1 radiographic contrast media rad tech 255 rad tech 255 special procedures special procedures...
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RadiographicRadiographicContrast MediaContrast Media
RAD TECH 255RAD TECH 255
SPECIAL PROCEDURESSPECIAL PROCEDURESWEBPAGE VERSIONWEBPAGE VERSION
MERRILLS VOL2MERRILLS VOL2
RTA BOOK RTA BOOK
REV: SPRING 2010REV: SPRING 2010
22 Subject ContrastSubject Contrast
Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient).
For LOW CONTRAST stucures: What can be done to attain medical information- see
the difference between muscle, organs or vessels Define and outline – organ structure and function
CONTRAST MEDIA used to:CONTRAST MEDIA used to: enhanceenhance subject contrast or render high subject subject contrast or render high subject
contrast in a tissue that normally has low subject contrast in a tissue that normally has low subject contrastcontrast
33
Contrast mediaContrast media
Defines subtle differences in subject Defines subtle differences in subject contrast contrast
Increases atomic number of area injectedIncreases atomic number of area injected
Results in a SHORTER scale of subject Results in a SHORTER scale of subject contrastcontrast
44 Radiographic Contrast : Radiographic Contrast :
Influenced by…Influenced by…Radiation Quality (KVP)Radiation Quality (KVP)Film ContrastFilm ContrastRadiographic object (Patient)Radiographic object (Patient)
Atomic NumberAtomic NumberFat = 6.46Fat = 6.46Water = 7.51Water = 7.51Muscle = 7.64Muscle = 7.64Bone = 12.31Bone = 12.31
55
KVPKVP TYPE OF CONTRAST USED DETERMINES KVP RANGE
BARIUM _______kVp
IODINES ________kVp(Ionic / Nonionic Water or Oil)
66
INJECTABLEINJECTABLECONTRAST MEDIACONTRAST MEDIA
for RT 255 proceduresfor RT 255 procedures
INVASIVE PROCEDURESINVASIVE PROCEDURES
The “o-grams”The “o-grams”
77ALWAYS TAKE
A “SCOUT”
BEFORE CONTRAST INJECTION
Why?
List 4 reasons
88
SPECIAL “o-grams”SPECIAL “o-grams”
VenogramVenogramArthrogramArthrogramSialogramSialogramMyelogramMyelogramArteriogramArteriogramAngiogramAngiogramGalactogramGalactogramHystersalpingogram…….. etcHystersalpingogram…….. etc
99
CONTRAST INJECTIONCONTRAST INJECTION
KNEE ARTHROGRAM
1010DOUBLE CONTRAST WITH IODINE - DOUBLE CONTRAST WITH IODINE - HIP ArthrogramHIP Arthrogram
1111To check fertilityTo check fertility
can be oil or water based contrastcan be oil or water based contrast
1212
MyelogramMyelogram
1313
Myelogram ContrastMyelogram Contrast
Pantopaque was introduced in 1944 as a Pantopaque was introduced in 1944 as a oil contrast medium oil contrast medium
The first low-osmolar contrast medium to The first low-osmolar contrast medium to be produced was metrizamide (Amipaque)be produced was metrizamide (Amipaque)
Oil never completely re –absorbedOil never completely re –absorbed (Pre-employment L.sp)(Pre-employment L.sp)
1414
SIALOGRAMSIALOGRAM
1515 Galactography - Galactography - Breast Breast Duct Duct
1616
Cerebral AngiogramCerebral Angiogram
1717
1818
LYMPHANGIOGRAMLYMPHANGIOGRAM
Now largely replaced by ________ ?
1919
DacryocystographyDacryocystography
Now largely replaced by CT
2020SPECIAL PROCEDURESSPECIAL PROCEDURES
ARE ARE INVASIVEINVASIVE
ALWAYSALWAYS GET PATIENT’S GET PATIENT’S HISTORY AND CONSENTHISTORY AND CONSENT
BEFORE BEGINNING BEFORE BEGINNING
OR GIVINGOR GIVING ANY ANY CONTRAST MEDIACONTRAST MEDIA
2121
CONSENTSCONSENTS
SIGNED AND WITNESSEDSIGNED AND WITNESSEDAFTER PROCEDURE HAS AFTER PROCEDURE HAS
BEEN EXPLAINEDBEEN EXPLAINEDCHECK DEPARTMENT CHECK DEPARTMENT
PROTOCOLPROTOCOLWHO’S RESPONSIBLE ??????WHO’S RESPONSIBLE ??????
2222
CONSENTSCONSENTS
ASSAULT ASSAULT
verbal threat of harmverbal threat of harmBATTERYBATTERY
Unlawful touching - unauthorized treatmentUnlawful touching - unauthorized treatment
““X-RAY” TAKEN ON WRONG PATIENTX-RAY” TAKEN ON WRONG PATIENTFALSE IMPRISONMENTFALSE IMPRISONMENT
Restraints require permissionRestraints require permission
from patient or authorized personfrom patient or authorized person
2323
The ARRT has a The ARRT has a published code of ethics.published code of ethics.
The ARRT Code of Ethics provides the The ARRT Code of Ethics provides the radiologic technologist with an operational radiologic technologist with an operational blueprint of norms of professional conduct.blueprint of norms of professional conduct.
2424Review of EthicsReview of Ethics
(Pt Care Book –Professional Ethics)(Pt Care Book –Professional Ethics)
The science of rightness and wrongness of The science of rightness and wrongness of human conduct and character is termed human conduct and character is termed ethics. ethics.
____________________is the ethical principle that is the ethical principle that means that “above all, do no harm.”means that “above all, do no harm.”
__________________ principle that means that principle that means that being truthful is right.being truthful is right.
____________________ is the ethical principle that is the ethical principle that means that actions benefit others.means that actions benefit others.
