Download - Contrast media 2

Transcript
Page 1: Contrast media 2

Contrast media 2

Page 2: Contrast media 2

CONTRAST MEDIACHEMICAL PROPERTIES

• TRIIODINATED COMPOUNDS• BASED ON THE BENZOID ACID RING

• IODINE IS USED DUE TO THE HIGH ATOMIC NUMBER

Page 3: Contrast media 2
Page 4: Contrast media 2

CONTRAST MEDIA• IONIC CONTRAST

• NON IONIC CONTRAST

Page 5: Contrast media 2

Iodine Contrast Material

• Ionic Contrast– Anion -– Cation +– More patient allergic

reactions

• Ionic contrast media dissociates into two molecular particles in blood plasma =

• Causing pt reactions

•Non-Ionic Contrast

• Less patient allergic reactions

Page 6: Contrast media 2

Iodine Contrast Material

• ANIONS • - CHARGE IONS• Responsible For Stabilizing And Detoxifying

The Contrast Media

• CATIONS• + CHARGED IONS• Responsible For Increasing The Solubility Of

The Medium

Page 7: Contrast media 2

What contributes to discomfort, side effects, reactions:

• VISCOSITY – (thick, sticky)thicker – harder to inject, more heat and vessel irritation (higher = greater viscosity)

Warming contrast will help• TOXICITY - (higher = greater viscosity)• MISCIBILITY - easily mixes with blood

Page 8: Contrast media 2

Iodinated CONTRAST AGENTSAdverse Reactions

• Osmolarities higher than body fluids• Viscous• Greater chance for contrast reactions• Anaphylatic shock is the most severe

Page 9: Contrast media 2
Page 10: Contrast media 2

CONTRAST MATERIALADVERSE REACTIONS

ALWAYS GET PATIENT’S HISTORY BEFORE ANY CONTRAST

MEDIA IS GIVEN

SEE Ch. 19 Table 19-7 pg 296 Carlton Pt Care (3RD ed)

Page 12: Contrast media 2

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%

Page 13: Contrast media 2

GOOD PATIENT HISTORY

• Kidney problems• Diabetes• Heart conditions• Allergies• Asthma

• Previous reaction• Current medications• Beta Blockers• Antihypertensive medications

• VITAL SIGNS

Page 14: Contrast media 2

CONTRAST REACTIONS

• General

• > 10 million diagnostic procedures

per year • Conventional ionic contrast

reactions - 10% • 1 in 1000 severe

Page 15: Contrast media 2

Contraindiatons for Contrast

• Renal Failure (Check BUN & Creatinine) Elevated levels could cause renal shutdown

• Anuria (no urine production)• Asthma (possible allergies)• Hx of Contrast Allergy / Reactions• Diabetes - get a hx of medications taken

– glucophage must be stopped 48 hrs before contrast injection

• Multiple Myeloma

Page 16: Contrast media 2

MORE Risk Factors for Contrast Reaction

• Older patient age

• Allergic Rhinitis, medication or Food Allergy

• Cardiovascular disease

Page 17: Contrast media 2

CONTRAINDICATIONS

• Pregnancy (risk of fetal Thyroid toxicity) • + Radiation concerns

• Allergic Reaction• Pathologic Conditions• Infection

Page 18: Contrast media 2

Allergic to Iodine

• General Rule: • No Iodine Contrast will be

given– Pre – medication is available

• May or may not react if previous iodine given

Page 19: Contrast media 2

Aseptic Technique for injection

betadine scrub

Contains iodine

Page 20: Contrast media 2
Page 22: Contrast media 2

Catagories of Adverse Reactions

MILD Ch. 19 pg 297 Pt Care

– nausea, vomiting– Uticaria (hives) rash – itching– Flush face – feeling of warmth– Headace, Chills, Anxiety– Diaphoresis Treatment – does not usually get worse Watch patient and reassure(cool cloth on forehead, emesis basin

Page 23: Contrast media 2

Catagories of Adverse Reactions

MODERATE Ch. 19 pg 297 Pt Care

• Hypotension (bradycardia) • Hypertension (tachycardia) • Dyspnea• Bronchospasms /wheezing• Laryngeal EdemaTREATMENT:Needs immediate treatment –GET RN/RADNeeds Meds* – (Keep IV line in) could lead to severe reactions

Page 24: Contrast media 2

Catagories of Adverse Reactions

SEVERE Ch. 19 pg 297 Pt Care

• Laryngeal edema• Convulsions• Profound hypotension• Clincally manifested arrhythmias• Unresponsiveness• Cardiopulmonary Arrest

PROMPT TREATMENT – CODE BLUE!

