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Patient Care-CTBC > Contrast Administration (29/30) > Flashcards

Contrast Administration (29/30) Flashcards

1
Q

Most common IV contrast injection complications (4)

A

Extravasation
Air Embolism
Adverse Reactions
Contrast-Induced Nephrotoxicity

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2
Q

Extravasation: Acute local inflammatory response (time)

A

may peak at 24-48h

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3
Q

Extravasation: Next Steps (3)

A

Notify Radiologist
Elevate extremity
Apply hot/cold to encourage good blod flow/accelerate resorption/relieve Pn

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4
Q

Air Embolism

A

Clinically significant: large-volume (potentially fatal, but rare)
Clinically insignificant: small-volume (common)

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5
Q

Air Embolism: SE (9)

A

Air hunger
Dyspnea
Cough
CP
Pulmonary edema
Tachycardia
Hypotention
Expiratory wheezing
Neurologic deficits from stroke d/t decreased cardiac output or paradoxical air embolism (from rt–>lt side of heart occluding a instead of v)

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6
Q

Air Embolism: Treatment (3)
Admin…
Position…
Initiate…

A

Admin 100% O2
Position in left lateral decubitus
Initiate CPR if indicated

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7
Q

Adverse Reactions: Mild (7)

A

Scattered urticaria (hives)–most commonly reported
Pruritis (itching)
Rhinorrhea (runny nose)
Nausea, brief retching (“dry heaving”) and vomiting
Diaphoresis (sweating)
Coughing
Dizziness

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8
Q

Adverse Reactions: Dizziness

A

Mild

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9
Q

Adverse Reactions: Coughing

A

Mild/Air Embolism

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10
Q

Adverse Reactions: Diaphoresis

A

Mild

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11
Q

Adverse Reactions: Nause/Dry Heave/Vomiting

A

Mild

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12
Q

Adverse Reactions: Rhinorrhea

A

Mild

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13
Q

Adverse Reactions: Pruritis

A

Mild

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14
Q

Adverse Reactions: Scattered urticaria

A

Mild

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15
Q

Adverse Reactions: Moderate (10)

A

Persistent vomiting
Diffuse urticaria
Headache
Facial edema
Laryngeal edema-moderate
Bronchospasm/dyspnea-moderate
Palpitations-moderate Tachycardia,Bradycardia
Hypertension
Abdominal cramps

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16
Q

Adverse Reactions: Persistent Vomiting

A

Moderate

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17
Q

Adverse Reactions: Diffuse Urticaria

A

Moderate

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18
Q

Adverse Reactions: Headache

A

Moderate

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19
Q

Adverse Reactions: Facial Edema

A

Moderate

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20
Q

Adverse Reactions: bronchospasm or dyspnea

A

Moderate or Severe

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21
Q

Adverse Reactions: Palpitations, tachycardia, bradycardia

A

Moderate

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22
Q

Adverse Reactions: Hypertension

A

Moderate

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23
Q

Adverse Reactions: Abdominal cramps

24
Q

Adverse Reactions: Severe (7)

A

Life-threatening arrhythmias (i.e., ventricular tachycardia)
Altered mental status
Severe hypotension
Severe bronchospasm
Laryngeal edema
Pulmonary edema
Seizures, syncope, death