2525
Review of Contrast AgentsReview of Contrast Agents
Types of ContrastTypes of Contrast
Routes of AdminstrationRoutes of Adminstration
Chemical ComponentsChemical Components
2626Contrast Media changes the Contrast Media changes the
density of the organsdensity of the organsTherefore changing the
Subject contrast
will change the
Radiographic contrast and film contrast
May need to INCREASE TECHNIQUE FROM SCOUT IMAGE* f/s
2727
Contrast Media Contrast Media (review)(review)
Negative contrastNegative contrast (AIR OR CO2)(AIR OR CO2)
RadiolucentRadiolucent
Low atomic # materialLow atomic # material
Black on filmBlack on film
Positive contrastPositive contrast (all others)(all others)
RadiopaqueRadiopaque
High atomic # High atomic # materialmaterial
White on filmWhite on film
2828 Types of Contrast MediaTypes of Contrast Media
Radiolucent-Radiolucent- negative contrast agentnegative contrast agent x-rays easily penetrate x-rays easily penetrate areas- appear areas- appear ________ on films on films
Negative Contrast MediaNegative Contrast Media Air and gasAir and gas
complicationscomplications emboli-air pockets in emboli-air pockets in
vesselsvessels lack of oxygenlack of oxygen
Radiopaque- Radiopaque- positive contrast agent- positive contrast agent- absorbs x-raysabsorbs x-rays areas- appear areas- appear ________ on films on films
Positive Contrast AgentsPositive Contrast Agents BARIUM BARIUM IODINESIODINES
Both + & - can be used in same Both + & - can be used in same studystudy
2929 2 BASIC 2 BASIC TYPESTYPESOF CONTRAST materialOF CONTRAST material
BARUIM BARUIM Z# 56 Z# 56
NON WATER NON WATER SOLUABLESOLUABLE
GI TRACT ONLY GI TRACT ONLY INGESTED OR INGESTED OR RECTALLYRECTALLY
KVP 90 – 120*KVP 90 – 120*
IODINE IODINE Z# 53 Z# 53 WATER SOLUABLEWATER SOLUABLE POWDERPOWDER LIQUIDLIQUID INTRAVENOUS ORINTRAVENOUS OR IntrathecalIntrathecal GI TRACTGI TRACT Also OIL basedAlso OIL based KVP BELOW 90*KVP BELOW 90*
3030Methods of AdministrationMethods of Administration
of Contrast Materialof Contrast MaterialINGESTED INGESTED
(ORAL)(ORAL)
RETROGRADE RETROGRADE AGAINST NORMAL FLOWAGAINST NORMAL FLOW
INTRATHECAL INTRATHECAL Spinal canalSpinal canal
PARENTERAL (IV, Intrathecal)PARENTERAL (IV, Intrathecal)Injecting into bloodstreamInjecting into bloodstream(anything other than oral)(anything other than oral)
3131Contrast media for Contrast media for
SPECIAL PROCEDURESSPECIAL PROCEDURES
Diagnostic agents
that are injected intoCirculatory System, Joint Spaces, DuctsCirculatory System, Joint Spaces, Ducts
Body orifices/organs: uterus, breast, Body orifices/organs: uterus, breast,
salivary & lymph glandssalivary & lymph glands
3232 BLOOD WORKBLOOD WORK LAB TESTS to check function of kidneys LAB TESTS to check function of kidneys
prior to injection of contrastprior to injection of contrast WATCH THE UPPER LIMITSWATCH THE UPPER LIMITS BUN = BLOOD UREA NITROGENBUN = BLOOD UREA NITROGEN Merrills Merrills pg 214pg 214 range is range is 8 to 258 to 25 pg 242pg 242 range is range is 10 - 20 10 - 20
always check with RAD when level above always check with RAD when level above 2020
CREATININE levels rangeCREATININE levels range:: pg 214pg 214 (0.6 - 1.5)(0.6 - 1.5) pg 242pg 242 (0.05 - 1.2) (0.05 - 1.2)
always check with RAD when level above always check with RAD when level above 1.21.2
Indicates function of kidneys Indicates function of kidneys Diseases / dehydration / kidney failureDiseases / dehydration / kidney failure
3333
EGFR (new test)EGFR (new test)
Estimated Estimated Glomerular Glomerular Filtration Filtration RateRate
More advanced test for More advanced test for CREATININE levelsCREATININE levelsWhy is this important?Why is this important?
3434various water-soluble contrast media for
urography and angiography
Both ionic and non-ionic Both ionic and non-ionic monomers*monomers*are all extracellular contrast mediaare all extracellular contrast mediaare excreted unmetabolized by glomerular are excreted unmetabolized by glomerular
filtrationfiltrationApproximately 85-90% of the injected Approximately 85-90% of the injected
dose is found in urine within the first 6 dose is found in urine within the first 6 hourshours
95-100% within the first 24 hours95-100% within the first 24 hours
3535monomers*monomers*
The ionic monomeric agents are salts thatThe ionic monomeric agents are salts thatdissociate into two moleculesdissociate into two moleculesone anion containing the radiopaque one anion containing the radiopaque
property due to three iodine atomsproperty due to three iodine atomsand one cation without radiopaque and one cation without radiopaque
propertiesproperties
More on this later in the lecture…..More on this later in the lecture…..
3636
BARIUM – BARIUM – a reviewa review
BARUIM SULFATEBARUIM SULFATE
Not used in Special ProceduresNot used in Special Procedures
3737
Barium SulfateBarium Sulfate
High atomic number High atomic number Z #? ______Z #? ______Not soluble in waterNot soluble in waterUsed to coat the lining of organsUsed to coat the lining of organsSupplied in different thicknessesSupplied in different thicknessesUsedUsed
Esophogram, UGI, Small Bowel,Lower Esophogram, UGI, Small Bowel,Lower GI or BEGI or BE
3838
BaBa ADVERSE REACTIONS ADVERSE REACTIONS
BARIUM INERTBARIUM INERTSUSPENSION MAY CAUSE ALLERGYSUSPENSION MAY CAUSE ALLERGYOCG TABLETS (IODINE) ALLERGYOCG TABLETS (IODINE) ALLERGYAFTER EXAM – MAY SOLIDIFY AFTER EXAM – MAY SOLIDIFY
DIFFICULT TO EVACUATEDIFFICULT TO EVACUATE INCREASE FLUIDS, MILD LAXATIVEINCREASE FLUIDS, MILD LAXATIVEEXTRAVASATION OF CONTRAST INTO
PERITONEUM
3939
Extravasation of BA in abdExtravasation of BA in abd
4040
Ingested CONTRASTIngested CONTRASTGastrografin or HypaqueGastrografin or Hypaque
High atomic #High atomic # Close to iodineClose to iodine
Water solubleWater soluble
Similar usage as Similar usage as BariumBarium
4141GASTROGRAFINGASTROGRAFINAdverse ReactionsAdverse Reactions
Water soluble, safe in the abdominal Water soluble, safe in the abdominal cavitycavitySafe to use if perforation is Safe to use if perforation is
suspectedsuspected Very harmful to the lung tissueVery harmful to the lung tissue
