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radiographic con/age

contrast agents/media

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