undergoing cardiac catheterization.
- Contrast material is a significant risk factor for AKI in these procedures.
Purpose of the Study:
- To reduce contrast-induced AKI after cardiovascular interventional procedures.
- To implement and evaluate a nursing-led quality improvement initiative.
Main Methods:
- A 10-center quality improvement consortium prospectively collected data from 20,147 nonemergent percutaneous coronary interventions (2007-2012).
- A nursing task force developed and implemented standardized evidence-based best practices.
Main Results:
- Significant reductions in AKI rates were observed across 10 centers.
- A 21% reduction in AKI was noted overall, with a 28% reduction in patients with estimated glomerular filtration rate < 60 mL/min/1.73 m².
- Key factors included multidisciplinary teams, standardized fluid orders, IV fluid bolus, patient education, and contrast volume limitation.
Conclusions:
- Standardization of evidence-based nursing care practices can effectively reduce contrast-induced AKI.
- Multidisciplinary collaboration and standardized protocols are crucial for improving patient outcomes.
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