Do not use if aspiration is possibleDo not use if aspiration is possible
4242
Gastro – Pathology presentGastro – Pathology present
Bowel Bowel ObstructionObstruction
Note contrastNote contrast Seen in Seen in
kidneys as kidneys as wellwell
4343
IODINEIODINEIONIC OR NON IONICIONIC OR NON IONIC
WATER OR OIL BASEWATER OR OIL BASE
4444IODINATED CONTRASTIODINATED CONTRAST
iodine z # 53iodine z # 53 WATER BASEDWATER BASED
INJECTEDINJECTED VESSELLS/DUCTSVESSELLS/DUCTS INGESTEDINGESTED Organ function/flowOrgan function/flow OPEN WOUNDSOPEN WOUNDS
OIL BASEDOIL BASED INJECTEDINJECTED NEVER NEVER
VESSELLSVESSELLS ONLY DUCTSONLY DUCTS NOT INGESTEDNOT INGESTED OPEN WOUNDSOPEN WOUNDS
4545INJECTION OF INJECTION OF IODINEIODINE
into Vesselsinto Vessels ALWAYS A ALWAYS A WATER WATER
BASED IODINATED BASED IODINATED COMPOUNDCOMPOUND
BOLUS INJECTIONBOLUS INJECTION INFUSION DRIPINFUSION DRIP
IONIC VSIONIC VS NON IONICNON IONIC CONTRASTCONTRAST
50 -70 % 50 -70 % CONCENTRATECONCENTRATE
4646IODINE WATER BASED IODINE WATER BASED
CONTRASTCONTRAST IONICIONIC LESS $$$LESS $$$
MORE REACTIONSMORE REACTIONS
NON IONICNON IONIC MORE $$$MORE $$$
LESS REACTIONSLESS REACTIONS
4747CONTRAST MEDIACONTRAST MEDIA
IODINEIODINE
is either: IONIC or NON-IONIC is either: IONIC or NON-IONIC OsmolarityOsmolarity# Of Particles (Cations + And Anions -) # Of Particles (Cations + And Anions -)
In Solution Per Kilogram Of WaterIn Solution Per Kilogram Of WaterHigh OsmolarityHigh Osmolarity
=more Cations And Anions=more Cations And AnionsCan Upset HomeostasisCan Upset HomeostasisNonionic Have No Charged ParticlesNonionic Have No Charged Particles
4848
Contrast AgentsContrast AgentsIONICIONICHigh Osmolality High Osmolality
(Higher risk of (Higher risk of complications) complications)
Diatrizoate sodium Diatrizoate sodium (Hypaque) (Hypaque)
Iothalamate Iothalamate meglumine meglumine (Conray) (Conray)
NON-IONICNON-IONICLow Osmolality Low Osmolality
(Lower risk of (Lower risk of complications) complications)
Gadodiamide Gadodiamide (Omniscan) (Omniscan) Iodixanol Iodixanol
(Visipaque) (Visipaque) Iopamidol (Isovue) Iopamidol (Isovue) Iopromide Iopromide
(Ultravist) (Ultravist) Ioversol (OptirayIoversol (Optiray) )
4949
Less moneyLess money More reactionsMore reactions
More moneyMore money Less reactionsLess reactions
5050OIL – BASEDOIL – BASED
IODINE CONTASTIODINE CONTAST
Instilled in ORGAN – Instilled in ORGAN – Not vessellsNot vessells
Oil-based iodine contrast media Oil-based iodine contrast media
are made from fatty acidsare made from fatty acids
of poppy seed oil containing 48% and 37% iodine of poppy seed oil containing 48% and 37% iodine
5151Oil Based IodineOil Based Iodine
Fatty AcidsFatty Acids Insoluble in waterInsoluble in water
White on the radiograph = RadiopaqueWhite on the radiograph = Radiopaque UsesUses
Broncography (lungs)Broncography (lungs) Tear ductsTear ducts Salivary glandsSalivary glands Lymphatic systemLymphatic system HysterrosalpingogramHysterrosalpingogram Galactography (breast ducts)Galactography (breast ducts)
FAT EMBOLUS FAT EMBOLUS IF IT GETS INTO IF IT GETS INTO BLOOD VESSELBLOOD VESSEL
5252CONTRAST MEDIACONTRAST MEDIA
CHEMICAL PROPERTIESCHEMICAL PROPERTIESTRIIODINATED COMPOUNDSTRIIODINATED COMPOUNDSBASED ON THE BENZOID ACID RINGBASED ON THE BENZOID ACID RING
IODINE IS USED DUE TO THE HIGH IODINE IS USED DUE TO THE HIGH ATOMIC NUMBERATOMIC NUMBER
5353
The benzene ring is associated with the anion.The benzene ring is associated with the anion.
5454 CONTRAST MEDIACONTRAST MEDIA IONIC CONTRASTIONIC CONTRAST
NON IONIC NON IONIC CONTRASTCONTRAST
5555 Iodine Contrast MaterialIodine Contrast Material
Ionic ContrastIonic Contrast Anion -Anion - Cation +Cation + More patient allergic reactionsMore patient allergic reactions
Ionic contrast media Ionic contrast media dissociates into two dissociates into two molecular particles in blood molecular particles in blood plasma =plasma =
Causing pt reactionsCausing pt reactions The benzene ring is The benzene ring is
associated with the anion.associated with the anion.
•Non-Ionic Contrast
•Less patient allergic reactions
Nonionic contrast media is associated with low osmolality.
5656
Iodine Contrast MaterialIodine Contrast Material
ANIONS ANIONS - CHARGE IONS- CHARGE IONS Responsible For Responsible For
Stabilizing And Stabilizing And Detoxifying The Detoxifying The Contrast MediaContrast Media
CATIONSCATIONS + CHARGED IONS+ CHARGED IONS Responsible For Responsible For
Increasing The Increasing The Solubility Of The Solubility Of The MediumMedium
The benzene ring is associated with the ________ ?The benzene ring is associated with the ________ ?
5757Newer Contrast Newer Contrast Agents BalanceAgents Balance
Safety and Visualization Safety and Visualization
•In addition to osmolality, toxicity is a concern
•Although the mechanism of contrast medium toxicity is not completely understood
•it is believed that "chemotoxicity" is related to the protein-binding capacity of the medium,
•which is caused by non-specific weak interactions between the contrast medium and surrounding enzymes.
5858What contributes to What contributes to
discomfort, side effects, reactions:discomfort, side effects, reactions:VISCOSITYVISCOSITY – (thick, sticky) – (thick, sticky)
thicker – harder to inject, more heat and thicker – harder to inject, more heat and vessel irritation (higher = greater viscosity)vessel irritation (higher = greater viscosity)
Warming contrast will helpWarming contrast will helpTOXICITYTOXICITY - (higher = greater viscosity) - (higher = greater viscosity)MISCIBILITY MISCIBILITY - easily mixes with blood- easily mixes with bloodOSMOLALITY - OSMOLALITY - is a measure of the total is a measure of the total
number of particles in solution.number of particles in solution.
5959Iodinated CONTRAST AGENTSIodinated CONTRAST AGENTS
Adverse ReactionsAdverse ReactionsOsmolarities higher than body fluidsOsmolarities higher than body fluidsViscousViscousGreater chance for contrast reactionsGreater chance for contrast reactionsAnaphylatic shock is the most severeAnaphylatic shock is the most severeInjection of ionic contrast media may Injection of ionic contrast media may
lead to lead to hypovolemia.hypovolemia.
