Download Radiographic Contrast Media RAD TECH 255 SPECIAL

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Radiographic Contrast Media
RAD TECH 255
SPECIAL PROCEDURES
Reference: MERRILLS VOL2 RTA BOOK CH 19
SPECIAL PROCEDURES ARE INVASIVE
ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING
OR GIVING ANY CONTRAST MEDIA CONTRAST MEDIA & ADVERSE REACTIONS
RISK
Any foreign substance introduced in the body Chance the body will react negatively to the material
Minor to Life Threatening Minor = 5%
Major 0.1%
HISTORY
Kidney problems
Diabetes
Heart conditions
Allergies
Asthma
Previous reaction
Current medications
Beta Blockers
Antihypertensive medications
VITAL SIGNS
Older patient age
Renal insufficiency
History of contrast-related anaphylactoid reaction
Allergic Rhinitis, medication or Food Allergy
Cardiovascular disease
CONSENTS
SIGNED AND WITNESSED AFTER PROCEDURE HAS BEEN EXPLAINED
CHECK DEPARTMENT PROTOCOL WHO’S RESPONSIBLE ??????
CONSENTS
ASSAULT verbal threat of harm
BATTERY Unlawful touching - unauthorized treatment
“X-RAY” TAKEN ON WRONG PATIENT
FALSE IMPRISONMENT Restraints require permission from patient or authorized person
Subject Contrast
Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient).
Low Subject Contrast
What can be done to attain medical information- see the difference between muscle, organs or vessels
Define and outline – organ structure and function
Defines subtle differences in subject contrast
Increases atomic number of area injected
Results in a SHORTER scale of subject contrast
Purpose of Contrast Media
To enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast.
Radiographic Contrast : Influenced by…KVP
TYPE OF CONTRAST USED DETERMINES KVP RANGE
BARIUM
90 – 120 kVp
IODINES 70 – 80 kVp (Ionic / Nonionic Water or Oil)
Contrast media
Diagnostic agents That are either:
Ingested (GI Tract) Instilled (body orifices)
Injected Circulatory System, Joint Spaces, Ducts
Methods of Administration of Contrast Material
INGESTED (ORAL)
RETROGRADE AGAINST NORMAL FLOW
INTRATHECAL Spinal canal
PARENTERAL Injecting into bloodstream (anything other than oral)
2 BASIC TYPES OF CONTRAST
BARUIM Z# 56 NON WATER SOLUABLE
POWDER
GI TRACT ONLY INGESTED OR RECTALLY
LIQUID
KVP 90 – 120*
INTRAVENOUS ORGI TRACT
IODINE
Z# 53 WATER SOLUABLE
KVP BELOW 90*
2
Iodine Contrast Material
WATER BASED:
Ionic Iodine Contrast
Anion -Cation +
More patient allergic reactions
Non-Ionic Contrast
Less patient allergic reactions
Used in:
Broncography (lungs)
Tear ducts Salivary glands
Lymphatic system
Hysterosalpingogram
White on the radiograph = Radiopaque
Oil Based Iodine
Fatty Acids
Insoluble in water
CONTRAST MATERIAL ADVERSE REACTIONS
ALWAYS GET PATIENT’S HISTORY BEFORE ANY CONTRAST MEDIA IS GIVEN
SEE Ch. 19 Table 19-7 pg 296 Pt Care
General Information
Nonionic vs ionic
Greater chance for contrast reactions
Risk Factors
Anaphylatic shock is the most severe
Severity of Reactions
REACTIONSTreatment
Renal toxicity
USUALLY** WITHIN FIRST 5 MINUTES
Glucophage
Nausea & Vomiting & Urticaria
Screening Creatinine
Hypotension (bradycardia)
Pretreatment
Hypotension (tachycardia)
Bronchospasm
Iodinated CONTRAST AGENTS
Adverse Reactions
Anaphylactoid
Osmolarities higher than body fluids
Seizures
Viscous
Extravasation
CONTRAST REACTIONS
General
> 10 million diagnostic procedures / year
Conventional ionic contrast reactions - 10%
Catagories of Adverse Reactions
MILD Ch. 19 pg 297 Pt Care
nausea, vomiting
Uticaria (hives) rash – itching
Flush face – feeling of warmth
Headace, Chills, Anxiety
Diaphoresis
Hypotension (bradycardia)
Hypertension (tachycardia)
Dyspnea
Bronchospasms /wheezing
Laryngeal Edema
Laryngeal edema
Convulsions
Profound hypotension
Clincally manifested arrhythmias
1 in 1000 severe
Treatment – does not usually get worse
Watch patient and reassure
(cool cloth on forehead, emesis basin
Catagories of Adverse Reactions
Catagories of Adverse Reactions MODERATE
TREATMENT:
Needs immediate treatment –GET RN/RAD
Needs Meds* – (Keep IV line in)
could lead to severe reactions
Catagories of Adverse Reactions SEVERE
Unresponsiveness
Cardiopulmonary Arrest
PROMPT TREATMENT – CODE BLUE!
3
Rx for REACTIONS
have ready on Emergency cart or Crash Cart
UTICARIA (HIVES) –
Benadryl (diphenhydramine)
Vistaril (hydorxyzine)
Contrast Reactions/MYTHS
not caused by iodine
Ionic vs non ionic - binding elements
not related to shellfish
Anaphylactoid (idiosyncratic)
unpredictable
dose independent
Renal Toxicity (increased serum creatinine > 0.5 mg%)
2
-7%
5 - 10 fold increase with pre-existing renal
insufficiency
direct relationship between serum creatinine and
likelihood nephrotoxicity
Hydrate 100 ml/hr Normal saline 4 hrs prior to
procedure, continue for 24 hours
patients with renal insufficiency may develop lactic acidosis
PreMedications
Steroids (Prednisone)
Benadryl (diphenhydramine)
Epinephrine
EXTRAVASATION
Contrast material has seeped outside of vessel
Local redness and swelling
SCHEDULING CONSIDERATIONS
Diabetics – first
Contrast Agents
IONIC
High Osmolality (Higher risk of complications)
Diatrizoate sodium (Hypaque)
Iothalamate meglumine (Conray)
NON-IONIC
Tagament or Zantac
Facial/Laryngeal Edema/Bronchospasms
Epinephrine , Oxygen
not true allergy (no drug-antibody)
mechanism remains unknown
prevalence 1-2% (0.04 - 0.22% severe)
fatal 1 in 75,000
GLUCOPHAGE
Pt is DIABETIC =
oral diabetic agent
MUST STOP __ DAYS BEFORE EXAM
withhold drug for 48 hrs after contrast
administration
(Insulin= low blood sugar occurs while fasting)
After Nuclear Medicine Tests
(iodine goes to thyroid and will alter results)
Iodine BEFORE Barium
BE before UGI ( IVP before BE)
WATER – OIL - BARIUM
Low Osmolality (Lower risk of complications)
Gadodiamide (Omniscan)
Iodixanol (Visipaque)
Iopamidol (Isovue)
Iopromide (Ultravist)
Ioversol (Optiray)