Contrast Media - PowerPoint by linzhengnd

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               Radiographic
              Contrast Media
    RAD TECH 255
    SPECIAL PROCEDURES
     WEBPAGE VERSION

    MERRILLS VOL2
    RTA BOOK
    REV: SPRING 2010
2
                    Subject 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:
       enhance subject contrast or render high subject
        contrast in a tissue that normally has low subject
        contrast
3
                  Contrast media
        Defines subtle differences in subject
        contrast

       Increases atomic number of area injected

       Results in a SHORTER scale of subject
        contrast
4
           Radiographic Contrast :
              Influenced by…
     Radiation Quality (KVP)
     Film Contrast
     Radiographic object (Patient)

    Atomic Number
     Fat = 6.46
     Water = 7.51
     Muscle = 7.64
     Bone = 12.31
5
                     KVP
         TYPE OF CONTRAST USED
        DETERMINES KVP RANGE

        BARIUM                _______kVp

        IODINES          ________kVp
          (Ionic / Nonionic    Water or Oil)
6



         INJECTABLE
     CONTRAST MEDIA
    for RT 255 procedures
     INVASIVE PROCEDURES
          The “o-grams”
7
    ALWAYS TAKE
     A “SCOUT”
      BEFORE
     CONTRAST
     INJECTION
        Why?
     List 4 reasons
8
           SPECIAL “o-grams”
     Venogram
     Arthrogram
     Sialogram
     Myelogram
     Arteriogram
     Angiogram
     Galactogram
     Hystersalpingogram…….. etc
9
         CONTRAST INJECTION




    KNEE ARTHROGRAM
10
     DOUBLE CONTRAST WITH IODINE -
     HIP Arthrogram
11
        To check fertility
     can be oil or water based contrast
12
     Myelogram
13
             Myelogram Contrast
      Pantopaque was introduced in 1944 as a
       oil contrast medium
      The first low-osmolar contrast medium to
       be produced was metrizamide (Amipaque)

      Oil never completely re –absorbed
      (Pre-employment L.sp)
14
     SIALOGRAM
15
     Galactography - Breast Duct
16
     Cerebral Angiogram
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           LYMPHANGIOGRAM




     Now largely replaced by ________ ?
19
     Dacryocystography




                 Now largely replaced by CT
20
      SPECIAL PROCEDURES
         ARE INVASIVE
     ALWAYS GET PATIENT’S
     HISTORY AND CONSENT
       BEFORE BEGINNING
         OR GIVING ANY
        CONTRAST MEDIA
21
                CONSENTS
      SIGNED AND WITNESSED
      AFTER PROCEDURE HAS
       BEEN EXPLAINED
      CHECK DEPARTMENT
       PROTOCOL
      WHO’S RESPONSIBLE ??????
22
                     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
23
              The ARRT has a
          published code of ethics.


        The ARRT Code of Ethics provides the
         radiologic technologist with an operational
         blueprint of norms of professional conduct.
24
               Review of Ethics
                    (Pt Care Book –Professional Ethics)


     The science of rightness and wrongness of
       human conduct and character is termed
       ethics.
      __________is the ethical principle that
       means that “above all, do no harm.”
      _________ principle that means that
       being truthful is right.
      __________ is the ethical principle that
       means that actions benefit others.
25




     Review of Contrast Agents

           Types of Contrast
         Routes of Adminstration
         Chemical Components
26
         Contrast Media changes the
            density of the organs
     Therefore changing
     the
     Subject contrast
     will change the
     Radiographic
     contrast and film
     contrast
     May need to
     INCREASE
     TECHNIQUE FROM
     SCOUT IMAGE* f/s
27
             Contrast Media (review)
        Negative contrast          Positive contrast
        (AIR OR CO2)               (all others)

        Radiolucent                Radiopaque

        Low atomic # material      High atomic #
                                     material
        Black on film
                                    White on film
28
            Types of Contrast Media
        Radiolucent-                     Radiopaque-
        negative contrast agent          positive contrast agent-
        x-rays easily penetrate          absorbs x-rays
        areas- appear ____ on films      areas- appear ____ on films

