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radiographic con/age
contrast agents/media
| Question | Answer |
|---|---|
| oral | upper GI abrium, tablet, capsule,liquid- slow prolonged onset |
| sublingual | under the tongue, levsin- muscle relaxer. effectsa in other body parts |
| rectal/vaginal | suppositories, cremes etc |
| inhalation | aerosol- inhalers |
| parental | injection |
| what are some parental routes of administration? PR intradermal | allergy test which is placed under the skin |
| PR subcutaneus | PPD |
| PR intramuscular | immediate effect- buttocks, arm |
| PR intra-arterial/organic | into the antery- antibiotics, chemo |
| PR intravenous/organic | IV fluid, contrast |
| PR intrathecal/organic | into the spinal canal |
| PR enteral | anything through the digestive system |
| what has low inherent subject contrast? | the abdomen |
| what is the purpose of contrast agents/media? | to demonstrate density densities (contrast diff) or defferential absorption in soft tissue organs and vessels which have low inherent sub contrast |
| the first contrast was made up of what? | cinnabar, vaseline, and gypsum |
| when was iodine introduced as a contrast agent? | in 1923 |
| organic iodine | contains carbon in order to be injected into the body |
| inorganic iodine | inorganic toxicity, retrograde use |
| water soluble | absorbed by the blood and excreted by the kidneys |
| toxicity | degree of being poisonous |
| miscible | mixes w/body fluids |
| viscosity | thickness/resistance to flow |
| RT can control contrast by what? | temperature |
| the manufacturer controls (iodine) by? | concentration |
| what is used to check renal function? | BUN/creatinine/GFR |
| BUN | blood urea nitrogen level |
| creatinine | in the blood |
| GFR | glumorial flow rate |
| is barium miscible? | no, so make sure pt. drinks lots of fluids |
| morbidity | rate of adverse occurences |
| mortality | death rate |
| positive contrast | radiopaque- shows up white becuase it absorbs more contrast. it is also more dense than surrounding tissue |
| negative contrast | radiolucent- shows up black, air |
| osmolarity | concentraion of iodine in solution or #iodine particles per kg of water |
| chemical composition | monomer or dimer |
| what type of osmolarity should we use | we want to use low osmolarity becuase its safer and has fewer iodine particles which decreases adverse occurences (reactions) |
| ionic contrast | chemical composition involves binding w/ sodium or meglumine and dissociates in water |
| non-ionic contrast | chemical composition is not ionic bound so will not dissociate in water. |
| what type of ionic contrast do we want to use? | we want to use non-ionic contrast low osmolar becuase it does not dissociate in water and has less particles which makes it safer. |
| negative contrast agents | decr. density diff or differential absorption. organs show up darker density v. surrounding structures. low k-shell edge- neg contrast hydrogen, helium, oxygen. double contrast studies, CO2 invasive, and PEG |
| CO2 is used for ? | imaging both arterial and venous circulations/ endovascular aswell |
| when should CO2 not be used? | as an arterial contrats agent in sites above the diaphragm becuase of risk of gas embolism of the spinal, coronary, and cerebral arteries |
| positive contrast agents | increases density differences or differential absorption. organ shows up light density v. surrounding structures on IR (fluoro screen-black) |
| positive contrast agents | harder to penetrate and have a higher k-shell egde and atomic #. barium 37/iodine 33. A# barium 56/ iodine 53 |
| positive agents barium sulfate | oral/rectal. thin for single contrast studies |
| what is used for double contrast studies? | high density and air |
| pos contrast agents/ organic iodinated | oral, iv, intra-arterial, intrathecal, rectal |
| ionic | high osmolar contrast agent |
| non-ionic | low osmolar contrast agent which gives you less chance of adverse reactions and less particles. also does not dissociate in water |
| HOCA | urografin/ gastrografin |
| low osmolar | does not dissipate in water/ cystografin is non- ionic |
| LOCA | ultravist, visipaque, omnipaque |
| if osmolarity is close to blood its called? | isosmolar which is given if pt. has renal failure/visipaque |
| what are the advantages of non-ionic contrast? | less toxic, lower rate of adverse occurances (morbidity), less heat and discomfort at injection site, less neurotoxicity |
| non ionic | omniopaque/ 300 cervical myelogram/ 180 lumbar thoracic myelogram/350 IVU |
| ionic | cystogram/ renografin/ non injection/ retrograde |
| if pt. has toximegacolon do not use what? | barium |
| gastrografin | water soluble iodinated is used when barium is contraindicated/ 80-85 kvp/ med hx form. if used for small bowel follow through consult w/ MD |
| side affects w/ gastragrafin | nausea, vomiting, urticaria (hives), erythema (redening of the skin), hypoxia (low O2) |
| oral or rectal water solubles? | GI aspiration can lead to pulmonary edema |
| iodine contrast labs | lab values creatinine- con if > 1.7. BUN - > 65. GFR- < 30ml |
| iodine contrast contraindications | iodine sensitivity, diabetics on oral insulin, prev hx of severe reaction, renal failure, unless pt. is scheduled for dialysis w/in 48 hours. multiple myeloma, pulmonary edema,pheachromocytoma ( cancer on endocrine glands) |
