Download Sacred Heart Hospital Pensacola

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