Advanced Medical Imaging 1
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What is extravasation?
when injection is not in vein.
Effects of cm on cutaneous system?
Urticaria ( hives)
Effects of contrast media on urinary system?
- -flank pain
- -hematuria ( blood in urine)
What are effects of cm on gastrointestinal systems?
Effects of Contrast Media on Cardiovascular System?
- -Cardiac arrhythmia
- -Cardiac arrest
Effects on Contrast Media on Respriatory System?
- -Increase/decrease in respiration
- -Pulmonary edema
- -Laryngeal edema
- -Respriatory arrest
What are the effects contrast media on systems?
- A.Neurological System
- -aphasia ( trouble speaking)
- -hemiplegia ( parital paralyzed)
Treatment for Nephrotoxicity?
- Stop injection CM
- Administer directics
What is Nephrotoxicity?
Acute renal failure
Treatment of an anaphylaxis allerigic reaction?
- -Access vital signs
- -Start IV fluids
- -Call Code
- -Start CPR
Treatment of Vasovagal alleric reactions?
- -Stop injecting CM
- -Elevate legs
- -Start IV
- -Give atropine (makes heart beat faster)
- -Give Epinephrine (vessel dialator)
What are Vasovagal allergic reaction symptoms?
- -<80 systolic (hypotension)
- -<50 pulse
What is the treatment for vasomotor allergic reaction?
- -inject slower
- -Slow deep breaths
- -Use non ionic cm
If patient has a vasomotor allergic reaction what are symtoms?
- -Tingling sensation
- -Metallic tase
What are the four major categories of allergic reactions?
- 1. Vasomotor
- 2. Vasovagal
- 3. Anaphylaxis
- 4. Nephrotxicity
What patients are prone to contrast media?
- -Pts who have had prior CM reactions
- -Iodine sensitivity
- -Urticaria (hives)
- -Hay Fever
- -Cardiac History
Factors that seem to relate to adverse contrast media reactions?
- -Iodine content
- -speed of injection
What is primary route of excretion of contrast media?
- Secondary is hepatic portal system
What does concentration help do?
Concentration of a medium represents the amount of salt in the solution.
What is persistence?
How fast or slow contrast media leaves the body rapid excretion very important.
What is Miscibility?
ability to mix contrast media must be completely miscible to prevent emoblization in vascular angiography
Which salt is more viscous Sodium or meglumine?
Meglumine is more viscous
Which salt is more toxic Sodium or meglumine?
Sodium salts are more toxic
What determines toxicity in cm?
- Biological acceptability
- Some salts more toxic that others
What determines the radiopacity and stregnth of cm?
- -Concentration of iodine
- -High atomic #
- -Higher iodine content- higher radiographic contrast on image receptor
What is viscosity?
The resistance of fluid to movement (degree of thickness)
Non ionic osmolality?
What is osmolality in Humans?
300 mOsm per kg
Characteristics of non ionic Contrast Media?
- -Osmolality # of particals in a givin volume of solution.
- -Primary factor in causing adverse reactions
- -****Osmolality in CM greater that blood plasma
- -Penetrates blood cells
- -Main cause of heat pain during injection
****Amount of Iodine Needed to produce image in...
Digital Subtraction Angiography
Radiography 180-200 mg/ml
DSA 15-65 mg/ml
CT 3-5 mg/ml
What is the generic name of Oxilan Non Ionic CM?
What is Generic name of Visipaque Non Ionic Contrast Media?
What is Generic name of Omnipaque Non Ionic Contrast Media?
What is the Generic name for Isovue Non Ionic CM?
Non Ionic Contrast Media Characteristics?
- Basic structure similar with Iodine but diffrent chemical structure
- -Does not dissociate in the blood
- -Less osmolality
- -Low incidence of serious reaction
- *****Very expensive*****
Example of LOCA?
Hexabrix : Ioxaglate meglumine
Used for hearts
What are examples of Ionic Contrast Media?
Brand Name Anion Cation
Hypaque 60% Diatrizoate Meglumine
Renografin 60 Diatrizoate Meglumine
Conray 60 Iothalamate Meglumine
What is the blood brain barrier?
Endothelial cells tightly bound together seperates organ tissue (parenchyma) of CNS from the blood thus preventing or slowing potentially harmful substance from passing from the blood to the CNS
What is Neurotoxicity?
The potential for ionic contrast media to disrupt the electrical charges of the brain.
Ionic Contrast Media Characteristics?
- -Composed of Cation(+)
- -provides solubility (ability to dissolve)
- -Usually Sodium, Meglumine, Magnesium, or calcium also composed
- -Anion (-)
- -provides stability & detoxification
- -Usually Iothalamate, diatrizoate, or metrizoate
- also composed of
- -Iodine used for radiopacity
Ionic Contrast Media types?