6060HypovolemiaHypovolemia
basically means low blood volume basically means low blood volume Symptoms of hypovolemia may includeSymptoms of hypovolemia may include
cold hands and feet, light headedness, infrequent cold hands and feet, light headedness, infrequent urination, increased heart rate, and weakness.urination, increased heart rate, and weakness.
Low blood volume can result in multiple organ Low blood volume can result in multiple organ failure, kidney damage, brain damage, and deathfailure, kidney damage, brain damage, and death
hypovolemiahypovolemia differs from dehydration (which is differs from dehydration (which is excessive loss of body waterexcessive loss of body water
hypovolemiahypovolemia can lead to dehydration can lead to dehydration
6161
Hypovolemia is the Hypovolemia is the most common causemost common cause
ofofOrthostatic hypotensionOrthostatic hypotension
What? __________ What? __________
6262
High osmolality of the contrast media is related to adverse reactions.
6363CONTRAST MATERIALCONTRAST MATERIALADVERSE REACTIONSADVERSE REACTIONS
ALWAYSALWAYS GET PATIENT’S GET PATIENT’S HISTORY BEFORE HISTORY BEFORE ANYANY CONTRAST MEDIA IS CONTRAST MEDIA IS
GIVENGIVEN
SEE Ch. 19 Table 19-7 pg 296 SEE Ch. 19 Table 19-7 pg 296 Carlton Pt Care Carlton Pt Care (3 (3RDRD ed) ed)
6464
Reaction classificationReaction classification
Immediate reactionsImmediate reactions were defined as were defined as those occurring within the department those occurring within the department (within one hour)(within one hour)
DelayedDelayed as those occurring between the as those occurring between the time the patients left the department and time the patients left the department and up to seven days later up to seven days later
6565
Delayed Side Effects to ContrastDelayed Side Effects to Contrast
Skin effects included itching, Skin effects included itching, rash, and hives. rash, and hives.
Nausea, vomiting, and Nausea, vomiting, and diarrhea were the diarrhea were the gastrointestinal side effectsgastrointestinal side effects
General side effects included General side effects included headache, dizziness, and headache, dizziness, and fever.fever.
Infants and patients older than 60 years are at increased risk of developing a side effect.
6666General Factors for General Factors for Contrast ReactionsContrast Reactions
Nonionic vs ionicRisk FactorsSeverity of ReactionsRenal toxicity
Glucophage Diabetic?
Screening Creatinine Pretreatment
6767CONTRAST MEDIA CONTRAST MEDIA
& ADVERSE REACTIONS& ADVERSE REACTIONSRISK RISK Any foreign substance introduced in the Any foreign substance introduced in the
body body Chance the body will react negatively to Chance the body will react negatively to
the materialthe materialMinor to Life ThreateningMinor to Life Threatening
Minor = 5% Major 0.1%Minor = 5% Major 0.1%
6868
GOOD PATIENT HISTORYGOOD PATIENT HISTORY
Kidney problemsKidney problems DiabetesDiabetes Heart conditionsHeart conditions AllergiesAllergies AsthmaAsthma
Previous reactionPrevious reaction Current medicationsCurrent medications Beta BlockersBeta Blockers Antihypertensive Antihypertensive
medicationsmedications
VITAL SIGNSVITAL SIGNS
6969
CONTRAST REACTIONSCONTRAST REACTIONS
General General
> 10 million diagnostic procedures > 10 million diagnostic procedures
per year per year Conventional ionic contrast Conventional ionic contrast
reactions - 10% reactions - 10% 1 in 1000 severe1 in 1000 severe
7070
Contraindiatons for ContrastContraindiatons for Contrast
Renal Failure (Check BUN & Creatinine)Renal Failure (Check BUN & Creatinine) Elevated levels could cause renal Elevated levels could cause renal
shutdownshutdown
Anuria (no urine production)Anuria (no urine production)Asthma (possible allergies)Asthma (possible allergies)Hx of Contrast Allergy / ReactionsHx of Contrast Allergy / ReactionsDiabetes - get a hx of medications takenDiabetes - get a hx of medications taken
glucophage must be stopped 48 hrs before contrast injectionglucophage must be stopped 48 hrs before contrast injection
Multiple Myeloma Multiple Myeloma
7171 MORE Risk Factors MORE Risk Factors for Contrast Reactionfor Contrast Reaction
Older patient age Older patient age
Allergic Rhinitis, medication or Food Allergic Rhinitis, medication or Food AllergyAllergy
Cardiovascular disease Cardiovascular disease
WHO are at increased risk of developing a side effect? (2 age classifications?)
7272
CONTRAINDICATIONSCONTRAINDICATIONS
Pregnancy (Pregnancy (risk of fetal Thyroid toxicity)
+ Radiation concerns
Allergic Reaction Pathologic Conditions Infection
7373
Allergic to IodineAllergic to Iodine
General Rule: General Rule: No Iodine Contrast will be No Iodine Contrast will be
givengivenPre – medication is Pre – medication is
availableavailableMay or may not react if May or may not react if
previous iodine givenprevious iodine given
7474
Aseptic Technique for injectionAseptic Technique for injection
betadine scrub
Contains iodine
7575
7676
REACTIONS & Treatment
USUALLY** WITHIN FIRST 5 MINUTES Nausea & Vomiting & Urticaria Hypotension (bradycardia) Hypotension (tachycardia) Bronchospasm Anaphylactoid Seizures Extravasation
7777 Categories of Adverse Reactions
MILDMILD Carlton – Patient Care Book:
Vol 3 Ch. 19 pg 297 or Vol 4 Ch. 20 pg 337
nausea, vomitingnausea, vomitingUticaria (hives) rash – itchingUticaria (hives) rash – itchingFlush face – feeling of warmthFlush face – feeling of warmthHeadace, Chills, AnxietyHeadace, Chills, AnxietyDiaphoresis Diaphoresis
Treatment – does not usually get worse Treatment – does not usually get worse
Watch patient and reassureWatch patient and reassure
(cool cloth on forehead, emesis basin(cool cloth on forehead, emesis basin
7878 Catagories of Adverse ReactionsCatagories of Adverse Reactions
MODERATEMODERATE Carlton Carlton Pt CarePt Care
Hypotension (Hypotension (bradycardiabradycardia)) Hypertension (tachycardia)Hypertension (tachycardia) DyspneaDyspnea Bronchospasms /wheezingBronchospasms /wheezing Laryngeal EdemaLaryngeal EdemaTREATMENT:TREATMENT:Needs immediate treatment –GET RN/RADNeeds immediate treatment –GET RN/RADNeeds Meds* – (Keep IV line in)Needs Meds* – (Keep IV line in) could lead to severe reactionscould lead to severe reactions
7979 Catagories of Adverse ReactionsCatagories of Adverse Reactions
SEVERESEVERE Carlton Carlton Pt Care Pt Care
Laryngeal edemaLaryngeal edemaConvulsionsConvulsionsProfound hypotensionProfound hypotensionClinically manifested arrhythmiasClinically manifested arrhythmiasUnresponsivenessUnresponsivenessCardiopulmonary ArrestCardiopulmonary Arrest
PROMPT TREATMENT – CODE BLUE!PROMPT TREATMENT – CODE BLUE!
