1

CONTRAST MEDIAVenipuncture

& TomographyBrief Review of Contrast - More detail in RT 93

2

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

Important Conditions to be Aware of……• Level of Consciousness:

ALOC– Altered Level Of

Consciousness

• Anaphylatic Shock: vasogenic shock

• Hypoglycemic/• Hyperglycemia

– NPO – Nothing by Mouth

7

8

FEAR

Needles?

9

10

11

12

Have emesis basin

Towels

Wet cloth available

13

14

15

16

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 !!

20

21

22

INJECTABLE IODINE - NONIONIC

23

Supplies for Venipuncture• Disposable gloves• Alcohol Swabs• Tourniquet• Needle

– Butterfly or Angiocath

• Tape• 2X2 or 4X4• Contrast & Syringes• Saline

24

25

26

Venipuncture Anatomy

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

27

28

29

30

31

32

Standard Precautions

33

34

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

36

37

Extravasation of Contrastinto soft tissue of arm

38

39

TOMOGRAPHY (historical) taken between 1 – 5 min images

40

TOMOGRAPHY

• PURPOSE:• TO BLUR OUT

ANATOMY ABOVE AND BELOW THE PLAIN OF INTEREST

• USUALLY 1CM FOR KIDNEYS

CHANGE FULCRUMLEVEL FOR EACH EXPOSURE

41

42

43

Note level of kidneys to spine

44

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

47

48

tomogram

49

nephrotomogram

50

51

52

Why is this blurry?Why taken?

53

Must mark cm levels“fulcrum “ also remember

to change levels inbetween exposures!