CONTRAST MEDIA Venipuncture & Tomography

1. CONTRAST MEDIAVenipuncture& Tomography Brief Review of Contrast - More detail in RT 93

3. BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast • BUN = BLOOD UREA NITROGEN – ______ always check with RAD when level above ___ • CREATININE levels range__________ always check with RAD when level above ______ Why are these important to check? What is the name of the other test now done?

4. BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast WATCH THE UPPER LIMITS • BUN = BLOOD UREA NITROGEN – 8 to 20 always check with RAD when level above 20 • CREATININE levels range: 0.6 - 1.2 (1.5) always check with RAD when level above 1.2 • Indicates function of kidneys • Diseases / dehydration / kidney failure • New test: GFR glomerular filtration rate • estimates the amount of blood per minute that passes through the small filters in the kidney • Shows how well the kidneys are working to filter out waste products.

5. Contrast InducedNEPHROPATHY • ANGIOS • CT SCAN (includes urography) • 30 % MORTALITY • MORE THAN JUST BUN & CREATININE • LAB WILL DO ANALYSIS • Should be taken with last month – • Most over 50 need blood work before contrast injection

6. Requirements for CREATININE testing prior to iodinated contrast media injections (for the purpose of reducing the chance of contrast-induced renal failure): • Patients > 50 years of age are to have a recent (within 30 days) serum creatinine prior to contrast injection. • Patients < 50 years of age do not require labs, UNLESS the patient has one or more of the following: • An underlying medical condition that impairs the renal system • Cancer • Recently (within 30 days) had chemotherapy • History of renal disease. • Diabetes mellitus • Receiving treatment with potentially nephrotoxic drugs • Guidelines from UCSD

7. Important Conditions to be Aware of…… • Level of Consciousness: ALOC • Altered Level Of Consciousness • Anaphylatic Shock: vasogenic shock • Hypoglycemic/ • Hyperglycemia • NPO – Nothing by Mouth

8. FEAR Needles?

12. Have emesis basin Towels Wet cloth available

17. Become familiar with……….. • In your work environment: • Emergency assistance protocol (how to get help) • Emergency Cart/Crash Cart Location

18. KNOW WHERE YOUR CRASH CART AND DRUG TRAYS ARE LOCATED And HOW to CALL FOR HELP

19. Patient Assessment Check List • Information update !!

22. INJECTABLE IODINE - NONIONIC

23. Supplies for Venipuncture • Disposable gloves • Alcohol Swabs • Tourniquet • Needle • Butterfly or Angiocath • Tape • 2X2 or 4X4 • Contrast & Syringes • Saline

26. Venipuncture Anatomy • Most Common sites for IV introduction in Radiology • Anticubital space • Anterior forearm • Dorsum of the hand • Radial wrist (ouch)

32. Standard Precautions

35. Principles of Drug Administration • “The golden rules of drug administration” • The five rights of drug administration • Right drug Right amount • Right patient Right time • Right route

37. Extravasation of Contrastinto soft tissue of arm

39. TOMOGRAPHY (historical) taken between 1 – 5 min images

40. PURPOSE: TO BLUR OUT ANATOMY ABOVE AND BELOW THE PLAIN OF INTEREST USUALLY 1CM FOR KIDNEYS TOMOGRAPHY CHANGE FULCRUM LEVEL FOR EACH EXPOSURE

43. Note level of kidneys to spine

45. Tomogram – “PREPPED”

46. Tomography = blurs out anatomy above and below selected level Long exposure Times At least 1 second Must reduce mA Increase time

48. tomogram

49. nephrotomogram