8080Rx for REACTIONSRx for REACTIONS
have ready on Emergency cart or Crash Carthave ready on Emergency cart or Crash Cart
UTICARIA (HIVES) –UTICARIA (HIVES) –
Benadryl (diphenhydramine)Benadryl (diphenhydramine)
Vistaril (hydorxyzine)Vistaril (hydorxyzine)
Tagament or ZantacTagament or Zantac
Facial/Laryngeal Edema/BronchospasmsFacial/Laryngeal Edema/Bronchospasms
Epinephrine , OxygenEpinephrine , Oxygen
8181
Contrast Reactions/MYTHSContrast Reactions/MYTHS
not caused by iodinenot caused by iodine Ionic vs non ionic - binding elements Ionic vs non ionic - binding elements
not related to shellfish not related to shellfish not true allergy (no drug-antibody) not true allergy (no drug-antibody) mechanism remains unknown mechanism remains unknown
8282
Anaphylactoid (idiosyncratic)Anaphylactoid (idiosyncratic)
unpredictable unpredictable dose independent dose independent prevalence 1-2% (0.04 - 0.22% severe) prevalence 1-2% (0.04 - 0.22% severe) fatal 1 in 75,000 fatal 1 in 75,000
8383
RENAL TOXICITYRENAL TOXICITY
(increased serum creatinine > 0.5 mg%) (increased serum creatinine > 0.5 mg%) 2-7% 2-7% 5 – 10 x increase with pre-existing renal 5 – 10 x increase with pre-existing renal
insufficiency insufficiency direct relationship between serum direct relationship between serum
creatinine and likelihood nephrotoxicity creatinine and likelihood nephrotoxicity Hydrate 100 ml/hr Normal saline 4 hrs Hydrate 100 ml/hr Normal saline 4 hrs
prior to procedure, continue for 24 hours prior to procedure, continue for 24 hours
8484GLUCOPHAGEGLUCOPHAGE
Vol 4 Ch. 19 Vol 4 Ch. 19 pg 297 or pg 297 or
Pt is DIABETIC = oral diabetic agent Pt is DIABETIC = oral diabetic agent
MUST STOP __ DAYS BEFORE EXAMMUST STOP __ DAYS BEFORE EXAM withhold drug for 48 hrs after contrast withhold drug for 48 hrs after contrast
administrationadministration patients with renal insufficiency may develop patients with renal insufficiency may develop
lactic acidosis lactic acidosis The signs of lactic acidosis are deep and rapid breathing, vomiting, and The signs of lactic acidosis are deep and rapid breathing, vomiting, and
abdominal pain abdominal pain
What is the name of the medication given for GI peristalsis?What is the name of the medication given for GI peristalsis?
8585
Pre-MedicationsPre-Medications
Steroids (Prednisone) Steroids (Prednisone) Benadryl (diphenhydramine)Benadryl (diphenhydramine)EpinephrineEpinephrine
8686
EXTRAVASATION
Contrast material has seeped outside of Contrast material has seeped outside of vesselvessel
Local redness and swellingLocal redness and swelling
Apply WARM Compress 1Apply WARM Compress 1stst 24 hours 24 hoursCool compress for swellingCool compress for swelling
8787
EXTRAVASATION
The act of injecting a drug/contrast into an The act of injecting a drug/contrast into an area area other than the vessel (soft tissue)other than the vessel (soft tissue)
RTA BOOK: Pharmacology ChapterRTA BOOK: Pharmacology Chapter Defines as: Discharge or escape of fluid from a vessel
into the surrounding tissue that can cause localized vasoconstriction, resulting in sloughing of tissue and
tissue necrosis if not reversed with an antidote..
8888Extravasation of ContrastExtravasation of Contrast
into soft tissue of arminto soft tissue of arm
8989
9090
Contrast leaking from bladderContrast leaking from bladder
9191
Summary -Summary - Delayed side effects persist in IV iodinated Delayed side effects persist in IV iodinated
contrast media contrast media History of asthma and allergy predisposes History of asthma and allergy predisposes
patients to increased incidence of adverse patients to increased incidence of adverse reactionsreactions
Intravenous iodinated contrast agents are Intravenous iodinated contrast agents are generally safe. generally safe.
Though the frequency of side effects has fallen Though the frequency of side effects has fallen significantly since the introduction of nonionic, significantly since the introduction of nonionic, monomeric contrast agents,however, side monomeric contrast agents,however, side effects remain an important issue.effects remain an important issue.
Late adverse reactions were first recognized in Late adverse reactions were first recognized in the mid-1980s the mid-1980s
9292
Summary of Contrast ReactionsSummary of Contrast Reactions AnaphylactoidAnaphylactoid reactions may present with reactions may present with mild symptomsmild symptoms such as skin rash, itching, nasal such as skin rash, itching, nasal
discharge, nausea, and vomiting discharge, nausea, and vomiting moderate symptomsmoderate symptoms like facial or laryngeal like facial or laryngeal
edema, bronchospasm, dyspnea, tachycardia, edema, bronchospasm, dyspnea, tachycardia, and bradycardiaand bradycardia
severe symptomssevere symptoms such as life-threatening such as life-threatening arrhythmias, hypotension, bronchospasm, arrhythmias, hypotension, bronchospasm, laryngeal edema, pulmonary edema, seizure, laryngeal edema, pulmonary edema, seizure, syncope, and deathsyncope, and death
9393 Summary of Contrast ReactionsSummary of Contrast Reactions Nonanaphylactoid reactionsNonanaphylactoid reactions are due to the ability of the are due to the ability of the
contrast media to upset the body homeostasis, contrast media to upset the body homeostasis, especially the blood circulation. especially the blood circulation.
Increasing iodine concentrationIncreasing iodine concentration increases the risk of increases the risk of these reactions, which is also affected by the volume these reactions, which is also affected by the volume and route of administration of contrast.and route of administration of contrast.
Larger volumesLarger volumes or intra-arterial administration are more or intra-arterial administration are more likely to produce a reaction.likely to produce a reaction.
