Specialty Imaging ProceduresSpecialty Imaging ProceduresRadiation ProtectionRadiation Protection Contrast Media UseContrast Media Use

Nursing CareNursing Care

Department of Medical Imaging

Imaging Modalities that use Imaging Modalities that use Contrast Media & IsotopesContrast Media & Isotopes

• General Radiography/Fluoroscopy• Interventional Radiology a. Angiography b. Venography• Interventional Cardiology a. Cardiac Catheterization• CT Scan• MRI• Nuclear Medicine

Contrast MediaContrast Media• Contrast media is a substance used to

enhance the contrast of structures and fluids in the body.

• The Circulatory System and the organs/tissues supported by blood vessels (IV).

• The Gastrointestinal System (Oral).

Contrast Enhanced StudiesContrast Enhanced Studies

Cerebral Angiogram Lower GI

Contrast Enhanced StudiesContrast Enhanced Studies

Abdominal Angio CT Head

Contrast Enhanced MRIContrast Enhanced MRI

Axial T-1 Sagittal T-2

Contrast Enhanced CT Contrast Enhanced CT AngioAngio

• Coronal Chest Axial Chest

Cardiac CatheterizationCardiac Catheterization

• Left Coronary Circumflex Right Coronary

Consent FormConsent Form • ALL procedures requiring IV

contrast MUST first have a signed consent form by the patient or family member designated with POA or by 2 physicians.

• If a telephone consent is provided by family with POA, 2 nurses will document receipt of consent.

Contraindications for IV (Iodinated) Contraindications for IV (Iodinated) Contrast Media (ACR)Contrast Media (ACR)

• Allergies to Iodine• Asthma or Emphysema• Elevated BUN and Creatinine• Sickle Cell Disease• Multiple Myeloma• Hyperthyroidism• Diabetic patients on the following drugs: a. Glucophage b. Metaglip c. Advandmet

Contraindications for IV MRI Contraindications for IV MRI (gadolinium) Contrast Media(gadolinium) Contrast Media

• H/O Advanced Renal Disease

a. Recent information from the FDA states that patients with advanced renal disease are at great risk of Nephrogenic Systemic Fibrosis if gadolinium is used during an MRI procedure.

Nursing Care Post IV ContrastNursing Care Post IV Contrast Injection (iodine or gadolinium)Injection (iodine or gadolinium)• Monitor patient for reactions a. Bleeding at site b. Urticaria (Hives) c. Vomiting d. Bronchospasm (Wheezing) e. Swelling f. Itching g. Severe Headache h. Sneezing i. Stiffness in joints i. Respiratory arrest

RSH Pre - Procedure RSH Pre - Procedure ChecklistsChecklists

Pre – Procedure Pre – Procedure Checklists…Checklists…contcont

•The checklists ensure that proper screening for potential allergies and possible life threatening issues are addressed prior to contrast administration or procedure.

Nursing Care for all ICU/Tele Nursing Care for all ICU/Tele patients obtaining CT & MRI’spatients obtaining CT & MRI’s• ALL patients are to be escorted to the

CT/MRI Trailer by an ACLS Nurse.• ALL patients MUST be on a cardiac

monitor.• ALL patients MUST transport with

Medical Transport bag.• Bring walkie - talkie’s for direct

communication in case of CODE BLUE.

Nuclear MedicineNuclear Medicine• Nuclear Medicine requires the use of a

radioisotope instead of contrast media to visualize anatomic structures.

• The isotope is tagged with a chemical agent that is organ specific and causes the organ to enhance.

• The isotope of choice is Technetium 99m.

Patient Preparation for Most Patient Preparation for Most Common Nuclear Medicine Common Nuclear Medicine

ProceduresProcedures Procedure Preparation Indication1. Bone Scan None Osteomylitis

/Fx /Mets2. Liver/Spleen Scan None

Cancer/rupture/hepatitis3. Renal Scan None

Obstruction/perfusion4. Lung Scan None Pulmonary

Embolus5. WBC Scan None Abscess / infection6. Gallium Scan None Sepsis / tumors7. Hida Scan None Cholecystitis

Contraindications for Nuclear Contraindications for Nuclear Medicine ProceduresMedicine Procedures

•Pregnancy

•Women who may be breast feeding

Radiation ProtectionRadiation Protection• Individual exposure is controlled by 3 factors:

• Time - The amount of time of the exposure. • Distance - Distance from radiation source.

• Shielding - Use of lead protective equipment.

ConclusionConclusion• If you have questions please contact

Jay Haischer, MHA, RPA/RT, VA-BC in Medical Imaging.