Download - Van Wert County Hospital

VAN WERT COUNTY HOSPITAL
Policy/Procedure: Radiology/Imaging
No. 2.0 (N 15-04)
Issue Date: 1/85
No. Of Pages: 3
By: Radiology/Imaging
Revised: 3/14, 1/13, 12/12
Distribution List: Radiology, Nursing, Pharmacy
Concurrence:
Subject: ADMINISTRATION OF I.V. CONTRAST MEDIA AND INJECTION PROTOCOL
I.
POLICY:
To insure proper contrast media injection by assuring only trained personnel administers
these injections, and those patients having examinations requiring the use of contrast media
receive appropriate care through established protocol.
II.
PROCEDURE:
A. Technologists trained in I.V. contrast administration:
1. Have received training in sight (vein) selection.
2. Have been trained thoroughly in aseptic technique.
3. Are trained to recognize infiltration.
4. Have worked with Radiologist and trained technologist prior to performing injections
independently, and have demonstrated proficiency in the delivery of I.V. contrast.
5. Administer contrast media only under the direct or indirect supervision of the
Radiologist or (ER Physician / Ordering Physician after hours) at Van Wert County
Hospital.
6. Administer no drugs other than I.V. contrast. Technologists who are trained in Nuclear
Medicine administer the radionuclides used in the performance of Nuclear Medicine
examinations. These drugs are administered intravenously as well as orally and via a
ventilation system. (Protocols for such procedures may be found in the Nuclear
Medicine Policy & Procedure manual.).
7. All staff technologists have been trained in the administration of contrast media used in
Radiology through an existing I.V.
8. The following is a list of technologists trained in venipuncture and who may start
an I.V.:
Jacquelyn Clay, R.T.
Mark Cavinder, R.T.
Norma Rampe, R.T.
Lisa Mueller, R.T.
Sharon Kerns, R.T.
Rachel Moorman, R.T.
April Smith, R.T.
Mona Scheidt, R.T.
Michelle Huffine, R.T.
Jamie Welch, R.T.
B. Technologist or physician shall take a history from the patient, utilizing the Radiology
Contrast Screening Form. History verified includes:
1. Pregnancy.
2. Hx. of multiple myeloma &/ or pheochromocytoma.
3. Use of Glucophage, Glucovance, Metformin, Avandamet, Metaglip and
Janumet.*(Refer to attached Glucophage Protocol if patient is on any of the mentioned
forms of glucophage).
4. Allergies (particularly to iodine / iodides / latex / medicinal agents / contrast media).
5. Diabetes.
6. Respiratory problems (asthma).
7. Cardiac dysfunction.
8. Kidney disease.
9. BUN & Creatinine (results within 6 months) on all:
a. Patients over the age of 50
b. Patients with renal disease (excluding stones).
10. Prior to contrast administration, Technologist will review patient answers to the
Contrast Screening Form and consult Radiologist or (ER Physician / Ordering
Physician after hours) with any potential contraindications.
11. Patient is to provide a current medication list. This list will be reviewed as stated by the
“Medication Reconciliation Protocol” before any contrast is administered.
C. Technologist or physician will check contrast media to be injected (before and after
preparation for injection) regarding:
1. Verify type of contrast
2. Verify concentration
3. Verify expiration date on bottle/package.
4. Verify temperature of contrast warmer (98.6 +/- 2 degrees)
5. Verify date sticker on bottle/package for length of time in contrast warmer.
6. Verify volume of media to be injected (as relates to age & weight factors)
7. Verify patient identity (D.O.B. & name compared to wrist band/patient order) prior to
injection of contrast.
D. Physician or trained technologist administers contrast media.
1. A selected vein is found.
2. During injection, the butterfly remains in the vein for 10 minutes, secured by
tape in case further meds are needed.
3. Patient is closely observed by the technologist for the first 5 minutes post
injection to watch for signs of nausea, vomiting, hives or other behavior
compatible with an allergic reaction.
4. Technologist checks patient frequently during the next 15 minutes for any indication
of reaction or change.
5. Documentation on the request will include: type and amount of contrast administered
along with initials of technologist who injected the contrast.
6. Radiologist will dictate obtained information and Transcriptionists will type report.
E. Emergency drug carts will be available for use, as well as oxygen, airways and ammonia
capsules.
F.
Crash carts will be immediately available for after-hours exams.
G. Post injection, the technologist will:
1. Closely observe the patient for the first 5 minutes for any indication of
complications, nausea or reactions to the contrast.
2. Remain in close proximity to the patient for 20 minutes following the injection,
checking with the patient often for any complication or reaction to the
contrast media.
3. Post examination, the patient will be given discharge information / instructions.
H. Routine dosages for intravenous Pyelogram with use of Optiray 320:
1. Adult: 50 - 100 cc, per Radiologist order.
2. Infants and children: Radiologist shall determine exact dosage, with consideration to
patient’s age and body weight.
a. Guidelines used are 1 mL/kg to 3 mL/kg of OPTIRAY 320, with a usual
dosage of 2mL/kg. (lbs./2.2=kgs)
4. Post examination, the patient will be given discharge information/instructions.
I.
Dosages for CT
1. Normal adult dosage for CT scans requiring administration of intravenous contrast
media is 100cc. Optiray 320; for CTA’s dosage is 200cc. Optiray 320.
2. Infants and children: Radiologist shall determine dosage, with consideration to patient’s
age and body weight. (See guidelines H-2).
3. Per Radiologist instruction, dosage administered may vary in amount according to
patient’s body weight, history or condition.
4. Post examination, the patient will be given discharge information/instructions.
J.
Dosages for MRI: (see MRI section) Reference 17.0
K. Dosages for other contrast examinations are per Radiologist instructions.
Included are the following: Venogram, Sialogram, myelogram, Hysterosalpingogram,
Arteriogram, Arthrogram, Fistulagrams, etc.
L. Policy and Protocols have been established/reviewed by the Pharmaceutical & Therapeutic
Committee (P&T Committee).
2.0 Contrast administration/P&P