contrast media venipuncture & tomography

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CONTRAST MEDIAVenipuncture

& TomographyBrief Review of Contrast - More detail in RT 93

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BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast

• BUN = BLOOD UREA NITROGEN – ______always check with RAD when level above ___

• CREATININE levels range__________always check with RAD when level above ______

Why are these important to check?What is the name of the other test now done?

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BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast

WATCH THE UPPER LIMITS•BUN = BLOOD UREA NITROGEN – 8 to 20

always check with RAD when level above 20

•CREATININE levels range: 0.6 - 1.2 (1.5) always check with RAD when level above 1.2

•Indicates function of kidneys •Diseases / dehydration / kidney failure•New test: GFR glomerular filtration rate•estimates the amount of blood per minute that passes through the small filters in the kidney•Shows how well the kidneys are working to filter out waste products.

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Contrast InducedNEPHROPATHY

• ANGIOS • CT SCAN (includes urography)

• 30 % MORTALITY• MORE THAN JUST BUN & CREATININE• LAB WILL DO ANALYSIS• Should be taken with last month –• Most over 50 need blood work before

contrast injection

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• Requirements for CREATININE testing prior to iodinated contrast media injections (for the purpose of reducing the chance of contrast-induced renal failure):

• Patients > 50 years of age are to have a recent (within 30 days) serum creatinine prior to contrast injection.

• Patients < 50 years of age do not require labs, UNLESS the patient has one or more of the following:

• An underlying medical condition that impairs the renal system• Cancer• Recently (within 30 days) had chemotherapy• History of renal disease.• Diabetes mellitus• Receiving treatment with potentially nephrotoxic drugs

• Guidelines from UCSD

Important Conditions to be Aware of……• Level of Consciousness:

ALOC– Altered Level Of

Consciousness

• Anaphylatic Shock: vasogenic shock

• Hypoglycemic/• Hyperglycemia

– NPO – Nothing by Mouth

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FEAR

Needles?

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Have emesis basin

Towels

Wet cloth available

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Become familiar with………..

• In your work environment:– Emergency assistance protocol (how to get

help)– Emergency Cart/Crash Cart Location

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KNOW WHERE YOUR CRASH CART AND DRUG TRAYS ARE LOCATED

And HOW to CALL FOR HELP

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Patient Assessment Check List

• Information update !!

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INJECTABLE IODINE - NONIONIC

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Supplies for Venipuncture• Disposable gloves• Alcohol Swabs• Tourniquet• Needle

– Butterfly or Angiocath

• Tape• 2X2 or 4X4• Contrast & Syringes• Saline

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Venipuncture Anatomy

• Most Common sites for IV introduction in Radiology– Anticubital space– Anterior forearm– Dorsum of the hand– Radial wrist (ouch)

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Standard Precautions

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Principles of Drug Administration

• “The golden rules of drug administration”• The five rights of drug administration

• Right drug Right amount• Right patient Right time• Right route

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Extravasation of Contrastinto soft tissue of arm

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TOMOGRAPHY (historical) taken between 1 – 5 min images

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TOMOGRAPHY

• PURPOSE:• TO BLUR OUT

ANATOMY ABOVE AND BELOW THE PLAIN OF INTEREST

• USUALLY 1CM FOR KIDNEYS

CHANGE FULCRUMLEVEL FOR EACH EXPOSURE

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Note level of kidneys to spine

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Tomogram – “PREPPED”

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Tomography = blurs out anatomy above and below selected level

Long exposure

Times

At least

1 second

Must reduce mA

Increase time

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tomogram

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nephrotomogram

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Why is this blurry?Why taken?

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Must mark cm levels“fulcrum “ also remember

to change levels inbetween exposures!