     Negative Contrast Media
      Air and gas                     Positive Contrast Agents
                                        BARIUM
         complications                 IODINES
        emboli-air pockets in
         vessels                       Both + & - can be used in same
        lack of oxygen                  study
29
              2 BASIC TYPES
           OF CONTRAST material
        BARUIM Z# 56       IODINE      Z# 53
                            WATER SOLUABLE
        NON WATER          POWDER
         SOLUABLE           LIQUID
                            INTRAVENOUS OR
        GI TRACT ONLY      Intrathecal
         INGESTED OR        GI TRACT
         RECTALLY
                            Also OIL based
        KVP 90 – 120*
                            KVP BELOW 90*
30
          Methods of Administration
            of Contrast Material
      INGESTED
         (ORAL)
      RETROGRADE
         AGAINST NORMAL FLOW
      INTRATHECAL
       Spinal     canal
      PARENTERAL          (IV, Intrathecal)
       Injectinginto bloodstream
       (anything other than oral)
31
               Contrast media for
             SPECIAL PROCEDURES
               Diagnostic agents
              that are injected into
        Circulatory System, Joint Spaces, Ducts

        Body orifices/organs: uterus, breast,
                    salivary & lymph glands
32                 BLOOD WORK
         LAB TESTS to check function of kidneys
                prior to injection of contrast
         WATCH THE UPPER LIMITS
      BUN = BLOOD UREA NITROGEN
      Merrills pg 214 range is 8 to 25
                pg 242 range is 10 - 20
          always check with RAD when level above 20
     CREATININE levels range:
      pg 214 (0.6 - 1.5) pg 242 (0.05 - 1.2)
          always check with RAD when level above 1.2
      Indicates function of kidneys
      Diseases / dehydration / kidney failure
33
               EGFR (new test)
      Estimated
      Glomerular
      Filtration
      Rate


     More advanced test for
      CREATININE levels
      Why is this important?
34
         various water-soluble contrast media for
               urography and angiography
      Both ionic and non-ionic monomers*
      are all extracellular contrast media
      are excreted unmetabolized by glomerular
       filtration
      Approximately 85-90% of the injected
       dose is found in urine within the first 6
       hours
      95-100% within the first 24 hours
35
                      monomers*

      The ionic monomeric agents are salts that
      dissociate into two molecules
      one anion containing the radiopaque
       property due to three iodine atoms
      and one cation without radiopaque
       properties

        More on this later in the lecture…..
36




     BARIUM – a review

           BARUIM SULFATE
     Not used in Special Procedures
37
               Barium Sulfate
      High atomic number Z #? ______
      Not soluble in water
      Used to coat the lining of organs
      Supplied in different thicknesses
      Used
        Esophogram, UGI, Small Bowel,Lower
         GI or BE
38
         Ba ADVERSE REACTIONS
      BARIUM INERT
      SUSPENSION MAY CAUSE ALLERGY
      OCG TABLETS (IODINE) ALLERGY
      AFTER EXAM – MAY SOLIDIFY
       DIFFICULT TO EVACUATE
      INCREASE FLUIDS, MILD LAXATIVE
      EXTRAVASATION OF CONTRAST INTO
                  PERITONEUM
39
     Extravasation of BA in abd
40
                 Ingested CONTRAST
                Gastrografin or Hypaque
        High atomic #
            Close to iodine


        Water soluble

        Similar usage as
         Barium
41
                GASTROGRAFIN
                Adverse Reactions
      Water   soluble, safe in the abdominal
       cavity
        Safe to use if perforation is
         suspected
      Very harmful to the lung tissue
        Do not use if aspiration is possible
42
          Gastro – Pathology present
        Bowel
        Obstruction

        Note contrast
        Seen in
         kidneys as
         well
43




           IODINE
     IONIC OR NON IONIC
        WATER OR OIL BASE
44
             IODINATED CONTRAST
                  iodine z # 53
        WATER BASED              OIL BASED
                                  INJECTED
        INJECTED                   NEVER
          VESSELLS/DUCTS          VESSELLS
        INGESTED                  ONLY DUCTS
        Organ function/flow       NOT INGESTED
        OPEN WOUNDS              OPEN WOUNDS
45
             INJECTION OF IODINE
                  into Vessels
        ALWAYS A WATER       IONIC VS
         BASED IODINATED      NON IONIC
         COMPOUND             CONTRAST

