Radiographic Contrast Media RAD TECH 255 SPECIAL PROCEDURES

1 Radiographic Contrast Media RAD TECH 255 SPECIAL PROCEDURES Reference: MERRILLS VOL2 RTA BOOK CH 19

SPECIAL PROCEDURES ARE INVASIVE ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA CONTRAST MEDIA & ADVERSE REACTIONS RISK Any foreign substance introduced in the body Chance the body will react negatively to the material Minor to Life Threatening Minor = 5% Major 0.1%

HISTORY Kidney problems Previous reaction Diabetes Current medications Heart conditions Beta Blockers Allergies Antihypertensive medications Asthma VITAL SIGNS

Older patient age Renal insufficiency History of contrast-related anaphylactoid reaction Allergic Rhinitis, medication or Food Allergy Cardiovascular disease

CONSENTS SIGNED AND WITNESSED AFTER PROCEDURE HAS BEEN EXPLAINED CHECK DEPARTMENT PROTOCOL WHO’S RESPONSIBLE ?????? CONSENTS ASSAULT verbal threat of harm BATTERY Unlawful touching - unauthorized treatment “X-RAY” TAKEN ON WRONG PATIENT FALSE IMPRISONMENT Restraints require permission from patient or authorized person

Subject Contrast Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient). Low Subject Contrast What can be done to attain medical information- see the difference between muscle, organs or vessels Define and outline – organ structure and function Defines subtle differences in subject contrast Increases atomic number of area injected Results in a SHORTER scale of subject contrast Purpose of Contrast Media To enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast. Radiographic Contrast : Influenced by…KVP TYPE OF CONTRAST USED DETERMINES KVP RANGE BARIUM 90 – 120 kVp IODINES 70 – 80 kVp (Ionic / Nonionic Water or Oil) Contrast media Diagnostic agents That are either: Ingested (GI Tract) Instilled (body orifices) Injected Circulatory System, Joint Spaces, Ducts Methods of Administration of Contrast Material INGESTED (ORAL) RETROGRADE AGAINST NORMAL FLOW INTRATHECAL Spinal canal PARENTERAL Injecting into bloodstream (anything other than oral) 2 BASIC TYPES OF CONTRAST BARUIM Z# 56 NON WATER SOLUABLE POWDER GI TRACT ONLY INGESTED OR RECTALLY LIQUID KVP 90 – 120* INTRAVENOUS ORGI TRACT IODINE Z# 53 WATER SOLUABLE KVP BELOW 90* 2 Iodine Contrast Material WATER BASED: Ionic Iodine Contrast Non-Ionic Contrast Anion -Cation + Less patient allergic reactions More patient allergic reactions

Oil Based Iodine Used in: Fatty Acids Broncography (lungs) Insoluble in water Tear ducts Salivary glands Lymphatic system Hysterosalpingogram White on the radiograph = Radiopaque

CONTRAST MATERIAL ADVERSE REACTIONS ALWAYS GET PATIENT’S HISTORY BEFORE ANY CONTRAST MEDIA IS GIVEN SEE Ch. 19 Table 19-7 pg 296 Pt Care General Information

Nonionic vs ionic Greater chance for contrast reactions Risk Factors Anaphylatic shock is the most severe Severity of Reactions REACTIONSTreatment Renal toxicity USUALLY** WITHIN FIRST 5 MINUTES Glucophage Nausea & Vomiting & Urticaria Screening Creatinine Hypotension (bradycardia) Pretreatment Hypotension (tachycardia) Iodinated CONTRAST AGENTS Bronchospasm Adverse Reactions Anaphylactoid Osmolarities higher than body fluids Seizures Viscous

Extravasation CONTRAST REACTIONS General > 10 million diagnostic procedures / year 1 in 1000 severe Conventional ionic contrast reactions - 10%

Catagories of Adverse Reactions

MILD Ch. 19 pg 297 Pt Care Treatment – does not usually get worse nausea, vomiting Watch patient and reassure Uticaria (hives) rash – itching (cool cloth on forehead, emesis basin Flush face – feeling of warmth Headace, Chills, Anxiety Catagories of Adverse Reactions Diaphoresis

Catagories of Adverse Reactions MODERATE Hypotension (bradycardia) TREATMENT: Hypertension (tachycardia) Needs immediate treatment –GET RN/RAD Dyspnea Needs Meds* – (Keep IV line in) Bronchospasms /wheezing could lead to severe reactions Laryngeal Edema

Catagories of Adverse Reactions SEVERE Laryngeal edema Profound hypotension Convulsions Clincally manifested arrhythmias 3 Unresponsiveness PROMPT TREATMENT – CODE BLUE! Cardiopulmonary Arrest

Rx for REACTIONS Tagament or Zantac have ready on Emergency cart or Crash Cart UTICARIA (HIVES) – Facial/Laryngeal Edema/Bronchospasms Benadryl (diphenhydramine) Epinephrine , Oxygen Vistaril (hydorxyzine) Contrast Reactions/MYTHS not caused by iodine not true allergy (no drug-antibody) Ionic vs non ionic - binding elements mechanism remains unknown not related to shellfish

Anaphylactoid (idiosyncratic) unpredictable prevalence 1-2% (0.04 - 0.22% severe) dose independent fatal 1 in 75,000

Renal Toxicity (increased serum creatinine > 0.5 mg%) 2 -7% GLUCOPHAGE 5 - 10 fold increase with pre-existing renal Pt is DIABETIC = oral diabetic agent insufficiency direct relationship between serum creatinine and MUST STOP __ DAYS BEFORE EXAM likelihood nephrotoxicity withhold drug for 48 hrs after contrast Hydrate 100 ml/hr Normal saline 4 hrs prior to administration procedure, continue for 24 hours patients with renal insufficiency may develop lactic acidosis PreMedications (Insulin= low blood sugar occurs while fasting) Steroids (Prednisone) After Nuclear Medicine Tests Benadryl (diphenhydramine) (iodine goes to thyroid and will alter results) Epinephrine EXTRAVASATION Iodine BEFORE Barium Contrast material has seeped outside of vessel BE before UGI ( IVP before BE) Local redness and swelling SCHEDULING CONSIDERATIONS WATER – OIL - BARIUM Diabetics – first Contrast Agents Low Osmolality (Lower risk of complications) IONIC Gadodiamide (Omniscan) High Osmolality (Higher risk of complications) Iodixanol (Visipaque) Iopamidol (Isovue) Diatrizoate sodium (Hypaque) Iopromide (Ultravist) Iothalamate meglumine (Conray) Ioversol (Optiray) NON-IONIC