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Sacred Heart Hospital Pensacola Radiology Fluoroscopy Scheduling/Orders: Results: Monday – Friday 6:30 am – 5:30 pm (850) 416-2940 Fax Server (850) 416-7337 (850) 416-6020 Contact Name: Phone: Department Fax: Jennifer Wilmoth, Lead Radiologic Technologist Office (850) 416-4923 (850) 416-6047 Location: 1st Floor Center for Diagnostic Services Regular Hours: For questions regarding prep information please call 416-6020. New Adult Colon Prep is attached. Patients are asked to check in at the Center for Diagnostic Services located on the first floor of the Medical Mall adjacent to the Brent Lane parking garage. The first floor is one floor above ground level when entering the hospital from the Brent Lane Parking Garage. Patients who are registering for a scheduled exam are urged to check in at least 30 minutes prior to their appointment time. If plain x-rays are also ordered, the patient must be here at least one hour prior to their appt. time. Patients may be required to change into a gown for their procedure. Changing rooms and personal belonging containers are provided to ensure the safety of all personal items. Please leave valuables at home. Please remind patients to inform the technologist of any possibility of pregnancy before beginning any procedure. Please ask the patients to bring a home medication list. Radiology results are generally available within 24 hours of a procedure and a report will be faxed to the referring physician. For Copies of Images on CD or to obtain a copy of a report, please contact the Radiology Film File room at 416-6020. SHH-Pen Section U-1 10.28.16 Sacred Heart Hospital Pensacola ADULT FLUOROSCOPY PROCEDURE PREPARATIONS EXAM Adult Barium Enema Or Barium Enema with Air Contrast Adult Upper Gastrointestinal Tract PREP The patient must follow the Adult Colon Prep. If the patient has a colostomy, please ask the patient to bring an extra bag for after the procedure. The patient cannot have anything to eat, drink or smoke after midnight. Adult Barium Swallow No Prep unless scheduled with another study. Adult Modified Barium Swallow With Speech Therapy Adult Small Bowel Series Adult Cystogram No Prep Required. The order must state modified barium swallow with speech therapy. The patient cannot have anything to eat, drink, or smoke after midnight. Please advise pt this exam may take several hours to complete. No Prep Required. The patient must follow the Adult Colon Prep. If Patient is Allergic to X-ray Contrast he/she must be prepped as follows: 50 mg Prednisone every six hours for 3 doses, ending one hour before procedure and 50 mg Benadryl one hour before exam. Anyone being prepped this way must have a driver. If Patient is insulin dependent diabetic a creatinine/BUN level must be drawn. Lab work must be drawn 2 weeks prior to IVP if pt is an outpatient or 3 days prior if pt is an inpatient. If Patient is taking Glucovance, Glucophage / Metformin he/she must be off this medication for 48 hours after exam and must not resume medication until after their physician performs a kidney function test and approves of restart. Please remind the patient to bring a home medication list with them to their appointment. Adult IVP Hysterosalpingogram (HSG) SHH-Pen No PREP required. Please encourage the patient to eat prior to exam in case meds are suggested afterwards. Section U-2 10.28.16 Sacred Heart Hospital Pensacola Adult Voiding Cystourethrogram (VCUG) Loopogram Urography Retrograde Urethrogram Joint Arthrogram, Aspirations, or Injections No Prep required. The patient can only have liquids on the day of the exam. No Prep required. Myelogram or Lumbar Puncture No Prep required If Injection- Dr’s order must specify type of injection. Ex. - Steroid vs MRI vs Nuclear Med. If the patient is on blood thinners they must be stopped 5 days prior to the appointment. Patient must bring a home medication list. Patient must have a driver to stay with them throughout the exam up to 3 hours. If the patient has a history of or presently on anticoagulant/blood