        BOLUS INJECTION
        INFUSION DRIP        50 -70 %
                               CONCENTRATE
46
             IODINE WATER BASED
                  CONTRAST
        IONIC               NON IONIC
        LESS $$$            MORE $$$

        MORE REACTIONS      LESS REACTIONS
47
                   CONTRAST MEDIA
                       IODINE
            is either: IONIC or NON-IONIC
      Osmolarity
      # Of Particles (Cations + And Anions -)
            In Solution Per Kilogram Of Water
        High Osmolarity
            =more Cations And Anions
      Can Upset Homeostasis
      Nonionic Have No Charged Particles
48
              Contrast Agents
 IONIC                        NON-IONIC
  High Osmolality             Low Osmolality
   (Higher risk of              (Lower risk of
   complications)               complications)
                                 Gadodiamide
                                  (Omniscan)
      Diatrizoate   sodium         Iodixanol
       (Hypaque)                     (Visipaque)
                                    Iopamidol (Isovue)
      Iothalamate
       meglumine                    Iopromide
       (Conray)                      (Ultravist)
                                    Ioversol (Optiray)
49




        Less money          More money
        More reactions      Less reactions
50
                OIL – BASED

                 IODINE CONTAST
         Instilled in ORGAN – Not vessells



             Oil-based iodine contrast media
                 are made from fatty acids

     of poppy seed oil containing 48% and 37% iodine
51
                    Oil Based Iodine
    Fatty Acids
    Insoluble in water
        White on the radiograph = Radiopaque
    Uses
        Broncography (lungs)
        Tear ducts
        Salivary glands
        Lymphatic system
        Hysterrosalpingogram
        Galactography (breast ducts)

    FAT EMBOLUS IF IT GETS INTO
         BLOOD VESSEL
52
             CONTRAST MEDIA
           CHEMICAL PROPERTIES
      TRIIODINATED COMPOUNDS
      BASED ON THE BENZOID ACID RING


        IODINE IS USED DUE TO THE HIGH
         ATOMIC NUMBER
53




     The benzene ring is associated with the anion.
54         CONTRAST MEDIA
    IONIC CONTRAST




                         NON IONIC
                          CONTRAST
55
               Iodine Contrast Material
    Ionic Contrast              •Non-Ionic Contrast
        Anion -
                                   •Less patient allergic
        Cation +                  reactions
        More patient allergic
         reactions
    Ionic contrast media           Nonionic
                                    contrast media
     dissociates into two
                                    is associated
     molecular particles in
                                    with low
     blood plasma =                 osmolality.
    Causing pt reactions
    The benzene ring is
     associated with the anion.
56
            Iodine Contrast Material
        ANIONS                       CATIONS
        - CHARGE IONS                + CHARGED IONS
        Responsible For              Responsible For
         Stabilizing And               Increasing The
         Detoxifying The               Solubility Of The
         Contrast Media                Medium




 The benzene ring is associated with the ________ ?
57
         Newer Contrast
         Agents Balance
     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.
58
            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
      OSMOLALITY - is a measure of the total
       number of particles in solution.
59
        Iodinated CONTRAST AGENTS
               Adverse Reactions
      Osmolarities   higher than body fluids
      Viscous
      Greater  chance for contrast reactions
      Anaphylatic shock is the most severe
      Injection of ionic contrast media may
       lead to hypovolemia.
60
                       Hypovolemia
        basically means low blood volume
        Symptoms of hypovolemia may include
             cold hands and feet, light headedness, infrequent
             urination, increased heart rate, and weakness.
            Low blood volume can result in multiple organ
             failure, kidney damage, brain damage, and death


        hypovolemia differs from dehydration (which is
         excessive loss of body water
        hypovolemia can lead to dehydration
61


      Hypovolemia is the
       most common cause
             of
      Orthostatic hypotension




        What? __________
62




     High osmolality of the contrast media is related
     to adverse reactions.
63
       CONTRAST MATERIAL
       ADVERSE REACTIONS
     ALWAYS GET PATIENT’S
      HISTORY BEFORE ANY
       CONTRAST MEDIA IS
            GIVEN

        SEE Ch. 19 Table 19-7 pg 296
            Carlton Pt Care (3 ed)
                            RD
64
              Reaction classification
        Immediate reactions were defined as
         those occurring within the department
         (within one hour)

