contrast media and venipuncture

Question 1

are contrast agents drugs

Answer 1

yes

Question 2

whay are contrast agents considered drugs

Answer 2

they can absorb into systemic circulation
may produce a physiologic response in the body

Question 3

why do we use contrast agents

Answer 3

to visualize areas of the body where the interest looks like the surrounding area

Question 4

what are positive contrast agents’ properties (3)

Answer 4

add density
are radiopaque
effective photon absorbers

Question 5

give 3 examples of positive contrast agents

Answer 5

barium sulfate
gastrogafin
iodinated intravenous contrast media

Question 6

what is BaSO4

Answer 6

barium sulfate

Question 7

what is the z of Ba

Answer 7

56

Question 8

how is BaSO4 formulated

Answer 8

does not dissolve, so suspended in a solution

Question 9

where is BaSO4 generally used

Answer 9

in imaging of the GI system

Question 10

what is flocculation

Answer 10

clumping, causing the material to come out of suspension

Question 11

what causes flocculation in BaSO4

Answer 11

stomach acid

Question 12

what are added to BaSO4 to prevent flocculation?
give 2 examples

Answer 12

stabilizing agents
sodium carbonate
sodium citrate

Question 13

what ways can BaSO4 be administrated?

Answer 13

orally and rectally

Question 14

what is a major contraindication to prevent BaSO4

Answer 14

suspicion of perforation of the digestive tract

Question 15

what happens if BaSO4 leaks into the body

Answer 15

will not be absorbed, must be surgically removed
can cause barium peritonitis

Question 16

if GI perforation is suspected, what is recommended instead of BaSO4

Answer 16

a water-soluble iodinated contrast

Question 17

what is a contraindication to avoid BaSO4

Answer 17

hemorrhoids

Question 18

what is a major factor that can contribute to risk of colon perforation

Answer 18

age (due to loss of tissue tone)

Question 19

why must pts drink a lot of water post BaSO4

Answer 19

to prevent obstruction from water absorbtion

Question 20

what is hypervolemia

Answer 20

excess of fluid entering the circulatory system

Question 21

are sedative pre-medications contraindicated for lower GI exams, and why

Answer 21

yes, hypervolemia is easily masked in sedated pts

Question 22

what is one hypervolemia symptom

Answer 22

drowsiness

Question 23

why should sedated pts not undergo upper GI exams

Answer 23

swallowing reflex is diminished, high risk for aspiration

Question 24

what is water soluble iodinated contrast media primarily used for

Answer 24

adding density to vasculature

Question 25

what is used primarily for adding density to vasculature

Answer 25

water soluble iodinated contrast media

Question 26

what is osmolality

Answer 26

measure of total particles in a solution per kg of solvent

Question 27

ionic media must have a (higher/lower) osmolality than blood

Answer 27

higher

Question 28

what are IV radiopaque contrast media primarily used for?

Answer 28

to add density to vasculature

Question 29

what does the osmolality of a solution determine

Answer 29

the osmotic presure

Question 30

what study using barium sulfate suspensions uses the most concentration

Answer 30

small intestine

Question 31

what study using barium sulfate suspensions uses the least concentration

Answer 31

large intestine: barium enema CT GI exams

Question 32

differentiate between ionic and non ionic media

Answer 32

ionic DO dissociate in suspension HIGHER osmolality than blood plasma

Question 33

water soluble iodinated contrast media tend to have (high/low) viscisity

Answer 33

high viscosity

Question 34

what about the medium does viscosity affect

Answer 34

the injectability of the medium

Question 35

why would you heat medium

Answer 35

Heating the medium to body temperature significantly reduces viscosity and facilitates rapid injection

Question 36

what are reactions to IV contrast media (5)

Answer 36

feeling of warmth/flushing metallic taste nausea/vomiting headache sensation of urination

Question 37

what is the effect of a mild allergic reaction to contrast

Answer 37

urticaria

Question 38

what pre-medications are used if hx of contrast allergy

Answer 38

steroids and antihistamines

Question 39

what are the effects of a severe allergy to contrast

Answer 39

dyspnea related to laryngeal edema seizure cardiac arrest

Question 40

what are moderate reactions to contrast

Answer 40

tachycardia/brachycardia hypey/hypo tension dyspnea bronchospasm/wheezing

Question 41

what are clinical manifestations of vasovagal reaction (6)

Answer 41

pallor cold sweats rapid pulse syncope / faintness bradycardia hypotension

Question 42

what is CIN

Answer 42

contrast induced nepropathy transient and reversible form of acute renal failure

Question 43

who is extra susceptible to CIN (4)

Answer 43

diabetic pts with renal disease elderly pts solitary kidney pts

Question 44

what eGFR means NO CONTRAST

Answer 44

<30 mL/min

Question 45

what can be used with high-risk pts to prevent impaired renal function

Answer 45

N-acetylcysteine

Question 46

what is the exemption to IV contrast media contraindications

Answer 46

dialysis

Question 47

what is metformin used to treat

Answer 47

non-insulin dependant diabetes

Question 48

what can metformin do

Answer 48

increase glucose uptake by cells

Question 49

why is metformin problematic

Answer 49

does NOT react with iodinated contrast agents but, can dec blood pH resulting in lactic acidosis

Question 50

how long before contrast should metformin be stopped

Answer 50

48 hours

Question 51

what are properties of negative contrast agents

Answer 51

low z of elements appears radiolucent often used w pos agents

Question 52

what are the 2 syringe types are used for parenteral administration

Answer 52

standard hypodermic syringe prefilled syringe

Question 53

what are the syringe sizes

Answer 53

2, 2.5, 2, 5, 10, 20, & 50

Question 54

shorter needles are used for _____ injections longer needles are used for ______ injections

Answer 54

subcutaneous intramuscular

Question 55

bevel should always face ___ when entering the skin

Answer 55

UP

Question 56

what gauge is the green needle

Answer 56

18 gauge

Question 57

what gauge is the pink needle

Answer 57

20 gaugew

Question 58

what gauge is the blue needle

Answer 58

22 gauge

Question 59

which port of IV bag goes OUT

Answer 59

the blue side

Question 60

when is IV administration used

Answer 60

immediate effect is desired cannot be injected into body tissues without damage

Question 61

what are the 2 methods (size related) that drugs can be given

Answer 61

through an infusion or a bolus

Question 62

what flow rate can 22g handle

Answer 62

up to 3cc/s

Question 63

what flow rate can 20g handle

Answer 63

3-4 CC/s

Question 64

what flow rate can 18 g handle

Answer 64

5cc/s and uo

Question 65

what are concerns when injecting contrast to an elderly pt

Answer 65

fragile veins tourniquet more likely to damage skin contrast is more likely to dehydrate pt

Question 66

extravasation of IV contrast media is better handled with (LOCM / HOCM)

Answer 66

LOCM

Question 67

what is the first step when extravasation occurs

Answer 67

remove the needle and apply pressure