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DIAGNOSTIC IMAGING
MARIETTA MEMORIAL HOSPITAL
PREP SHEETS
Revised: February 14, 2014 klr
Per: Steven M. Boker, MD
DIAGNOSTIC IMAGING
General guidelines regarding any invasive procedure on an anticoagulated patient or patient with
known clotting abnormality (eg arthrogram, biopsy, drainage, myelogram, lumbar puncture):
INR
PLATELETS
PTT
INR should be 1.5 or less. Ordering
physician to alter therapy to achieve this goal.
If unable to get INR 1.5 or less, procedure must be
approved by radiologist. If patient not on Coumadin,
value can be up to 10 days old.
Plt must be greater 90,000. Ordering physician to
alter therapy to achieve this goal. Value can be up to
10 days unless recent instability. If recent instability,
Plt must be re-drawn within 3-7 days of procedure.
PTT should be less than 35. Value can be up to 10
days old unless patient is on Heparin. If on Heparin,
follow Heparin protocol.
Radiologist must be notified of all abnormal labs
Following medication guidelines:
Coumadin
INR should be 1.5 or less. Ordering Physician
to alter therapy to achieve this goal
Heparin IV Drip Turn off Heparin drip 4 hrs. prior to procedure
unless radiologist approves otherwise
Heparin SQ
Continue, no reason to hold or DC unless dose is
greater than 10,000 U
Lovenox
Hold for 24 hrs. pre-procedure unless approved by
radiologist
Aspirin
Hold for 5 days pre-procedure
Plavix
Hold for 7 days pre-procedure
Ticlid
Hold for 7 days pre-procedure
Persantine
Hold for 2 days pre-procedure
Pletal
Hold for 2 days pre-procedure
NOTE: If the procedure is a STAT/emergency, please contact radiologist for instructions regarding
anticoagulant medication, etc.
ARTHROGRAM
Lab work: None unless patient is on
“blood thinner”/anticoagulant. Then PT,
PTT & Platelets are required.
BE
Referring Physicians Office will need to give
Bowel Prep to patient prior to procedure
DEXA SCAN
(BONE DENSITY)
Patient must be able to stand and get on to scan table.
NO calcium supplements for 24 hours prior to exam
NO barium study, radioisotope injection, oral or
intravenous contrast material from CT scan or MRI
(5) five days prior to DEXA testing.
ESOPHOGRAM
NPO 4 hours prior to procedure (HTN & Cardiac
medications) allowed with a small amount water.
FISTULAGRAM
NO Prep
HYSTERSALPINOGRAM
(HSG)
Lab work: HCG (pregnancy test)
IVP
NPO 6 hours prior to procedure (except for clear liquids)
Lab work needed: Creatinine/EGFR if patient meets
any of the following:
60 years or older
Diabetic
HTN
Renal disease
Multiple Myeloma
Sickle Cell Disease
Dehydration
MODIFIED BARIUM
SWALLOW
MYELOGRAM or
LUMBAR PUNCTURE
NO Prep
Prep - Myelogram
Light Liquid Breakfast 2 hours prior to procedure, then
NPO (water is allowed)
Patient needs to take or bring own pain medications day of
procedure
Follow “invasive procedure” guidelines listed at beginning of sheet
For myelogram (NOT lumbar puncture), the following medications
should be stopped 48 hours before & for 24 hours
after myelogram:
Antidepressants (e.g. Elavil, Effexor, Zoloft, Cymbalta,
Celexa, etc.)
Appetite Suppressants, (e.g. Dexedrine, Dapex, Didrex, etc.)
Antipsychotics (e.g. Artane, Clorazipine, Cogentin, Holdol
Limbitrol, etc.)
NOTE: If the procedure is a STAT/emergency, please contact radiologist for instructions regarding
anticoagulant medication and/or medications listed above for myelogram patient.
Radiologist must be notified of all abnormal labs
Post - Myelogram
Patient to be in bed with head of bed elevated 30 degrees
Patient is discharged from hospital (if no problems occur)
Limited activity until next morning
Diet as tolerated, encourage fluids next 24 hours
(particularly water)
Avoid Phenothiazines
Observation 1 hours (min.) - headache, nausea, vomiting, neck
stiffness, numbness, backache, are all common after procedure
Other medications may or may not need to be stopped
Must have a ride home and not allowed to drive or operate
heavy equipment for 24 hour post procedure if done as outpatient.
RETROGRADE
CYSTOGRAM
SMALL BOWEL STUDY
No Prep
NPO after midnight or 6 – 8 hours prior to procedure
(HTN & Cardiac medications allowed with small
amount of water)
T-TUBE CHOLANGIOGRAM NO Prep
UPPER GI
NPO 4 hours prior to procedure (HTN & Cardiac
medications allowed with a small amount of water)
CAT SCAN
INVASIVE PROCEDURES
BIOPSY/DRAINAGE
Lab work: All biopsy/drainage procedure patients require PT, PTT &
Platelets be assessed.