         Delayed as those occurring between the
         time the patients left the department and
         up to seven days later
65
     Delayed Side Effects to Contrast

                     Skin effects included itching,
                      rash, and hives.
                     Nausea, vomiting, and
                      diarrhea were the
                      gastrointestinal side effects
                     General side effects included
                      headache, dizziness, and
                      fever.
                      Infants and patients older
                      than 60 years are at increased
                      risk of developing a side
                      effect.
66
             General Factors for
             Contrast Reactions
      Nonionic vs ionic
       Risk Factors
       Severity of Reactions
       Renal toxicity
      Glucophage
        Diabetic?
      Screening Creatinine
      Pretreatment
67
               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%
68
          GOOD PATIENT HISTORY
        Kidney problems       Previous reaction
        Diabetes              Current medications
        Heart conditions      Beta Blockers
        Allergies             Antihypertensive
        Asthma                 medications

                               VITAL SIGNS
69
           CONTRAST REACTIONS
        General
     >  10 million diagnostic procedures
           per year
      Conventional ionic contrast
       reactions - 10%
      1 in 1000 severe
70
          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
71                MORE Risk Factors
                 for Contrast Reaction

        Older patient age

      Allergic Rhinitis, medication or Food
       Allergy
      Cardiovascular disease


        WHO are at increased risk of developing
         a side effect? (2 age classifications?)
72
           CONTRAINDICATIONS
        Pregnancy (risk of fetal Thyroid
         toxicity)
        + Radiation concerns

        Allergic Reaction
        Pathologic Conditions
        Infection
73
                 Allergic to Iodine
      General Rule:
      No Iodine Contrast will be
       given
         Pre – medication is
          available
      May    or may not react if
         previous iodine given
74
     Aseptic Technique for injection
                    betadine scrub
                    Contains iodine
75
76
         REACTIONS &        Treatment
     USUALLY** WITHIN FIRST 5 MINUTES
      Nausea & Vomiting & Urticaria
      Hypotension (bradycardia)
      Hypotension (tachycardia)
      Bronchospasm
      Anaphylactoid
      Seizures


        Extravasation
77              Categories of Adverse Reactions


                        MILD
                                       Carlton – Patient Care Book:
                            Vol 3 Ch. 19 pg 297 or Vol 4 Ch. 20 pg 337


      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
78                Catagories of Adverse Reactions


                 MODERATE
                                                    Carlton Pt Care

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


                     SEVERE
                                                     Carlton Pt Care

      Laryngeal edema
      Convulsions
      Profound hypotension
      Clinically manifested arrhythmias
      Unresponsiveness
      Cardiopulmonary Arrest


     PROMPT TREATMENT – CODE BLUE!
80
               Rx for REACTIONS
              have ready on Emergency cart or Crash Cart

        UTICARIA (HIVES) –
           Benadryl (diphenhydramine)
           Vistaril (hydorxyzine)
              Tagament or Zantac

        Facial/Laryngeal Edema/Bronchospasms
           Epinephrine , Oxygen
81
         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
82
     Anaphylactoid (idiosyncratic)
      unpredictable
      dose independent
      prevalence 1-2% (0.04 - 0.22% severe)
      fatal 1 in 75,000
83
              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
84
                           GLUCOPHAGE
                                                            Vol 4 Ch. 19 pg 297 or

        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

        What is the name of the medication given for GI peristalsis?
85
            Pre-Medications

      Steroids (Prednisone)
      Benadryl (diphenhydramine)
      Epinephrine
86
                EXTRAVASATION
        Contrast material has seeped outside of
         vessel

        Local redness and swelling

      Apply WARM Compress 1st 24 hours
      Cool compress for swelling
87
                  EXTRAVASATION
        The act of injecting a drug/contrast into an
         area other than the vessel (soft tissue)

        RTA 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.
88
     Extravasation of Contrast
      into soft tissue of arm
89
90
     Contrast leaking from bladder
91
                        Summary -
        Delayed side effects persist in IV iodinated
         contrast media
        History of asthma and allergy predisposes
         patients to increased incidence of adverse
         reactions
        Intravenous iodinated contrast agents are
         generally safe.
        Though the frequency of side effects has fallen
         significantly since the introduction of nonionic,
         monomeric contrast agents,however, side
         effects remain an important issue.
         Late adverse reactions were first recognized in
         the mid-1980s
92

