Bolus vs Drip for DTPA administration

April 8, 2019

 

This post addresses why we use a bolus technique, most often, and not a drip. Here is the explanation: The manufacturer originally described bolus rather than drip with Ca-DTPA. Bolus also more closely follows the administration pattern of the original GBCA injection. Bolus has been preferred for administering iodine radiology contrast since the 1980s, where bolus and drip were compared. There is much better opacification of organs with bolus than with drip - much better penetration into the capillary spaces. For a brief time in the early 1990's slow bolus was recommended by manufacturers, but it quickly became clear that rapid bolus administration has vastly superior opacification (brightening) of organs and disease processes. SO rapid bolus is used with both iv Iodine contrast and CT and iv GBCA and MRI. The down-side for GDD patients is that the Gd has now deposited into these various deep extra-capillary spaces in higher concentration. So the technique for administration of DTPA empirically is to follow the path of where the GBCA went. This is the rationale.I will use a drip technique as one variation to make the Flare less strong, but this is also empiric thinking. The best method to manage the Flare is to administer concurrent extended hypersensitivity protocol drugs: which is steroid and antihistamines. Follow-up administration of minerals also makes sense.

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