- High osmolality ionic compounds(HOCA)
- Low osmolality ionic compounds (LOCA)
There are two major classes of aqueous iodinated contrast media.
What are two categories of Postive Contrast Media?
- 1. Aqueous iodinated contrast media (water based/water soluble)
- 2. Oil based iodintated contrast media.
- -**Oil based contrast media should not
- injected intravenously
- -**Oil based contrast media should
- never be injected with a plastic
The positve contrast agents used in advanced radiographic procedures are iodinated compounds.
****Note in sailogram only the parotid and submandibular glands can be canulated.*******
*****Subligual cannot be injected. Difficulty finding orific of barthowens duct and distinguishing wartons duct****not gland*****
****Note iodine attenuates five times the radiation as soft tissue and three times the radiation of bone********
What is a Sailogram?
Using aqueous iodinated contrast media to delineate the Parotid gland or the submandibular gland.
What kind of positive contrast media is no longer used?
Examples of Positive Contrast Media?
- -High atomic #
- Iodine # 53
- Barium # 56
- -Increased attenuation
- -Create area of decreased radiographic density
- -Iodine, Barium
What are advantages/Disadvantages of Negative Contrast Media?
- -Rapidly absorbed by body
- -Many radiographs needed
- -Air and Oxygen dangerous in some procedures my cause gas emboli
- -Carbon Dioxide and nitrogen no such risk.
Nitrous used when pt is allergic to all contrast.
What are examples of Negative Contrast?
- -Low atomic #
- -Attenuates less radiation
- -Air, Oxygen, Carbon Dioxide, and Nitrous Oxide
What are two major groups of contrast media?
1. Negative ( radiolucent)
2. Positive ( Radiopaque)
What are the major characteristics of Contrast Media?
Alters the density of structures hus differentiating them from surrounding tissues.
- -May increase organ/structure density
- -May decrease organ/structure density
What is used for Venous Puncture Access?
Femoral Vein usual approch 1-2 cm below inguinal ligament .5 cm medial to femoral artery.
How would you perform a translumbar artery access?
- -Patient prone
- -High or low approch
- -High 6-8 cm to left of midline and 1-2 cm inferior to 12th rib
- -Low 6-8 cm to the left of midline and at L2-L3
**Risk may pucture kidney or lungs
What is the least popular choice of artery access and why?
Translumbar access used for patients with suspected aneurysms and occlusions of the aorta and when transfemoral and transaxillary are not available.
What are the risks when using the axillary artery access point?
Possible damage to brachial plexus.
Evaluation of radial ulnar, brachial and axillary pulses evaluated prior to access
Puncture site lateral to axillary fold
Avoid deep penetration.
When is the axillary artery access point used?
Used when brachial and femoral access points are compromised.
Where is the brachial artery access located?
- Entry site over proximal to mid brachial artery.
- **Risk include arterial spasm of brachial artery
When is the Brachial Artery used?
When femoral arteries are compromised.
What is most common arterial access point?
Femoral Artery directly over femoral head
****Femoral artery is lateral to femoral vein and inferior to the inguinal ligament***
Common access sites for Arterial Puncture access
-Common Femoral artery
Common technique for Arterial Puncture Access
What is involved when preparing for procedure?
- -Prepare room with equipment
- -Shave proposed injection site approx 6-10 inches
- -Prep patient
- ***Circular area 4-6 inches at site of entry
- -Clean skin from inside to outside
- -Use circular motion
- -***10 min scrub recommended no less than
- 3 min.
- -Draping front to back
- -Start IV
What reverses coumadin/warfarin sodium?
FFP Fresh frozen Plasma or give 25-50 mg of vitamine K
What reverses heparin?
Protamine sulfate 10 mg reverses 1000 units of heparin.
What is restricted medication when having a special procedure done?
-Heparin- Anticoagulant stopped 2-6 hrs prior to actual entry.
-Coumadin/Warfarin Sodium-Anticoagulant stopped 3-4 days prior to exam.
-Diuretics may be suspended prior to exam patients should be hydrated for procedure.
-Insulin-1st 1/ given pre exam 2nd 1/2 post exam keep hydrated.
Glucopahge- Withheld for at least 48hrs post exam.
Medications for Diabetes including glucovance, metaglyp, avandament.
What is oxygen saturation?
Amount of hemoglobin in blood
What is the Platelet count?
- It plays a role in blood coagulation and blood formation
- WBC 500-100,000/mm3
What are normal levels of hemoglobin in females and males?
Female 12-16 g/100ml of blood
Male 14-18 g/100 ml of blood
What is responsible for the red color in blood?
What is Hemoglobin?