thinners he/she must have labs drawn between 24 and 72 Hours PRIOR to Appt (PT, PTT, INR) and the patient must stop the medication 5 days prior to study. If Patient is on medications such as tranquilizers, mood drugs, muscle relaxers, stop 24 Hours PRIOR and 48 Hours POST Procedure. Please refer to the Medication List for the meds to avoid. If Patient is allergic to contrast media patient must be prepped with 50 mg Prednisone every 6 hours for 3 doses, ending 1 hour before Exam and 50 mg Benadryl 1 hour before exam. SHH-Pen Section U-3 10.28.16 Sacred Heart Hospital Pensacola Department of Radiology 5151 North Ninth Avenue Pensacola Florida 32504 850-416-6020 Adult Colon Prep for Radiology Studies This prep is to be followed by adult patients scheduled for one of the procedure listed below. o Adult Barium Enema o Adult IVP This prep requires the patient to purchase a bottle of Magnesium Citrate from any pharmacy or store that sells over the counter medicine. If there are any questions please call our Radiology Department at 416-6020 or 416-2960. Day before exam Patient may eat a light lunch and clear liquids* thereafter. Do not eat anything after lunch. Drink a glass of clear liquids* every hour until 5pm At 5pm, drink an entire bottle of Magnesium Citrate. Patient should continue drinking clear liquids* as desired. Day of exam Do not eat or drink anything by mouth Patient may have small amount of water to take with Physician approved medications. After exam Patient may return to normal diet. *Clear Liquids consist of Bouillon, fruit juices with no pulp, tea, black coffee, JellO, and water. SHH-Pen Section U-4 10.28.16 Sacred Heart Hospital Pensacola Medications to Avoid Pre and Post Myelograms Sacred Heart Radiology Department Radio contrast agents used in myelography have the ability to lower the seizure threshold and when used with other drugs that also have this ability, may lead to convulsions. Drugs that possess the ability to lower seizure threshold should be discontinued at least 48 hours prior to myelography if possible and should not be resumed until at least 24 hours post procedure. These drugs are listed below. Phenothiazines Acetophenazine (Tindal) Chlorpromazine (Thorazin) Promethazine (Phenergan) Ethopropazine (Parsidol) Fluphenazine (Prolixin) Mesoridazine (Serentil) Methdilazine (Tacaryl) Perphenazine (Trilafon) Proclorperazine (Compazine) Promazine (Sparine) Thiethylperazine (Torecan) Thioridazine (Mellaril) Trifluoperazine (Stelazine) Triflupromazine (Vesprin) Largon Levoprome MAO Inhibitors Furazolidone (Furoxone) Isocarboxazid (Marplan) Pargyline (Eutonyl) Phenelzine (Nardil) Procarbazine (Matulane) Antidepressants Amitriptyline (Elavil) Amoxapine (Asendin) Bupropion * (Wellbutrin,Zyban) Clomipramine (Anafranil,Placil) Desipramine (Norpramin) Doxeprin (Sinequan) Imipramine (Tofranil) Maprotiline (Ludiomil) Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil) Combination Antidepressants Amitriptyline +Chlordiazepoxide (Limbitrol DS) Amitriptyline+Perphenazin e (Truavil) Cyclobenzaprine ( Flexeril) Misc. Antipsychotics Clozapine (Clozaril) Haloperidol (Haldol) Loxapine (Loxitane) Pimozide (Orap) Thiothixene (Navane) CNS Stimulants Amphetamines Pemoline (Cylert) Other Blood Thinners for 5 days o Plavix,Coumadin, and Warfarin Lovenox or Aggrenox is for 24 hours Glucophage or Glucovance for 48 hrs Skeletal Muscle Relaxant Traylcypromine (Parnate) *Dose dependant risk of seizure. Do not exceed 450 ml/day or 150 mg/dose. Additional drugs Cycloserine ( Seromycin) Cyclosporine ( Sandimmune, Neoral) Dextroamphetamine (Dexedrine) Fentanyl ( Duragesic) Fluoxetine (Prozac) Mitazapine (Remeron) Molindone (Moban) Netazodone (Serzone) Olanzapine (Zyprexa) Paroxetine (Paxil) SHH-Pen Section U-5 Perphenazine Quetiapine Risperidone Ritalin Triflupromazine Trifluoperazine Tramadol Trimipramine Trazodone Venlafaxine (Trilafon) (Stelazine) (Risperdal) (Methylphenidate) (Vesprin) (Stelazine) (Ultram) (Surmontil) (Desyrel) (Effexor) 10.28.16 Sacred Heart Hospital – Pensacola PEDIATRIC FLUOROSCOPY PROCEDURE PREPARATIONS EXAM Pediatric Barium Enema PREP No Prep required for history of Constipation for all pediatrics. For any history other than constipation such as bleeding, please verify prep with Radiology before scheduling at 416-2960. 