The cardiovascular, respiratory, urinary, gastrointestinal, The cardiovascular, respiratory, urinary, gastrointestinal, and nervous systems are most commonly affected by and nervous systems are most commonly affected by physiologic changes produced by contrast media. physiologic changes produced by contrast media.
The symptoms of nonanaphylactoid reactions are The symptoms of nonanaphylactoid reactions are warmth, metallic taste, nausea, vomiting, bradycardia, warmth, metallic taste, nausea, vomiting, bradycardia, hypotension, vasovagal reactions, neuropathy, and hypotension, vasovagal reactions, neuropathy, and delayed reactionsdelayed reactions
9494
SCHEDULING CONSIDERATIONSSCHEDULING CONSIDERATIONSDiabetics – first Diabetics – first
(Insulin= low blood sugar occurs while fasting)(Insulin= low blood sugar occurs while fasting)
After Nuclear Medicine Tests After Nuclear Medicine Tests (iodine goes to thyroid and will alter results)(iodine goes to thyroid and will alter results)
Iodine BEFORE BariumIodine BEFORE Barium BE before UGI ( IVP before BE)BE before UGI ( IVP before BE)
WATER – OIL - BARIUMWATER – OIL - BARIUM
9595SPECIAL PROCEDURSSPECIAL PROCEDURS
CONTRAST MEDIACONTRAST MEDIA
ARTHROGRAMSARTHROGRAMSInjected into JOINT SPACESInjected into JOINT SPACESIODINE IODINE (positive contrast)(positive contrast)
WATER soluble WATER soluble (Ionic or Non-Ionic)(Ionic or Non-Ionic)
AIR AIR (negavitve contrast)(negavitve contrast)
9696SPECIAL PROCEDURSSPECIAL PROCEDURS
CONTRAST MEDIACONTRAST MEDIA
MYELOGRAMSMYELOGRAMS Injected INTRATHECALLYInjected INTRATHECALLY
(into the subarachnoid space)(into the subarachnoid space)NonionicNonionic water-soluble contrastwater-soluble contrast (NO IONIC CONTRAST)(NO IONIC CONTRAST)
979731 y/o male DIES31 y/o male DIESafter Myelogram Procedureafter Myelogram Procedure
Myelography is safely performed usingMyelography is safely performed usingnonionicnonionic water-soluble radiographic water-soluble radiographic
contrast mediacontrast media intended for this route of intended for this route of administrationadministration
Misadministration of Misadministration of ionicionic contrast media contrast media intrathecally intrathecally can result in a syndrome of can result in a syndrome of spasms and convulsions, often leading to spasms and convulsions, often leading to death death
ISOVUE –M ( 20 or 30 cc) ISOVUE –M ( 20 or 30 cc)
9898
mix-up between look-alike vialsmix-up between look-alike vialsionic ionic HYPAQUEHYPAQUE
(diatrozoate meglumine)(diatrozoate meglumine) nonionic nonionic OMNIPAQUEOMNIPAQUE 300 300
(iohexol)(iohexol)Each type of contrast media Each type of contrast media
should be stored separately, should be stored separately, based on its usebased on its use..
9999SPECIAL PROCEDURSSPECIAL PROCEDURS
CONTRAST MEDIACONTRAST MEDIASIALOGRAPHYSIALOGRAPHY
– – injected into Salivary Ductsinjected into Salivary Ducts IODINE –IODINE –
WATER (ionic or nonionic) WATER (ionic or nonionic) OR OIL BASEDOR OIL BASED
SINOGRAPHIN (OIL)SINOGRAPHIN (OIL)RENOVUE (WATER)RENOVUE (WATER)
100100
MRI ContrastMRI Contrast
101101
MRI with contrastMRI with contrast
Without With Without With
What is the name of the contrast used for MRI ?
102102Gadolinium z# 64Gadolinium z# 64
Once injected, gadolinium accumulatesOnce injected, gadolinium accumulates
in abnormal tissues of the brain and body.in abnormal tissues of the brain and body.Provides a greater contrast between Provides a greater contrast between
normal and abnormal tissuesnormal and abnormal tissues
MORE diluteMORE dilutethan used for Radiologythan used for Radiology
103103
gadoliniumgadolinium
On its own gadolinium is toxic to the On its own gadolinium is toxic to the human body, but when coated in a special human body, but when coated in a special chelating agent, it is safe to use. chelating agent, it is safe to use.
When the chelating agent breaks down When the chelating agent breaks down prematurely, or the kidneys are unable to prematurely, or the kidneys are unable to excrete the gadolinium from the body, excrete the gadolinium from the body, gadolinium poisoning can occurgadolinium poisoning can occur
104104 Gadolinium Side EffectsGadolinium Side Effects With impaired kidney function, gadolinium With impaired kidney function, gadolinium
could lead to a serious and potentially fatal could lead to a serious and potentially fatal disorder called Nephorgenic Systemic disorder called Nephorgenic Systemic Fibrosis.Fibrosis. (NSF) (NSF)
More common conditions associated with More common conditions associated with exposure includesexposure includes
impaired kidney function impaired kidney function irritation of blood vessels irritation of blood vessels facial swelling facial swelling skin conditions, including rashes, itching and skin conditions, including rashes, itching and
hives hives
105105
CT ContrastCT Contrast
Oral/RectumOral/Rectum – – Barium or IodineBarium or Iodine
IV: IodineIV: Iodine
Usually less diluteUsually less dilute than for Radiologythan for Radiology
106106
CT w contrastCT w contrast
107107
CT ContrastCT Contrast CT Scan Contrast CT Scan Contrast
Indications Indications
History of tumor, cancer, History of tumor, cancer, or surgery or surgery
Looking for infection, Looking for infection, inflammationinflammation
Evaluating blood vesselsEvaluating blood vessels
Investigate a finding in a Investigate a finding in a scan done without scan done without contrast contrast
CT Scan Contrast Side CT Scan Contrast Side EffectsEffects
Mild to life-threatening Mild to life-threatening allergic reaction allergic reaction
Flushing/redness and Flushing/redness and hiveshives
Shortness of breath Shortness of breath Nausea, vomittingNausea, vomitting Blood clots Blood clots DizzinessDizziness
101088
PATIENT PREPPATIENT PREP
COVERED WITH EACH EXAMCOVERED WITH EACH EXAM
109109 REVIEW REVIEW SPECIAL PROCEDURSSPECIAL PROCEDURS
CONTRAST MEDIACONTRAST MEDIAONLY WaterONLY Water sol.sol.