| iodine contrast contraindications cont'd | only one kidney- do not exceed 75 cc, peds pt. under 12 determined by MD, based upon wt in kg. ALWAYS CHECK W/MD BEFORE INJ OR W/ANY |
| contrast induced nephropathy | greater than 25% incr. of serum creatinine or an absolute incr. in serum containing of 0.5 MG/DL ( after a radiologic examination using a contrast agent) |
| following intravascular administration of contrast media metformin should be stopped for? | 48 hours until renal function shows normal |
| iodinated contrast kvp range | k-egde 33 ke/ kvp 70-75/ kvp 85-90 for gastrografin because you are filling the colon |
| barium sulfate | insoluble (inert) does not mix w/water, not absorbed. not toxic if aspirated. can add flavoring agent. k-egde= 37kev/ kvp 90-105 |
| barium sulfate | weight in weight= powder form weight in volume= liquid form |
| barium sulfate contraindications | suspected or known perforation, can cuase peritonitis and be fatal. suspected large bowel requiring surgery. toxicmegacolon |
| toxic megacolon | if barium is used the pt. is at high risk for perfooration |
| barium at room temp. | adheres to the mucosal lining better |
| double contrast BE | to show lining membrane. high intensity barium, air. 90-95 kvp |
| single contrast BE | thin barium which is used for filling.100-105 kvp, pt. w/ limited mobility, elderly. * double contrast to single contrast you increase kv* |
| biphasic exams | initially used HD barium and air followed by thin barium |
| defeccography | barium w/similiar consistency as stool |
| double contrast UGI | high intensity barium, easy gas crystals, lining 90-95 kvp |
| single contrast UGI | thin barium, filling 100-105 kvp, pt. w/ limited mobility, elderly |
| enteroclysis (double contrast small bowel) | thin barium and air or methylcellulose. NG or NE tube - bilboa or sellink |
| double contrast small bowel | small bowel pre-mixed barium |
| esophogram/barium swallow | thin barium or paste |
| BaS | excreted by digestive tract (enteric). instruct pt. to drink fluids after the exam unless contraindicated per MD. may need laxative (per MD) |
| oral cholecystopaques | oral to GI to bloodstream to biliary system. binds with albumin (blood protein) so not excreted by renal system but liver |
| MRI contrast agents (low toxicity) /Gd DTPA/ multihance/ prohance | gadolinium dienthylenetriaminepenta acetic acid- CNS |
| metal chelate | molecule combined w/ metal (gadolinium) |
| IV | excreted by renal system |
| BBB | blood brain barrier. enters tumors in brain and is broken down by tumor |
| PCN | penicilin |
| NKA | no known allergies |
| gauge | size of opening in needle |
| chemotoxic | function of a substance to affect the chemical balance |
| angiocath vs. butterfly needle | butterfly neeedles are short term |
| dysphagia | difficulty swallowing |
| extravasation | escape |
| vasovagal | cardiovascular change, light headed, anxiety, sweating, low bp, slow heart rate |
| diaphoresis | sweating |
| bradycardia | slow heart rate |
| tachycardia | fast heart rate |
| anytime a pt. has benadryl they must ? | get a ride home |
| mild adverse occurences | nausea, flushing, metallic taste, numbness, tingling, mild hives, tx observe and notify RN and MD |
| moderate adverse occurences | erythema - skin redness, facial edema, severe urticaria- hives, laryngeal, brochial spasm/ asthmatic attack, mild bp drop. tx antihistamine (benadryl- IV,IM or PO) epi |
| severe adverse occurences | prolonged bp drop, circulatory collapse, convulsion, coma, anaphylactic shock, cardiac and resp arrest |
| symptoms of severe occurences | sense of warmth, tingling, itching of palms and soles, dysphagia, constriction of throat, feeling of doom, expiratory wheeze. tx shock, code blue, crash cart, 02, suction |
| fatal reactions are often preceded by | lesser reactions |
| majority of reactions occur | immediately but can take up to 30 minutes |
| medications in case of adverse occurences | atropine- inhibits vasovagal raection. cardiovascular change, light headed, anxiety, low bp, bradycardia, diaphoresis |
| demerol | (meperidine hydrochloride) analgesic |
| valium | diazepam- muscle relaxant, sedative |
| benadryl | antihistamine |
| treating adverse occurences | hives no symptims watch/ symptoms benadryl/ anihistamine ride home |
| diffuse erythema | mild iv fluids/ benadryl, hydrocortisone. severe- epinephrine 1:1000 sub Q or IM - slower reaction due to route but higher solution. 1:10,000 slow IV (watch for chest pains) |
| bronchospasm | IV, O2/ mild albuterol inhaler/ moderate 1:1000 sub Q or IM. severe- epi 1:10,000 slow IV acts as bronchodilator and vasoconstrictor |
| hypotension with tachycardia (anaphylactic) | mild trendelenburg- IV, O2, with mask severe- epi 1:10,000 slow IV acts as vasoconstrictor |
| hypotension w/ bradycardia (vasovagal) | due to pain and/or anxiety mild- IV, trendelenburg, cool cloth on head severe- IV atropine to speed heart rate |
| hypertensive crisis | IV, O2. furosemide (water pill), nitroglycerin |
| suspicious for phaechromocytoma (contraindication) | phentioamine |
| pulmonary edema (contraindication) | IV, O2, fowlers position, furosemide (water pill), morphine, hydrocortisone |
| post pocedure patient education: barium/iodine | tell pt to drink plenty water which is best. if they need a laxative refer them to a DR. |
Created by:
eckoultd1972
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