Venipuncture & Contrast Media Flashcards
what emergency drugs should be available before contrast media is administered?
epinephrine and benadryl
list the exams or reasons that allow radiologic technologists to perform venipuncture
administering contrast media, radiopharmaceuticals, IV medications
what type of density to radiopaque contrast agents have?
high density
what do radiopaque contrast agents allow to be imaged?
low contrast tissues such as blood vessels, kidneys, GI tract
what are the most common contrast agents
barium and iodine
barium atomic number
56
iodine atomic number
53
how can barium sulfate be administered
orally or rectally
when imaging a patient, what is barium used to image?
GI disorders
what does the barium coat in the GI tract
the mucosa
when shouldn’t barium sulfate be used?
when a perforation of the GI tract is suspected
if perforation of the GI tract is suspected, what will replace the barium sulfate?
water soluble iodine solution
when imaging the UGI, how should barium sulfate be administered?
orally
when imaging the lower GI, how should barium sulfate be administered?
enema
what adds density to vascular structures and organs?
iodinated contrast media
what are the five ways iodinated contrast media can be administered
intravenously, intra-arterially, orally, rectally, intrathecal
the concentration of a solution expressed as the total number of solute particles per kilogram
osmolality
concentration of a solution expressed as the total number of solute particles per liter in a percentage?
osmolarity
measurement of the rate of flow of a liquid through a tube
viscosity
which contrast media generally has a high osmolar content?
ionic contrast media
what is the ratio of iodine atoms to osmotically active particles in ionic contrast media?
3:2
what is the ratio of iodine atoms to osmotically active particles in non ionic contrast media ?
3:1
what are the 5 rights of medication
right patient, right drug, right route, right amount, right time
how many atoms per molecule do ionic and non ionic contrast media have?
3
which type of contrast media has a higher chance of adverse reactions and toxicity to organs?
ionic contrast
which contrast type generally has low osmolar content?
non ionic contrast
when injected into the bloodstream, which contrast agent does not disassociate into osmotically active particles
non ionic
which type of contrast agent has a less chance of adverse reactions and toxicity to organs?
non ionic
what are the methods of administration for venipuncture?
hypodermic needle, butterfly needle, IV catheter
what important information about patients should we know before administering contrast media?
previous reactions, asthema, seizures, renal history, diabetic metformin drugs
what may a patient who is at risk of reactions be administered before being given contrast?
steroids, benadryl
what does BUN stand for
blood urea nitrogen
which lab value measures the amount of urea nitrogen in the blood
BUN
what is a waste product of protein metabolism
urea nitrogen
what is the average value of BUN levels?
7 - 20 mg
where is urea nitrogen creatine created and where does it carry to?
created in the liver and carried to the kidneys
what is the chemical waste generated from muscle metabolism?
Creatinine
what % of the body’s creatine is converted to creatinine daily?
2%
where is creatine created and where is it carried to?
created in the bloodstream and carried to the kidneys
what is the average value of creatinine levels
0.6 - 1.2 mg
what should be checked on the contrast before administration
type of contrast, expiration date, clarity of contrast
what angle should the needle be for venipuncture?
20 - 45 degrees
after blood return with an IV how much further should the needle be pushed into the vein?
1/4 - 1/2 inch
how many cc’s of normal saline should be injected into the IV after venipuncture and before administration of contrast?
1-3 cc
after injecting the normal saline into the IV, what should the tech observe for
redness, swelling, pain
after removing the IV, how long should pressure be held on the puncture wound?
3 minutes
what are the three types of reactions to contrast administration
mild, moderate, severe
how long after injecting a patient with a contrast agent do reaction signs occur?
2 - 3 minutes
what two types of administration are most likely to cause adverse reactions?
intravenously, intra-arterially
what are some symptoms of a mild reaction to contrast administration?
itching eyes and nose, cough, sneezing, hives
what should be done if the tech notices the patient having a mild reaction to contrast?
stop the infusion, notify the nurse and radiologist, observe the patient
what are some symptoms of intermediate / moderate reactions to contrast media
throat tightness, dyspenia or wheezing, rapid pulse or breathing, chest pain, hypotension
what should be done if the tech notices that the patient is having intermediate or moderate reactions to contrast?
stop the infusion, notify the nurse and radiologist, prepare medication to administer (antihistamines)
what are some symptoms of severe reactions to contrast agents?
shock, seizure, cardiac arrest
what should be done if the tech notices a patient having a severe reaction to contrast media?
notify nurse and radiologist, call for the emergency team, get the crash cart and the AED
t / f Mild or moderate reactions to contrast media cannot turn into severe reactions
false
what types of medications are administered to treat intermediate or moderate reactions to contrast agents?
antihistamines such as epinephrine or benadryl
what response do mild reactions to contrast media require?
observation and time
what response do moderate reactions to contrast media require?
medication and observation
what response do severe reactions to contrast media require?
immediate intervention and hospitalization
minimum hospitalization time for a patient that suffers a severe contrast media reaction
24 hours
how long after intravenous contrast media administration can a reaction occur?
up to 24 hrs from time of injection
what is the cause of a hematoma as a result of a contrast media complication
poor needle insertion
what is the cause of phlebitis as a result of a contrast media complication
unclean application / extravasation
what is the cause of tissue sloughing as a result of a contrast media complication
extravasation of caustic contrast material
are veins less or more superficial than arteries
more, closer to surface of skin
how long to apply pressure to puncture site after venipuncture?
at least 3 minutes
if a patient is on blood thinners or coumadin (warfrin), how long to hold puncture site after venipuncture?
5 minutes
which vein is mainly used for contrast media administration?
medial cubital (antecubital) vein
when medial cubital vein is inaccessible, which site of venipuncture is used?
palmar arch on the hand
cleaning site size and movement of alcohol
4 x 4, medialateral circular motion
maximum amount of contrast a person can recieve in a day
500cc
infiltration of contrast media or caustic material under the skin
extravasation
if extravasation occurs with contrast media, how to treat?
use heating pad to decrease viscosity of contrast and allow body to process it faster
maximum amount of time a tourniquet should be applied
1 minute
three major veins in the antecubital fossa
cephalic, medial cubital, basilic
vein located on the thumb side of the arm
cephalic vein
what is the cause of rolling veins?
needle enters to the side of the vein, causing it to roll to one side
what is creatinine produced from?
creatine
who oversees the scope of practice and contrast media for radiologic technologists?
ASRT
time frame for possible IV contrast reactions
2-3 minutes usually, but can be up to 24 to 48 hours
itching of the nose or eyes is a indication of which type of reaction
mild
coughing is a indication of which type of reaction
mild
sneezing is a indication of which type of reaction
mild
hives is a indication of which type of reaction
mild
what to do in case of a mild reaction?
stop infusion, notify nurse and radiologist, observe
tightness in the throat is a indication of which type of reaction
moderate
dyspnea or wheezing is a indication of which type of reaction
moderate
rapid pulse or breathing is a indication of which type of reaction
moderate
chest pain is a indication of which type of reaction
moderate
hypotension is a indication of which type of reaction
moderate
what to do in case of moderate reaction?
stop injection, call radiologist and nurse, prepare to give oxygen or epinepherine/benadryl. requires treatment
shock is a indication of which type of reaction
severe
seizures is a indication of which type of reaction
severe
cardiac arrest is a indication of which type of reaction
severe
what to do in case of severe reaction?
notify nurse and radiologist, call emergency team, get code cart and AED. requires hospitalization and observation