0-2 months: The patient cannot have anything to eat or drink for 3 hours prior to the exam. Do not add cereal to bottle for 6 hours before the exam time. 3 months to 11months: The patient cannot have solid foods or Upper Gastrointestinal cereal in bottle 6 hours prior to the exam. Clear liquids, pedialyte, Tract (UGI) or juice can be given until 3 hours before the exam time. 1 year to 6 years old: The patient cannot have any solid foods Unless scheduled with after midnight. Clear liquids, pedialyte, or juice can be given until Small Bowel see that 3 hours before the exam. prep 7 years and older: The patient cannot eat or drink anything after midnight prior to their appointment. This procedure is rarely ordered unless there is a specific history with the trachea or esophagus. Ex- Vascular ring and TE fistula Esophagram (Barium Swallow) Infant to 18 years: The patient cannot eat or drink anything for 3 hours prior to the exam time. The order MUST state Modified Barium Swallow w/Speech. Modified Barium Swallow (with speech 5 years and under: The patient cannot eat or drink anything for 3 therapy) hours prior to the study. 0-2 months: The patient cannot have anything to eat or drink for 3 hours prior to the exam. Do not add cereal to bottle for 6 hours before the exam time. 3 months to 6 years: The patient cannot have any solid food or cereal in a bottle after midnight. The patient can have clear Small Bowel Series liquids, pedialyte, or clear juice up until 3 hours prior to the exam. The patient cannot have anything to drink for 3 hours prior to the exam time. 7 years and older: The patient cannot eat or drink anything after midnight. 0-2 Years: The patient cannot eat or drink anything for 2 hours prior to the exam. 3- 12 Years: The patient cannot eat any solid foods for 6 hours IVP prior to the exam. The patient may have liquids up to 2 hours prior to the exam. 13-18 Years: Same as Adult Colon Prep unless the Patient has special needs. SHHP Section U-6 8/20/2015 Sacred Heart Hospital – Pensacola No Prep Required. Cystogram Voiding Cystourethrogram (VCUG) Retrograde Urethrogram SHHP If the procedure is a follow up for reflux it is usually a Nuclear Medicine Cystogram. Please confirm with Physician. No prep is required unless Sedation has been ordered by the Physician and approved by our Radiology Nursing. Please contact Scheduling for this approval 416-6800. No Prep required. Section U-7 8/20/2015 Sacred Heart Hospital – Pensacola Common CPT Codes Fluroscopy Procedures for Adults CPT Code(s) BARIUM ENEMA AIR CONTRAST 74280 BARIUM ENEMA 74270 BARIUM SWALLOW - ESOPHAGRAM 74220 CYSTOGRAM 74430 FLUOROSCOPY – SNIFF TEST- DIAPHRAGM 76000 HIP ARTHROGRAM 73525 HYSTEROSALPINGOGRAM 74740 KNEE ARTHROGRAM 73580 LOOPOGEAM UROGRAPHY, ANTEGRADE – PYLE, NEPH 74425 LUMBAR PUNCTURE 62270/62272 MODIFIED BARIUM SWALLOW WITH SPEECH THERAPY 74230/92611 MYELOGRAM CERVICAL 72240 MYELOGRAM LUMBAR 72265 MYELOGRAM THORACIC 72255 MYELOGRAM TWO OR MORE REGIONS 72270 SHOULDER ARTHROGRAM 73040 SINUS TRACT INJECTION/FISTULOGRAM 76080 SMALL BOWEL SERIES 74250 UPPER GASTROINTESTINAL TRACT W/O KUB 74240 UPPER GASTROINTESTINAL TRACT W/ KUB 74241 UPPER GI AND SMALL BOWEL SERIES 74245 URETHROGRAM – RETROGRADE 74450 VIDEO NECK, AIRWAY 76000 VOIDING CYSTOURETHROGRAM (VCUG) 74455 WRIST ARTHROGRAM 73115 SHHP Section U-8 8/20/2015 Sacred Heart Hospital – Pensacola Common CPT Codes – (continued) Fluoroscopy Procedures for Pediatrics CPT Code(s) PEDS BARIUM ENEMA 74270 PEDS BARIUM SWALLOW 74220 PEDS MODIFIED BARIUM SWALLOW WITH SPEECH THERAPY 74230/92611 PEDS SMALL BOWEL 74250 PEDS UPPER GASTROINTESTINAL TRACT W/O KUB 74240 PEDS UPPER GASTROINTESTINAL TRACT W/ KUB 74241 PEDS UPPER GI AND SMALL BOWEL SERIES 74245 PEDS VOIDING CYSTOURETHROGRAM (VCUG) 74455 SHHP Section U-9 8/20/2015 Sacred Heart Hospital – Pensacola SHHP 8/20/2015 Section U-10