Labs Requirements:
PT/INR
PLATELETS
PTT
(Creatinine
INR should be less 1.5 or less. Ordering physician to
alter therapy to achieve this goal. If unable to get
INR less 1.5 procedure must be approved by
radiologist. If patient not on Coumadin, value can
be up to 10 days old.
PLT must be greater 90,000. Ordering physician to
alter therapy to achieve this goal. Value can be up
to 10 days unless recent instability. If recent
instability, PLT must be re-drawn within 3-7 days of
procedure.
PTT must be less 35. Value can be up to 10 days old
unless patient is on Heparin, if on Heparin, follow
Heparin protocol.
Only needed if patient to get IV contrast, which is not
usually given. Notify radiologist if Creatinine is
greater 1.5. May use ISTAT for pre-procedure recheck.)
NPO 8 hours prior to procedure may take sips of water with
morning medication.
Following medications guidelines:
Coumadin
INR should be 1.5 or less. Ordering physician
to alter therapy to achieve this goal
Heparin IV Drip Turn off Heparin drip 4 hours prior to procedure
unless radiologist approves otherwise
Heparin SQ
Continue, no reason for hold or DC unless does is
Greater than 10,000 U
Lovenox
Hold for 24 hours pre-procedure unless approved
by radiologist
Aspirin
Hold for 5 days pre-procedure
Plavix
Hold for 7 days pre-procedure
Ticlid
Hold for 7 days pre-procedure
Persantine
Hold for 2 days pre-procedure
Pletal
Hold for 2 days pre-procedure
NOTE: If the procedure is a STAT/emergency, please contact radiologist for instructions regarding
anticoagulant medication, etc.
ENTEROGRAPHY
Prep: Patient needs to be NPO 4 hours prior to starting
oral contrast
IV CONTRAST EXAMS
Lab work needed: Creatinine/EGFR if patient meets
any of the following:
No lab work within the last 10 days
60 years or older
Diabetic
HTN
Renal Disease
Multiple Myeloma
Sickle Cell Disease
Dehydration
ORAL CONTRAST EXAMS
Patient needs to arrive 2 hours prior to procedure
to register
They then will be given oral contrast to drink over
1 ½ hours time, prior to scan
MAMMOGRAM
BREAST STEREO
BIOPSY
Mammogram Department contacts patient with Prep
before procedure, (ask about Blood Thinners)
MAMMOGRAMS
NO deodorants, perfumes or lotions applied to Breast/Axillary
Areas day of exam., prior to procedure
MRI
MRA
NPO 2 hours prior to procedure (to avoid vomiting)
(excluding MRA’s Head)
MRCP
NPO 8 hours prior to the procedure
MRI BREAST
Discontinue Hormone Replacement Therapies for 30 days
Menstrual Cycle/exam should be scheduled 10 – 12 days after
1st day of Menstruation
MRI HIPS & PELVIS
Empty bladder before procedure
IV CONTRAST EXAMS
Lab work needed Creatinine if patient meets
any of the following:
No lab work within the last 10 days
60 years or older
Diabetic
HTN
Renal Disease
Multiple Myeloma
Sickle Cell Disease
Dehydration
NUCLEAR MEDICINE
BONE SCAN
Schedule @ 10:00 MMH
Selby: Mon
9:00, 10:00
Tue
10:30
Wed
10:00
Thurs
10:00
Fri
9:00, 10:00
NO Prep; Scan 3 hours post injection
3 & 4 PHASE BONE
SCANS
Schedule @ 7:00 NO Prep, Scan 6 hours post injection
HEPATOLITE SCAN (HIDA)/GASTRIC EMPTYING/PARATHYROID
*Schedule @ 7:00 @ MMH on Mon, Tue, Thurs
Selby: Mon 8:00, 10:00
Tue 8:00
Wed None
Thurs None
Fri
8:00, 10:00
HEPATOLITE SCAN (GB)
HIDA *
Fatty Meal @ 6:00 – 8:00 PM the night before procedure
NPO & NO PAIN medication 6 hours prior to appointment
GASTRIC EMPTYING *
PARATHYROID *
LIVER/SPLEEN SCAN
LUNG SCAN
MUGA SCAN
RENAL SCAN
NPO & NO PAIN medication 6 hours prior to appointment
*Schedule @ MMH 7:00 Mon, Tue, Thur
Selby: Mon 8:00, 10:00
Tue 8:00
Wed None
Thurs None
Fri 8:00, 10:00
NO Prep
Schedule @ MMH 11:30, M-F
Selby: Tue 9:30
Wed 7:30
Thurs 7:30
NO Prep
NO Prep – Chest X-ray, (PA + LAT, PA/AP, PORT) at time of exam
or within 24 hrs prior to exam.