     Summary of Contrast Reactions
        Anaphylactoid reactions may present with
        mild symptoms such as skin rash, itching, nasal
         discharge, nausea, and vomiting
        moderate symptoms like facial or laryngeal
         edema, bronchospasm, dyspnea, tachycardia,
         and bradycardia
        severe symptoms such as life-threatening
         arrhythmias, hypotension, bronchospasm,
         laryngeal edema, pulmonary edema, seizure,
         syncope, and death
93
           Summary of Contrast Reactions
   Nonanaphylactoid reactions are due to the ability of the
    contrast media to upset the body homeostasis,
    especially the blood circulation.
   Increasing iodine concentration increases the risk of
    these reactions, which is also affected by the volume
    and route of administration of contrast.
    Larger volumes or intra-arterial administration are more
    likely to produce a reaction.
   The cardiovascular, respiratory, urinary, gastrointestinal,
    and nervous systems are most commonly affected by
    physiologic changes produced by contrast media.
   The symptoms of nonanaphylactoid reactions are
    warmth, metallic taste, nausea, vomiting, bradycardia,
    hypotension, vasovagal reactions, neuropathy, and
    delayed reactions
94
         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
95
          SPECIAL PROCEDURS
           CONTRAST MEDIA
     ARTHROGRAMS
      Injected   into JOINT SPACES
      IODINE (positive contrast)
        WATER     soluble
        (Ionic or Non-Ionic)

      AIR (negavitve contrast)
96
          SPECIAL PROCEDURS
           CONTRAST MEDIA
     MYELOGRAMS
       Injected INTRATHECALLY
       (into the subarachnoid space)
      Nonionic water-soluble contrast
       (NO IONIC CONTRAST)
97
                31 y/o male DIES
                after 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)
98
     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.
99
           SPECIAL PROCEDURS
            CONTRAST MEDIA
     SIALOGRAPHY
      – injected into Salivary Ducts
      IODINE –
        WATER  (ionic or nonionic)
        OR OIL BASED


        SINOGRAPHIN    (OIL)
        RENOVUE       (WATER)
100
      MRI Contrast
101
            MRI with contrast
  Without               With




 What is the name of the contrast used for MRI ?
102
               Gadolinium     z# 64
   Once injected, gadolinium accumulates
  in abnormal tissues of the brain and body.
   Provides a greater contrast between
    normal and abnormal tissues




 MORE dilute
 than used for Radiology
103
                gadolinium
   On its own gadolinium is toxic to the
    human body, but when coated in a special
    chelating agent, it is safe to use.
   When the chelating agent breaks down
    prematurely, or the kidneys are unable to
    excrete the gadolinium from the body,
    gadolinium poisoning can occur
104         Gadolinium Side Effects
     With impaired kidney function, gadolinium
      could lead to a serious and potentially fatal
      disorder called Nephorgenic Systemic
      Fibrosis. (NSF)

     More common conditions associated with
      exposure includes
     impaired kidney function
     irritation of blood vessels
     facial swelling
     skin conditions, including rashes, itching and
      hives
105
                      CT Contrast
     Oral/Rectum
         – Barium or Iodine
     IV: Iodine




     Usually less dilute
     than for Radiology
106
      CT w contrast
107
                       CT Contrast
     CT Scan Contrast                CT Scan Contrast Side
      Indications                      Effects

     History of tumor, cancer,       Mild to life-threatening
      or surgery                       allergic reaction
     Looking for infection,          Flushing/redness and
      inflammation                     hives
                                      Shortness of breath
     Evaluating blood vessels        Nausea, vomitting
                                      Blood clots
     Investigate a finding in a      Dizziness
      scan done without
      contrast
10
 8




       PATIENT PREP

     COVERED WITH EACH EXAM
109                REVIEW
             SPECIAL PROCEDURS
              CONTRAST MEDIA
     ONLY Water           sol.         Water or OIL
   Arthrograms                     Hysterosalpingogram
   Myelograms                      Sialogram
                                    Lymphangiograms
   Angio/Arterio grams
   Cardiac Cath
   Venograms