Protein molecule in red blood cells
Normal RBC's in Female and Males?
What does Hematorit measure?
It measures the amount of Red Blood Cells (RBC's) in total volume.
What is normal range for Activated Clotting Time (ACT)
Normal range = 150 seconds
What is ACT?
Activated clotting time performed during procedures. Used to monitor effect of protamine sulfate in heparin neutralization
What is a normal INR?
Normal is 0.8-1.2
* If too high= risk of uncontrolled bleeding
What does International Normalized Ration (INR) do?
Measures the time it takes for blood to clot and compares it to an average.
What is INR?
International Normalized Ratio
What is PTT used to screen?
- 1. Coagulation defects
- 2. Control heparin administration
- 3. Control oral anticoagulant treatment
What is the most common coagulation test employed in routine labs?
What is the normal range for (PTT)?
What is (PTT)
Partial Thromboplastin Time - Coagulation time for thromboplastin
(PT) normal range
What is (PT)?
Prothrombin time - Time it takes for prothrobin in blood to coagulate
What is coagulation profile?
What are normal BUN levels?
What does creatinine levels CHECK FOR
What are normal values for creatinine values?
- Adult 18-over 0.6 - 1.5 mg/dl
- (milligrams per decaliter)
Children 3-18 0.5-1.0 mg/dl
What is done for pre procedure check?
- 1. Check patients chart
- 2. Consent form signed and witnessed
- 3. Review clinical data
How do you open a sterile wrapped package.
1. Top flap opens away from the person opening the package
2. Open left flap
3. Open right flap
4. Open bottom flap
What are two types of gloving techniques?
What is needed for gowning for a sterile procedure?
- -Sterile gowns
- -Goggles/ glasses with eye covers
- -Head covering
- -Sterile gloves
What are primary ways of transmission.
Contact and airborne.
What are the four main methods of transmitting pathogens?
- 1. Contact
- a) Direct transmission person to
- b) Indirect object to host
- c) Droplet came in contact with a
- patients nose or mouth.
- 2. Airborn - infected dust particles etc.
- 3. Vehicle - transmitted through food,
- water, drugs, or blood
- 4. Vector - transmission through insect
- or animal.
Primary sources of infection in angiography?
What are the standard principles for a sterile enviornment?
- - Any sterile object of field touched by an unsterile object or person becomes contaminated
- -Never reach across a sterile field
- -Do not pass between the physician and the sterile table (sterile corridor)
- -Never leave a sterile are unattended
- -When leave a sterile area unattended
- -When in doubt throw it out
- -A "1" border at the perimeter of the sterile field is considered the "Buffer Zone"
What is Surgical asepsis?
The complete removal of all organisims and their spores from equipment used to perform patient care procedures.
What is on a complication or incedent report?
- -Type of incident
- -Course of action tanken
- -Follow up procedure
What belongs on procedure data form.
- -Vital signs - Pre, During, Post
- -Personnel present during exam
- -Types and amount of contrast media used.
- -Medications - amount, time given,
- -Flouro time
- -Number of exposures per run
- -Notes and comments
- -Form becomes part of medical records
What are requirments of a informed consent?
- -Nature of procedure and technique used
- -Possible alternative procedure
- -Rationale for physican's option
- -In simple language
- -Question periord
- -Signature of patient and disintrested patient
- -Physician performing exam
What are rights of every patient?
-Every adult of sound mind has the right to determine the course of medical diagnosis, and treatment of his/her body.
-All patients have angiographic and interventional procedures must be given informed consent and sigh a consent form.
When do you do study on heart?
During dystole when it closes
What is Coronary arteriography?
Demonstrates blood vessels around the heart.
What is Cardiac catheterization?
Demonstrates structures inside the heart.
What are some cardiac procedures?
- Cardiac catheterization
- Coronary arteriography
What are Interventional Procedures?
Combination of PTA, embolization, thrombolysis, and various other procedures.
What are special procedures?
Any specialized x-ray procedures.
What is Embolization?
Placing a substance into a vascular structure to prevent blood flow to that area.
What is Thrombolysis?
Thrombo - Blood Lysis - Break up
-Breaking up of blood clots.
What is PTA?
Percutanious transluminer angiography
What is Charles Dotter and Melvin Judkins know for.
Performing the first PTA
What year did Charles Dotter and Melvin Judkins perform the 1st PTA?
What three things should you do before using the seldinger technique?
Check pulse on groin, posterior tibia, and foot.
What is the Seldinger technique?
It is an introduction of a catheter through a percutaneously placed needle into an artery. It is a safer easier method of cathererization.
When was the Seidinger technique introduced?
What kind of contrast media used on the first cerebran angiograms and femora arteriograms?
What year was the first cerebral angiogram and femoral arteriograms performed?
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