Schedule @ MMH 12:30, 2:00
@ Selby Mon 2:00
Tue 12:30
Wed 2:00
Thurs 2:00
Fri 2:00
NO Prep
Schedule @ MMH 12:30
@ Selby Mon 1:30
Tues 12:30
Wed 2:00
Thur 2:00
Fri 1:30
8 – 16 oz. liquid day of procedure
Schedule @ MMH 12:30, 2:00
Selby
SENTINEL NODE MAPPING
NO Prep
STRESS TEST CARDIAC
Patient to arrive at OP Registration 30 minutes before
appointment
Drink white milk, juice or water ONLY for 24 hours
prior to test
(NO caffeine, caffeine free, decaf., or chocolate 24 hours
prior to procedure)
You may eat up to midnight, NPO after midnight
NO beta blockers 24 hours prior to procedure, unless Lexiscan
Check with Physician or Pharmacist if not sure of medications
DO NOT TAKE DRUG Pletal or Aggrenox for 48 hours
prior to procedure if you are for a Lexiscan Stress Test
Bring a list of medications, wear comfortable clothing the
day of procedure
If the above instructions are not followed your test will be
rescheduled
Any questions call 740-374-1525 or 740-374-1440
1-123 THYROID
Schedule @ MMH 8:00, 8:15 on Monday, Tuesday,
Wednesday ,Thursday ONLY
Selby Schedule @ 8:30, on Monday, Tuesday,
Wednesday, Thursday ONLY
2 – Day procedure
NPO after midnight
No Synthroid for 6 weeks prior to procedure
NO PTU/Tapazol 5 – 7 days prior to procedure
NO X-ray Contrast 6 weeks prior to procedure
NO Multi Vitamins – 2 weeks prior to procedure
1-131 THERAPY
NPO after midnight
Schedule at 9:00 (notify Nuclear Medicine Tech.)
WBC
Call Nuclear Medicine Tech., to schedule
procedure @ 6:30 AM
PET/CT
Are only done at Selby General Hospital.
CLOTHING
Dress comfortably and warmly, the scan room may be cool.
Clothing without metal fasteners are best.
FOOD & DRINK
Limit the amount of sugar & caffeine on the day before procedure.
NPO (except water) 6 hours before your arrival to Selby General
Hospital.
PROCEDURE
Labs will be done to check blood glucose level,
Injection of radioactive glucose (FDG) will be given. It will take
approximately 60 minutes to distribute throughout your body.
You will be asked to empty your bladder and to lie down on the
scan table.
The procedure can take between 20 – 60 minutes, depending upon
the type of scan you are having. It is very important that you lie still
during the scan.
If you need medication, please bring it with you.
You should plan on the entire scan to take approximately 2 hours.
AFTER YOUR SCAN
Once the scan is complete, you are required to drink plenty of fluids
and to void frequently throughout the day to flush the remaining FDG
out of your body.
ULTRASOUND
AMNIOCENTESIS
ABDOMEN
LIMITED/COMPLETE
ANKLE BRACHIAL
INDEX STUDY
AORTA
NO Prep
Fat free dinner by 6:00 PM night before procedure
water until midnight. NPO after midnight
NO Prep
Fat free dinner by 6:00 PM night before procedure,
water until midnight. NPO after midnight. Take 2
Gas-X tablets night before bed and another 2 Gas-X
tablets morning of procedure
AORTA BIFEMORAL
GRAFT
NPO after midnight
ARTERY GRAFT
NO Prep
BIOPHYSICAL – OB
NO Prep
BIOPSY
See “invasive procedure” guidelines at beginning of document
Radiologist must be notified of all abnormal labs
NOTE: If the procedure is a STAT/emergency, please contact radiologist for instructions regarding
anticoagulant medication, etc.
BREAST
NO Prep
BREAST NEEDLE
Prep given to patient by Surgery
CAROTID DOPPLER
NO Prep
CHEST ECHO
NO Prep
CYST ASPIRATION
NO Prep
ECHOCARDIOGRAM
NO Prep
EXTREMITIES
NON-VASCULAR
NO Prep
DIALYSIS FISTULA
NO Prep
L E DOPPLER
NO Prep
PARACENTESIS
Lab work needed prior to procedure: PT, PTT, INR
PELVIC OB
Drink 40 oz. water 1 hour prior to procedure
DO NOT VOID
PELVIC US
Drink 40 oz. water 1 hour prior to procedure
DO NOT VOID
POST VOID
BLADDER
RENAL ARTERIES
RETROPERITONEAL
(KIDNEYS)
Drink 40 oz. water before procedure
DO NOT VOID
Liquid diet the day before procedure. NPO after midnight
Take 2 Gas-X tablets before bed. Take 2 Gas-X tablets
the morning of procedure
NPO 4 hours prior to procedure, drink 16 oz. water 1 hour
prior to procedure. DO NOT VOID
SAPHENOUS VEIN
MAPPING
NO Prep
STRESS
ECHOCARDIOGRAM
Prep given by Stress Lab to patient
TRANS ESOPHAGEAL
(TEE)
Prep given by Cath. Lab to patient
TESTICULAR
NO Prep
THORACIC OUTLET
NO Prep
THYROID
NO Prep
THORACENTESIS
Lab work needed prior to procedure: PT, PTT, INR
VASTRAC
NO Prep
VENOUS REFULX
NO Prep
VENOUS TO
R/O DVT’S
NO Prep