                                    Lasts longer – may cause
                                     FAT EMBOLI
110
  REVIEW   (Bontrager Slides)
111




 SEE :   PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )
112
113
114
115
116
117
118
119     PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )
       Sample CRASH CART Medications
       MEDICATION                          INDICATION
                                         (used for what?_

                 Atropine
                                    ______________
                Benadryl            ________________
                 Dilantin           _________________
             Epinephrine            ___________________
                 Heparin            ___________________
                   Lasix            _________________
      Sodium Bicarbonate            _________________
               Xylocaine            __________________



 Spring 2010
120
             REVIEW
   TYPES OF CONTRAST & USES
   ADVERSE AFFECTS OF CONTRAST
    USAGE
   CONTRAINDICATIONS FOR CONTRAST
12
 1




     Review Questions

          RTA Book –
         Contrast Media
122

  Contrast media are used in radiographic
    imaging to
  a) increase the radiographic density of the
    area of interest
  b) enhance the subject contrast of the area
    of interest
  c) decrease the radiographic density of the
    area of interest
  d) lower the subject contrast of the area of
    interest
123

      Radiographic images that demonstrate few
        density differences define
      a) low subject contrast
      b) high subject contrast
      c) low x-ray photon absorption
      d) high x-ray photon absorption
124

      A negative contrast agent will
      a) increase density and is radiopaque
      b) decrease density and is radiopaque
      c) decrease density and is radiolucent
      d) increase density and is radiolucent
125


  Perforation of the colon during a lower GI
    barium study may result in complications
    resulting from
  a) flocculation
  b) bronchospasm
  c) convulsion
  d) extravasation
126


   Depending on the environment of the
    barium sulfate,such as acid in the
    stomach, the powder may have a
    tendency to clump – this is called
  a) flocculation
  b) bronchospasm
  c) convulsion
  d) extravasation
127


  4. Perforation of the vessel while injecting a
    contrast media may resulting in
  a) flocculation
  b) bronchospasm
  c) convulsion
  d) extravasation
128


  Barium sulfate:
  1. is filtered by the kidneys
  2. is absorbed by the stomach
  3. coats the gastrointestinal lining
  4. is absorbed by the jejunum
129


  High atomic number elements absorb x-rays
    at a greater rate than low atomic number
    elements.
  1. true
  2. false
130



      Barium sulfate is contraindicated if the
        patient is suspected of having a
        gastrointestinal tract perforation.
      1. true
      2. false
131



      Radiolucent contrast media:
      1. are positive contrast agents
      2. appear dark on radiographs
      3. are composed of elements with high
        atomic numbers
      4. none of the above
132


      Radiopaque contrast media:
      1. are positive contrast agents
      2. appear light on radiographs
      3. are composed of elements with high
        atomic numbers
      4. all the above
133


      Each of the following is an example of a
        negative contrast media except:
      1. air
      2. soda water
      3. barium sulfate
      4. gas-producing crystals
134


  An air embolus can form as a complication
    of negative contrast media administration.
  1. true
  2. false
135


  An fat embolus can form as a complication
    of AN OIL BASED contrast media
    administration.
  1. true
  2. false
136


  Ionic contrast media dissociates into two
    molecular particles in blood plasma.
  1. true
  2. false
137


  Most adverse reactions associated with
    Ionic contrast media are significantly
    decreased with the non-ionic contrast
    media
  1. true
  2. false
138

  Which of the following acute reactions to
   contrast media usually requires no medical
   treatment?

  a) bronchospasm
  b) laryngeal edema
  c) urticaria
  d) convulsions
139

  Which of the following acute reactions to
   contrast media usually requires immediate
   medical treatment?

  a) Bronchospasm / laryngeal edema
  b) Nausea & Vomiting
  c) Urticaria
  d) Warn flush /metallic taste
140

  What can be done for a patient who will receive
    water- soluble iodine contrast media to reduce
    allergic-like effects?

  a) premedicate with steroids and antihistamines
  b) give intravenous fluids
  c) instruct the patient to drink warm salt water
       before the procedure
  d) give a negative contrast agent with the iodinated
       medium
141

  When you schedule multiple procedures,
    what examination is usually done last?
  a) thyroid function tests
  b) Upper GI
  c) air-contrast colon (BE-AC)
  d) Intravenous pyelogram (IVP)
142