25
Adverse Reactions: Life-threatening arrhythmias (i.e., ventricular tachycardia)
Severe
26
Adverse Reactions: Altered Mental Status
Severe
27
Adverse Reactions: Hypotension
Marked Hypotension: Severe Hypotension also indicative of possible air embolism
28
Adverse Reactions: Laryngeal Edema
Moderate/Severe
29
Adverse Reactions: Pulmonary Edema
Severe
30
Adverse Reactions: Siezures, Syncope
Severe
31
Adverse Reaction: Next Steps (6)
D/C contrast admin Call for RN/MD support Assess ABCs Acquire vitals Have contrast reaction kit/O2 mask on-hand Call code PRN
32
Observation time for Mild Adverse Reaction (3)
20-30 min May evolve into moderate/severe Hypotension may be clinically silent while patient is supine
33
Moderate/Severe Adverse Reaction: Medical Interventions (6)
O2 by mask Antihistamine for hives/itching/running nose Beta agonist inhaler for bronchospasm Epinephrine for hypotension Epinephrine for laryngeal edema Furosemide for pulmonary edema
34
Adverse Reaction: Tx for Urticaria/Pruritis/Rhinorrhea
Benadryl/Antihistamine
35
Adverse Reaction: Tx for Bronchospasm
Albuterol/Beta Agonist Inhaler
36
Adverse Reaction: Tx for Laryngeal Edema
Epinephrine
37
Adverse Reaction: Tx for Pulmonary Edema
Lasix/Furosemide
38
Contrast-Induced Nephropathy: definition
Sudden deterioration in renal function d/t IV admin of iodine contrast Noted by sharp degradation in renal function lab values: creatinine, BUN, GFR
39
Contrast-Induced Nephropathy: Risk Factors (9)
Mult Iodine Admins in short interval Pre-existing renal insufficiency Dehydration Advanced age Multiple myeloma Diabetes Cardiovascular Ds Diuretic use HTN
40
Contrast-Induced Nephropathy: Max lab values
No agreed-upon threshold of serum creatinine or eGFR Contrast admin always implies a risk-benefit analysis
41
Iodine Contrast: Strict Contraindications (3)
Iodine Allergy Renal failure Recent contrast admin
42
Iodine Contrast: Relative Contraindications (3)
Pregnancy Lactation Dialysis
43
Iodine Contrast Relative Contraindication: Pregnancy
Iodine contrast shown to cross human placenta and enter fetus in clinical doses In-vivo animal testing shows no evidence of mutagenic/teratogenic effects w/LOCM
44
LOCM
Low-Osmolality Contrast Media
45
Iodine Contrast Relative Contraindication: Lactation
Less than 1% of admin'd maternal dose excreted into breast milk in 1st 24h Less than 1% of contrast medium ingested by infant is absorbed from GI tract Expected systemic dose absorbed by infant: <0.01%
46
Iodine Contrast Relative Contraindication: Lactaion-Pump&Dump
Often encouraged by Radiologists d/t nearly 100% excretion cleared from her bloodstream within 24h Ultimate choice lies w the mother
47
Iodine Contrast Relative Contraindication: Dialysis-Anuric ESCKD
No risk of further damaging kidneys (which are no longer functioning)
48
Iodine Contrast Relative Contraindication: Dialysis-Oliguric
Speculative risk of converting Pt to anuric
49
Oliguria
Urine output of 80-400/500 mL per day
50
Oliguria: Children
Less than 0.5 mL/kg/h
51
Oliguria: Infants
Less than 1 mL/kg/h
52
Iodine Contrast Relative Contraindication: Dialysis-Theoretical Risk (2)
Intravascular volume from IV iodine osmotic load may not be readily cleared & may result in Pulmonary Edema Anasarca
53
Anasarca
General accumulation of serous fluid in various tissues and body cavities characterized by swelling of the whole body.
54
Iodine Contrast Relative Contraindication: Dialysis-Dose Mitigation
Use of LOCM or Iso-osmolar Contrast w/dosing as low as necessary to achieve Dx
55
Iodine Contrast Relative Contraindication: Dialysis-When to dialyze immediately (2)
Cardiac dysfunction Volume overload
56
Iodine Contrast Strict Contraindication (3)
Iodine Allergy~adverse reactions commonly avoided via use of corticosteroids/anti-histamines Renal Failure~sometimes urgency outweighs risk Recent Contrast Admin (d/t POSS of inducing renal failure)~sometimes urgency outweigh risk
57
Adverse Reaction: Tx for Hypotension
Epinephrine

Patient Care-CTBC (4 decks)

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