Contrast media 2

1. Contrast media 2

2. CONTRAST MEDIACHEMICAL PROPERTIES • TRIIODINATED COMPOUNDS • BASED ON THE BENZOID ACID RING • IODINE IS USED DUE TO THE HIGH ATOMIC NUMBER

4. IONIC CONTRAST NON IONIC CONTRAST CONTRAST MEDIA

5. Iodine Contrast Material • Non-Ionic Contrast • Less patient allergic reactions • Ionic Contrast • Anion - • Cation + • More patient allergic reactions • Ionic contrast media dissociates into two molecular particles in blood plasma = • Causing pt reactions

6. ANIONS - CHARGE IONS Responsible For Stabilizing And Detoxifying The Contrast Media CATIONS + CHARGED IONS Responsible For Increasing The Solubility Of The Medium Iodine Contrast Material

7. 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

8. Iodinated CONTRAST AGENTSAdverse Reactions • Osmolarities higher than body fluids • Viscous • Greater chance for contrast reactions • Anaphylatic shock is the most severe

10. 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)

11. General Factors for Contrast Reactions • Nonionic vs ionicRisk FactorsSeverity of ReactionsRenal toxicity • Glucophage Diabetic? • Screening Creatinine • Pretreatment

12. 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%

13. Kidney problems Diabetes Heart conditions Allergies Asthma Previous reaction Current medications Beta Blockers Antihypertensive medications VITAL SIGNS GOOD PATIENT HISTORY

14. CONTRAST REACTIONS • General • > 10 million diagnostic procedures per year • Conventional ionic contrast reactions - 10% • 1 in 1000 severe

15. 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

16. MORE Risk Factors for Contrast Reaction • Older patient age • Allergic Rhinitis, medication or Food Allergy • Cardiovascular disease

17. CONTRAINDICATIONS • Pregnancy (risk of fetal Thyroid toxicity) • + Radiation concerns • Allergic Reaction • Pathologic Conditions • Infection

18. Allergic to Iodine • General Rule: • No Iodine Contrast will be given • Pre – medication is available • May or may not react if previous iodine given

19. Aseptic Technique for injection betadine scrub Contains iodine

21. REACTIONS & Treatment USUALLY** WITHIN FIRST 5 MINUTES • Nausea & Vomiting & Urticaria • Hypotension (bradycardia) • Hypotension (tachycardia) • Bronchospasm • Anaphylactoid • Seizures • Extravasation

22. Catagories of Adverse ReactionsMILD 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

23. Catagories of Adverse ReactionsMODERATE Ch. 19 pg 297 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

24. Catagories of Adverse ReactionsSEVERE Ch. 19 pg 297 Pt Care • Laryngeal edema • Convulsions • Profound hypotension • Clincally manifested arrhythmias • Unresponsiveness • Cardiopulmonary Arrest PROMPT TREATMENT – CODE BLUE!

25. 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

26. 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

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

28. 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

29. 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

30. PreMedications • Steroids (Prednisone) • Benadryl (diphenhydramine) • Epinephrine

31. EXTRAVASATION • Contrast material has seeped outside of vessel • Local redness and swelling • Apply WARM Compress 1st 24 hours • Cool compress for swelling

32. Extravasation of Contrastinto soft tissue of arm

34. Contrast leaking from bladder

35. 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

36. SPECIAL PROCEDURSCONTRAST MEDIA ARTHROGRAMS • Injected into JOINT SPACES • IODINE (positive contrast) • WATER soluble • (Ionic or Non-Ionic) • AIR (negavitve contrast)

37. SPECIAL PROCEDURSCONTRAST MEDIA MYELOGRAMS • Injected INTRATHECALLY (into the subarachnoid space) • Nonionicwater-soluble contrast • (NO IONIC CONTRAST)

38. 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)

39. 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.

40. SPECIAL PROCEDURSCONTRAST MEDIA SIALOGRAPHY – injected into Salivary Ducts • IODINE – • WATER (ionic or nonionic) • OR OIL BASED • SINOGRAPHIN (OIL) • RENOVUE (WATER)

41. PATIENT PREP COVERED WITH EACH EXAM

42. ONLY Watersol. Arthrograms Myelograms Angio/Arterio grams Cardiac Cath Venograms Water or OIL Hysterosalpingogram Sialogram Lymphangiograms Lasts longer – may cause FAT EMBOLI REVIEW SPECIAL PROCEDURSCONTRAST MEDIA

43. REVIEW (Bontrager Slides)