  When you schedule multiple procedures,
    what examination is usually done last?
  a) thyroid function tests
  b) Upper GI
  c) air-contrast colon (BE-AC)
  d) Intravenous pyelogram (IVP)

  It will take the BA the longest to travel
     through the GI tract
143

  When you schedule multiple procedures,
    using contrast media – which examination
    must be done first?
  a) thyroid function tests (Nuc Med)
  b) Upper GI
  c) air-contrast colon (BE-AC)
  d) Intravenous pyelogram (IVP)
144

  When you schedule multiple procedures,
    using contrast media – which examination
    must be done first?
  a) thyroid function tests (Nuc Med)
  b) Upper GI
  c) air-contrast colon (BE-AC)
  d) Intravenous pyelogram (IVP)

  WHY?
145


   Antihistamines are used to prevent and
    treat nausea and vomiting.
   1. true
   2. false
146


   Antihistamines are used to prevent and
    treat nausea and vomiting.
   1. true
   2. false


     So what is it used for?
147


     Antihistamines are used to prevent and
      treat ____________

     Allergic reactions to contrast media
148


   Glucophage is the brand name for
   __________________________


   What is it used for?
   _________________________
149


     Glucophage is the brand name for
     METAFORMIN

     What is it used for?
     DIABETICS


     RTA BOOK
     PHARMACOLOGY CHAPTER
150


   Which type of drug is used to prevent and
    control the occurrence of seizures?
   1. anticonvulsants
   2. antiemetics
   3. antihistamines
   4. antihypertensives
151


   Which type of drug is used to prevent and
    control the occurrence of seizures?
   1. anticonvulsants
   2. antiemetics
   3. antihistamines
   4. antihypertensives
152


   An intravenous push refers to a rapid
    bolus injection.
   1. true
   2. false
153


   An intravenous push refers to a rapid
    bolus injection.
   1. true
   2. false


     What is the name when it is injected
      slowly?
154


     What is the name when contrast it is
      injected slowly?

     INFUSION DRIP
155


   The act of injecting a drug into a vein is
    termed extravasation.
   1. true
   2. false
156


   The act of injecting a drug into a vein is
    termed extravasation.
   1. true
   2. false


     What does it mean? ______________
157
                 extravasation
     What does it mean? ______________

     The act of injecting a drug/contrast into an
      area other than the vessel (soft tissue) is
      termed extravasation.

     RTA BOOK: see definiton
158


   Contrast media are:
   1. diagnostic agents
   2. dyes
   3. all radiopaque
   4. all radiolucent
159


   Contrast media are:
   1. diagnostic agents
   2. dyes
   3. all radiopaque
   4. all radiolucent
160


   An air embolus can form as a complication
    of negative contrast media administration.
   1. true
   2. false
161


   An air embolus can form as a complication
    of negative contrast media administration.
   1. true
   2. false
162


   Oil-based iodine contrast media are used
    for each of the following except:
   1. dacrycystography
   2. bronchography
   3. lymphography
   4. myelography
163




   Ionic contrast media dissociates into two
    molecular particles in blood plasma.
   1. true
   2. false
164


   Iodinated contrast media dissociates into
    two molecular particles in blood plasma.
   1. true
   2. false
165


   The benzene ring is associated with the:
   1. anion
   2. cation
   3. positive charge
   4. none of the above
16
 6



       LIST 4 TYPES OF
     HIGH RISK PATIENTS
167


   Oil-based iodine contrast media are made
    from:
   1. fatty acids
   2. carbohydrates
   3. amino acids
   4. none of the above
168


   Osmolality is a measure of:
   1. the number of iodine atoms per
    molecule
   2. particle density
   3. the total number of particles in solution
   4. none of the above
169


   High osmolality of the contrast media is
    related to adverse reactions.
   1. true
   2. false
170


   Injection of ionic contrast media may lead
    to hypervolemia.
   1. true
   2. false
171


   Myelography most commonly uses ___
    contrast media.
   1. ionic
   2. nonionic
   3. nonionic and ionic
   4. neither ionic nor nonionic
17
 2



     End of Contrast Media
     for Special Procedures
             RT 255

                      Rev Spring 2010

								
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