Page 25: Contrast media 2

Rx for REACTIONShave ready on Emergency cart or Crash Cart

• UTICARIA (HIVES) –Benadryl (diphenhydramine)

Vistaril (hydorxyzine) Tagament or Zantac

• Facial/Laryngeal Edema/Bronchospasms Epinephrine , Oxygen

Page 26: Contrast media 2

Contrast Reactions/MYTHS

• not caused by iodine– Ionic vs non ionic - binding elements

• not related to shellfish • not true allergy (no drug-antibody) • mechanism remains unknown

Page 27: Contrast media 2

Anaphylactoid (idiosyncratic)

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

Page 28: Contrast media 2

RENAL TOXICITY

• (increased serum creatinine > 0.5 mg%) • 2-7% • 5 – 10 x increase with pre-existing renal

insufficiency • direct relationship between serum creatinine

and likelihood nephrotoxicity • Hydrate 100 ml/hr Normal saline 4 hrs prior to

procedure, continue for 24 hours

Page 29: Contrast media 2

GLUCOPHAGE• Pt is DIABETIC = oral diabetic agent

• MUST STOP __ DAYS BEFORE EXAM• withhold drug for 48 hrs after contrast administration

• patients with renal insufficiency may develop lactic acidosis

• The signs of lactic acidosis are deep and rapid breathing, vomiting, and abdominal pain

Page 30: Contrast media 2

PreMedications

• Steroids (Prednisone) • Benadryl (diphenhydramine)• Epinephrine

Page 31: Contrast media 2

EXTRAVASATION

• Contrast material has seeped outside of vessel

• Local redness and swelling

• Apply WARM Compress 1st 24 hours• Cool compress for swelling

Page 32: Contrast media 2

Extravasation of Contrastinto soft tissue of arm

Page 33: Contrast media 2
Page 34: Contrast media 2

Contrast leaking from bladder

Page 35: Contrast media 2

SCHEDULING CONSIDERATIONS• Diabetics – first

– (Insulin= low blood sugar occurs while fasting)

• After Nuclear Medicine Tests – (iodine goes to thyroid and will alter results)

• Iodine BEFORE Barium• BE before UGI ( IVP before BE)

• WATER – OIL - BARIUM

Page 36: Contrast media 2

SPECIAL PROCEDURSCONTRAST MEDIA

ARTHROGRAMS–Injected into JOINT SPACES–IODINE (positive contrast)

• WATER soluble • (Ionic or Non-Ionic)

–AIR (negavitve contrast)

Page 37: Contrast media 2

SPECIAL PROCEDURSCONTRAST MEDIA

MYELOGRAMS– Injected INTRATHECALLY

(into the subarachnoid space)–Nonionic water-soluble contrast– (NO IONIC CONTRAST)

Page 38: Contrast media 2

31 y/o male DIESafter Myelogram Procedure

• Myelography is safely performed using• nonionic water-soluble radiographic contrast

media intended for this route of administration

• Misadministration of ionic contrast media intrathecally can result in a syndrome of spasms and convulsions, often leading to death

• ISOVUE –M ( 20 or 30 cc)

Page 39: Contrast media 2

mix-up between look-alike vials• ionic HYPAQUE (diatrozoate

meglumine)• nonionic OMNIPAQUE 300

(iohexol)• Each type of contrast media

should be stored separately, based on its use.

Page 40: Contrast media 2

SPECIAL PROCEDURSCONTRAST MEDIA

SIALOGRAPHY – injected into Salivary Ducts

• IODINE –– WATER (ionic or nonionic) – OR OIL BASED

– SINOGRAPHIN (OIL)– RENOVUE (WATER)

Page 41: Contrast media 2

PATIENT PREP

COVERED WITH EACH EXAM

Page 42: Contrast media 2

REVIEW SPECIAL PROCEDURS

CONTRAST MEDIAONLY Water sol.

• Arthrograms• Myelograms• Angio/Arterio grams• Cardiac Cath• Venograms

Water or OIL• Hysterosalpingogram• Sialogram• Lymphangiograms

• Lasts longer – may cause FAT EMBOLI

Page 43: Contrast media 2

REVIEW (Bontrager Slides)

Page 44: Contrast media 2
Page 45: Contrast media 2
Page 46: Contrast media 2
Page 47: Contrast media 2
Page 48: Contrast media 2
Page 49: Contrast media 2
Page 50: Contrast media 2
Page 51: Contrast media 2