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
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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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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!