Why do you warm IV contrast?

With extrinsic warming of contrast there is a 3x less frequency of extravasation than if not warmed when high injection rates are used.

Should you place IV contrast in a warmer prior to using it?

Why would you not warm iodinated contrast?

• Cost and record keeping is needed
• Purchase warmer
• Keep log and monitor the warmer for correct temperature daily (Joint Commission rule)
• Need to label bottles with 30 day expiration date (Joint Commission rule).
• Extrinsic warming (to 37° C) does not appear to affect adverse event rates for intravenous injections of iopamidol 300 of less than 6 ml/sec but is associated with a significant reduction in extravasation and overall adverse event rates for the more viscous iopamidol 370."
  Rate of Contrast Material Extravasations and Allergic-like Reactions: Effect of Extrinsic Warming of Low-Osmolality Iodinated CT Contrast Material to 37° C
• "Because contrast media are designated as medications, the warming of contrast media has fallen under the regulation of The Joint Commission, which mandates that if contrast media are to be extrinsically warmed, there must be both a daily temperature log for each warmer and evidence of regular maintenance for the warming device(s). This regulation has led some institutions to reconsider the use of these warming devices and reevaluate whether warming iodinated contrast media to human body temperature has a significant practical, rather than just a theoretical, benefit for IV LOCM administration. Although some institutions have discontinued the routine use of contrast media warmers for low-rate .
• Extrinsic warming of iodinated contrast material to human body temperature (37°C) may be helpful to minimize complications and improve vascular opacification in the following circumstances:
  • For high-rate (>5 mL/second) IV LOCM power injections
  • For injections of viscous iodinated contrast (e.g., iopamidol 370, and presumably other contrast media with a similar or higher viscosity)
  • For direct arterial injections through small-caliber catheters (5 French or smaller)
  • For intravenously injected arterial studies in which timing and peak enhancement are critical features"