ArthrogramsArthrograms MyelogramsMyelograms Angio/Arterio gramsAngio/Arterio grams Cardiac CathCardiac Cath VenogramsVenograms
Water or OILWater or OIL HysterosalpingogramHysterosalpingogram SialogramSialogram LymphangiogramsLymphangiograms
Lasts longer – may causeLasts longer – may cause FAT EMBOLI FAT EMBOLI
110110 REVIEW (Bontrager Slides)
111111
SEE : PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )
112112
113113
114114
115115
116116
117117
118118
119119 PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )
Sample CRASH CARTCRASH CART MedicationsMEDICATIONMEDICATION
Atropine Benadryl
Dilantin Epinephrine
Heparin Lasix
Sodium Bicarbonate Xylocaine
INDICATIONINDICATION(used for what?_(used for what?_
______________ ________________ _________________ ___________________ ___________________ _________________ _________________ __________________
Spring 2010
120120
REVIEWREVIEW
TYPES OF CONTRAST & USESTYPES OF CONTRAST & USESADVERSE AFFECTS OF CONTRAST ADVERSE AFFECTS OF CONTRAST
USAGEUSAGECONTRAINDICATIONS FOR CONTRASTCONTRAINDICATIONS FOR CONTRAST
121211
Review QuestionsReview Questions
RTA Book – RTA Book –
Contrast MediaContrast Media
122122
Contrast media are used in radiographic Contrast media are used in radiographic imaging toimaging to
a) increase the radiographic density of the a) increase the radiographic density of the area of interestarea of interest
b) enhance the subject contrast of the area b) enhance the subject contrast of the area of interestof interest
c) decrease the radiographic density of the c) decrease the radiographic density of the area of interestarea of interest
d) lower the subject contrast of the area of d) lower the subject contrast of the area of interestinterest
123123
Radiographic images that demonstrate few Radiographic images that demonstrate few density differences definedensity differences define
a) low subject contrasta) low subject contrast
b) high subject contrastb) high subject contrast
c) low x-ray photon absorptionc) low x-ray photon absorption
d) high x-ray photon absorptiond) high x-ray photon absorption
124124
A negative contrast agent willA negative contrast agent will
a) increase density and is radiopaquea) increase density and is radiopaque
b) decrease density and is radiopaqueb) decrease density and is radiopaque
c) decrease density and is radiolucentc) decrease density and is radiolucent
d) increase density and is radiolucentd) increase density and is radiolucent
125125
Perforation of the colon during a lower GI Perforation of the colon during a lower GI barium study may result in complications barium study may result in complications resulting fromresulting from
a) flocculationa) flocculation
b) bronchospasmb) bronchospasm
c) convulsionc) convulsion
d) extravasationd) extravasation
126126
Depending on the environment of the Depending on the environment of the barium sulfate,such as acid in the barium sulfate,such as acid in the stomach, the powder may have a stomach, the powder may have a tendency to clump – this is calledtendency to clump – this is called
a) flocculationa) flocculation
b) bronchospasmb) bronchospasm
c) convulsionc) convulsion
d) extravasationd) extravasation
127127
4. Perforation of the vessel while injecting a 4. Perforation of the vessel while injecting a contrast media may resulting incontrast media may resulting in
a) flocculationa) flocculation
b) bronchospasmb) bronchospasm
c) convulsionc) convulsion
d) extravasationd) extravasation
128128
Barium sulfate:Barium sulfate:
1. is filtered by the kidneys1. is filtered by the kidneys
2. is absorbed by the stomach2. is absorbed by the stomach
3. coats the gastrointestinal lining3. coats the gastrointestinal lining
4. is absorbed by the jejunum 4. is absorbed by the jejunum
129129
High atomic number elements absorb x-rays High atomic number elements absorb x-rays at a greater rate than low atomic number at a greater rate than low atomic number elements.elements.
1. true1. true
2. false 2. false
130130
Barium sulfate is contraindicated if the Barium sulfate is contraindicated if the patient is suspected of having a patient is suspected of having a gastrointestinal tract perforation.gastrointestinal tract perforation.
1. true1. true
2. false 2. false
131131
Radiolucent contrast media:Radiolucent contrast media:
1. are positive contrast agents1. are positive contrast agents
2. appear dark on radiographs2. appear dark on radiographs
3. are composed of elements with high 3. are composed of elements with high atomic numbersatomic numbers
4. none of the above 4. none of the above
132132
Radiopaque contrast media:Radiopaque contrast media:
1. are positive contrast agents1. are positive contrast agents
2. appear light on radiographs2. appear light on radiographs
3. are composed of elements with high 3. are composed of elements with high atomic numbersatomic numbers
4. all the above 4. all the above
133133
Each of the following is an example of a Each of the following is an example of a negative contrast media except:negative contrast media except:
1. air1. air
2. soda water2. soda water
3. barium sulfate3. barium sulfate
4. gas-producing crystals 4. gas-producing crystals
134134
An air embolus can form as a complication An air embolus can form as a complication of negative contrast media administration.of negative contrast media administration.
1. true1. true
2. false 2. false
135135
An fat embolus can form as a complication An fat embolus can form as a complication of AN OIL BASED contrast media of AN OIL BASED contrast media administration.administration.
1. true1. true
2. false 2. false
136136
Ionic contrast media dissociates into two Ionic contrast media dissociates into two molecular particles in blood plasma.molecular particles in blood plasma.
1. true1. true
2. false 2. false
137137
Most adverse reactions associated with Most adverse reactions associated with Ionic contrast media are significantly Ionic contrast media are significantly decreased with the non-ionic contrast decreased with the non-ionic contrast media media
1. true1. true
2. false 2. false
138138
Which of the following acute reactions to Which of the following acute reactions to contrast media usually requires no medical contrast media usually requires no medical treatment?treatment?
a) bronchospasma) bronchospasm
b) laryngeal edemab) laryngeal edema
c) urticariac) urticaria
d) convulsionsd) convulsions
139139
Which of the following acute reactions to Which of the following acute reactions to contrast media usually requires immediate contrast media usually requires immediate medical treatment?medical treatment?
a) Bronchospasm / laryngeal edemaa) Bronchospasm / laryngeal edema
b) Nausea & Vomitingb) Nausea & Vomiting
c) Urticariac) Urticaria
d) Warn flush /metallic tasted) Warn flush /metallic taste
140140
What can be done for a patient who will receive What can be done for a patient who will receive water- soluble iodine contrast media to reduce water- soluble iodine contrast media to reduce allergic-like effects?allergic-like effects?
a) premedicate with steroids and antihistamines a) premedicate with steroids and antihistamines
b) give intravenous fluidsb) give intravenous fluids
c) instruct the patient to drink warm salt water c) instruct the patient to drink warm salt water before the procedurebefore the procedure
d) give a negative contrast agent with the iodinated d) give a negative contrast agent with the iodinated mediummedium
141141
When you schedule multiple procedures, When you schedule multiple procedures, what examination is usually done last?what examination is usually done last?
