Blood bottle shortage: Advice for radiographers using PGDs for administration of contrast agents

Guidance published for radiographers across the UK

Published: 10 September 2021 Contrast Media and Drugs

Specialist Pharmacy Services (SPS) in England have published guidance for the efficient use of blood bottles during the current shortage.

The SPS suggests that clinically urgent testing can continue and this includes 'essential for safe prescribing of medication or monitoring of conditions’.

Should this change or blood results not be available, radiographers in all four countries of the UK should follow the guidance below agreed with the Royal College of Radiologists.

Where a Patient Group Direction (PGD) is in place for contrast agent administration, radiographers must follow the PGD without deviation.

If the PGD states that an eGFR is needed and is not available, the radiographer cannot administer the contrast agent using the PGD. In line with the RAZNCR Iodinated Contrast Guidelines endorsed by the RCR: ‘R4. Intravascular iodinated contrast media should be given to any patient regardless of renal function status if the perceived diagnostic benefit to the patient, in the opinion of the radiologist and the referrer, justifies this administration.’

The radiographer should refer the patient to a prescribing clinician (radiologist) for a clinical decision, with a Patient Specific Direction (PSD)/prescription in place if considered appropriate, and the patient agrees.

This may cause issues in practice during the current blood bottle shortage, but PGDs are black and white, so they don't have the flexibility to adapt to such scenarios.

There is no change for emergency patients ‘R5. Emergency imaging procedures requiring contrast media administration e.g. acute stroke, acute bleeding, trauma etc. should not be delayed to obtain renal function testing results prior to the procedure.’

Whilst locally PGDs could be revised and reauthorised to remove specific requirements unless the supporting guidance is revised this would raise potential safety concerns. 

The SoR will update this advice should national guidance alter the situation. Please direct any queries about this guidance to Professional Officer Clinical Imaging Sue Johnson at [email protected].

View NHS Scotland guidance here: NHS Scotland Guidance: Recommended actions to optimise diagnostic testing during blood tube shortages.
View Welsh Government guidance here: Written Statement: Blood Collection Products Supply Issue (24 August 2021).
Northern Ireland is party to NHS England guidance.