RADIOGRAPHIC RADIOGRAPHIC CONTRAST MEDIA MEDIA CONTRAST

Gary D. Morrison, M.Ed., R.T.(R) Associate Professor, Radiologic Sciences Midwestern State University

What is it?
Any substance that renders an organ or structure more visible than is possible without its addition Allows visualization of structures that can not be seen well or at all under normal circumstances

Why do we need it?

Contrast media is needed because:
Soft tissue has a low absorption/interaction ratio Absorption is dependent on
atomic number atomic density electron density part thickness K-shell binding energy (K-edge)

P-E interaction is the process of absorption.

Why does it work?

Atomic Atomic Number of Main Main Number Density Electrons/cm.3 K-edge Element 7.64 0.00129 0.0039 x 1023 0.27 Oxygen Air 5.92 0.91 3.27 x 1023 0.40 Fat 7.42 1.00 3.34 x 1023 0.53 Oxygen Water 13.8 1.85 5.55 x 1023 1.6 Calcium Bone 53 4.93 33.2 Iodine Iodine 56 3.5 37.4 Barium Barium

Types of Contrast Media

Negative
Air Oxygen Carbon Dioxide Nitrous Oxide

Positive
Barium Iodine

Positive Contrast Media

Non-soluble
Absorbed - Oily &/or viscous Not absorbed - Inert (Barium)

Water-soluble
Non-injectible - Oral Injectible - Intravenous
Ionic Non-Ionic Low Osmolality

Ionic vs. Non-ionic

Ionic
Monomer Dissociates into 2 particles in the blood
Ions Cations

Generally hyperosmolal

Ionic vs. Non-ionic

Non-ionic
Dimer Does not dissociate Generally isomolal More viscous than ionic More hydrophilic

Positive Contrast Media

Properties of Water-soluble Injectibles
Low toxicity High opacity Low viscosity High miscibility

Routing of Contrast Media

Direct
Barium studies Myelography Angiography Arthrography

Indirect
Intravenous Pyelogram (IVP) Oral Cholecystogram (OCG)

Precautions
Screening - Medical History Pre-Testing??? Special Considerations
General anesthesia Pregnancy Nursing mothers Small children

Adverse Reactions - Mild

Symptoms
Itching Nausea & vomiting Pallor Cough Chills Warmth (heat) Tremors (shaking) Flushed sensation Nasal stuffiness Headache & dizziness Metallic taste in mouth Swelling of eyes or face Diaphoresis (sweats) Treatment observation & Urticaria (hives) reassurance only Anxiety

Adverse Reactions - Moderate

Moderate

Pulse change Hypotension Hypertension Dyspnea Bronchospasm Laryngospasm

Treatment
Close observation Treat symptoms. Generally, drug therapy or hospitalization not required

Adverse Reactions - Severe

Symptoms potentially life- Treatment threatening; mild & moderate Requires prompt recognition & signs & symptoms plus:

Unresponsiveness Convulsions Clinically manifest arrhythmias Cardiopulmonary arrest Renal failure DEATH!!

treatment Generally requires hospitalization & drugs

Technologists Responsibilities
Medical History Familiar with Contrast Media Know Location of Emergency Supplies Know Emergency Procedures
When & how to call a Code CPR

Medical History Table 19-7

Age - risk Allergies/asthma - risk Diabetes Insulin given prior to procedure, schedule 1st Coronary Art. Disease - cardiac risk Renal disease creatinine must be below 1.4 mg/dL, risk of renal failure Multiple myeloma - risk of renal failure Sickle cell anemia - risk of blood clots

Exam Sequencing
Intravenous Pyelography Oral Cholecystogram Barium Enema Barium Swallow, Upper GI, Small Bowel Series

Venipuncture
The puncturing of a vein for the removal of blood or for the administration of fluids &/or drugs.

Anatomic Considerations
Sites
Antecubital space
Cephalic vein Basilic vein Antecubital Vein

Posterior aspect of the hand

Cephalic vein Basilic vein

Supplies Required
Constricting band IV solution (if needed)
5% dextrose in water (D5W) 0.9% saline solution (Normal Saline NS)

IV tubing (if needed) Disposable gloves Antiseptic pads (Alcohol or Betadine) Tape

Supplies Required
Needle
Butterfly Angiocath

Syringe(s) Appropriate contrast media

Performing Venipuncture
Gather supplies Wash hands Check pt. ID Explain Put on gloves Select site & clean Apply constricting band Stabilize vein Hold needle bevel up Insert needle - 15 angle Wait for flash Attach syringe (if injecting) or IV tubing* Remove constricting band & inject/infuse If injection, remove needle & dispose of properly Chart information

*Setting up IV
Remove administration set, straighten tubing, & close clamp Prepare solution
Bottles remove protective cap & clean rubber stopper with alcohol pad Bags remove protective cap

Remove protective cap from spike of administration set & insert spike into bottle/bag Pump drip chamber until full Open clamp, bleed all air from tubing & close clamp