a) thyroid function testsa) thyroid function tests
b) Upper GIb) Upper GI
c) air-contrast colon (BE-AC)c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)d) Intravenous pyelogram (IVP)
142142
When you schedule multiple procedures, When you schedule multiple procedures, what examination is usually done last?what examination is usually done last?
a) thyroid function testsa) thyroid function tests
b) Upper GIb) Upper GI
c) air-contrast colon (BE-AC)c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)d) Intravenous pyelogram (IVP)
It will take the BA the longest to travel It will take the BA the longest to travel through the GI tractthrough the GI tract
143143
When you schedule multiple procedures, When you schedule multiple procedures, using contrast media – which examination using contrast media – which examination must be done first?must be done first?
a) thyroid function tests (Nuc Med)a) thyroid function tests (Nuc Med)
b) Upper GIb) Upper GI
c) air-contrast colon (BE-AC)c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)d) Intravenous pyelogram (IVP)
144144
When you schedule multiple procedures, When you schedule multiple procedures, using contrast media – which examination using contrast media – which examination must be done first?must be done first?
a) thyroid function tests (Nuc Med)a) thyroid function tests (Nuc Med)
b) Upper GIb) Upper GI
c) air-contrast colon (BE-AC)c) air-contrast colon (BE-AC)
d) Intravenous pyelogram (IVP)d) Intravenous pyelogram (IVP)
WHY?WHY?
145145
Antihistamines are used to prevent and Antihistamines are used to prevent and treat nausea and vomiting.treat nausea and vomiting.
1. true1. true2. false 2. false
146146
Antihistamines are used to prevent and Antihistamines are used to prevent and treat nausea and vomiting.treat nausea and vomiting.
1. true1. true2. false 2. false
So what is it used for?So what is it used for?
147147
Antihistamines are used to prevent and Antihistamines are used to prevent and treat ____________treat ____________
Allergic reactions to contrast mediaAllergic reactions to contrast media
148148
Glucophage is the brand name forGlucophage is the brand name for____________________________________________________
What is it used for?What is it used for?__________________________________________________
149149
Glucophage is the brand name forGlucophage is the brand name for METAFORMINMETAFORMIN
What is it used for?What is it used for? DIABETICSDIABETICS
RTA BOOK RTA BOOK PHARMACOLOGY CHAPTERPHARMACOLOGY CHAPTER
150150
Which type of drug is used to prevent and Which type of drug is used to prevent and control the occurrence of seizures?control the occurrence of seizures?
1. anticonvulsants1. anticonvulsants2. antiemetics2. antiemetics3. antihistamines3. antihistamines4. antihypertensives 4. antihypertensives
151151
Which type of drug is used to prevent and Which type of drug is used to prevent and control the occurrence of seizures?control the occurrence of seizures?
1. anticonvulsants1. anticonvulsants2. antiemetics2. antiemetics3. antihistamines3. antihistamines4. antihypertensives 4. antihypertensives
152152
An intravenous push refers to a rapid An intravenous push refers to a rapid bolus injection.bolus injection.
1. true1. true2. false 2. false
153153
An intravenous push refers to a rapid An intravenous push refers to a rapid bolus injection.bolus injection.
1. true1. true2. false 2. false
What is the name when it is injected What is the name when it is injected slowly?slowly?
154154
What is the name when contrast it is What is the name when contrast it is injected slowly?injected slowly?
INFUSION DRIPINFUSION DRIP
155155
The act of injecting a drug into a vein is The act of injecting a drug into a vein is termed extravasation.termed extravasation.
1. true1. true2. false 2. false
156156
The act of injecting a drug into a vein is The act of injecting a drug into a vein is termed extravasation.termed extravasation.
1. true1. true2. false 2. false
What does it mean? ______________What does it mean? ______________
157157
extravasationextravasation
What does it mean? ______________What does it mean? ______________
The act of injecting a drug/contrast into an The act of injecting a drug/contrast into an area area other than the vessel (soft tissue)other than the vessel (soft tissue) is is termed extravasation.termed extravasation.
RTA BOOK: see definitonRTA BOOK: see definiton
158158
Contrast media are:Contrast media are:1. diagnostic agents1. diagnostic agents2. dyes2. dyes3. all radiopaque3. all radiopaque4. all radiolucent 4. all radiolucent
159159
Contrast media are:Contrast media are:1. diagnostic agents1. diagnostic agents2. dyes2. dyes3. all radiopaque3. all radiopaque4. all radiolucent 4. all radiolucent
160160
An air embolus can form as a complication An air embolus can form as a complication of negative contrast media administration.of negative contrast media administration.
1. true1. true2. false 2. false
161161
An air embolus can form as a complication An air embolus can form as a complication of negative contrast media administration.of negative contrast media administration.
1. true1. true2. false 2. false
162162
Oil-based iodine contrast media are used Oil-based iodine contrast media are used for each of the following except:for each of the following except:
1. dacrycystography1. dacrycystography2. bronchography2. bronchography3. lymphography3. lymphography4. myelography 4. myelography
163163
Ionic contrast media dissociates into two Ionic contrast media dissociates into two molecular particles in blood plasma.molecular particles in blood plasma.
1. true1. true2. false 2. false
164164
Iodinated contrast media dissociates into Iodinated contrast media dissociates into two molecular particles in blood plasma.two molecular particles in blood plasma.
1. true1. true2. false 2. false
165165
The benzene ring is associated with the:The benzene ring is associated with the:1. anion1. anion2. cation2. cation3. positive charge3. positive charge4. none of the above 4. none of the above
161666
LIST 4 TYPES OFLIST 4 TYPES OFHIGH RISK PATIENTSHIGH RISK PATIENTS
167167
Oil-based iodine contrast media are made Oil-based iodine contrast media are made from:from:
1. fatty acids1. fatty acids2. carbohydrates2. carbohydrates3. amino acids3. amino acids4. none of the above 4. none of the above
168168
Osmolality is a measure of:Osmolality is a measure of:1. the number of iodine atoms per 1. the number of iodine atoms per
moleculemolecule2. particle density2. particle density3. the total number of particles in solution3. the total number of particles in solution4. none of the above 4. none of the above
169169
High osmolality of the contrast media is High osmolality of the contrast media is related to adverse reactions.related to adverse reactions.
1. true1. true2. false 2. false
170170
Injection of ionic contrast media may lead Injection of ionic contrast media may lead to hypervolemia.to hypervolemia.
1. true1. true2. false2. false
171171
Myelography most commonly uses ___ Myelography most commonly uses ___ contrast media.contrast media.
1. ionic1. ionic2. nonionic2. nonionic3. nonionic and ionic3. nonionic and ionic4. neither ionic nor nonionic4. neither ionic nor nonionic
171722
End of Contrast Media End of Contrast Media for Special Proceduresfor Special Procedures
RT 255 RT 255
Rev Spring 2010Rev Spring 2010