Benefits and Disadvantages of scheduling pt’s for multiple exams in one day
Benefits - less cost to system, allows some else to use hospital bed, patient only has to do exam prep once (fasting increasing dehydration hard on geriatric/peds pt’s)
Disadvantages - increased miscommunication occurs from sequencing perspective, hard to coordinate exams b/w units, variation in unit clerk/nurse knowledge of DI exams
Consequences if DI are incorrectly ordered
- residual barium from GI exams can cause complication/misinterpretations of UT exams
- residue barium can also cause artifacts in CT and US exams
- incorrect diagnoses of the scan especially with some NM exams (if iodinated cm is given before nm thyroid exam they must wait 3 weeks for it)
- inexperienced staff may not understand the importance of exam prep and result in suboptimal exam and misdiagnoses
Reference for scheduling sequence of exams
- those that DO NOT require cm should be scheduled first
- US exams
- NM exams of liver and spleen
- thyroid scans before iodinated contrast
- iodinated contrast exams before barium exams
- lower GI series (barium enema)
- upper GI series (UGI or OS&D)
- studies requiring pt to be NPO should be scheduled early in the morning
Factors to consider when deciding which pt gets to go first
- those who have been fasting (especially diabetic)
- ER patients
- paediatric and geriatric pt’s
When organizing room tech should consider pt’s
- mobility (ambulatory vs transfer)
- ability to follow instructions (hard of hearing or don’t speak English)
- is the pt accompanied by another health care professional, nurses usually have 2-4 pt’s to care for
What is extravasation
- IV fluids or meds may leak or be accidentally injected into the tissue surrounding a vein “fluid outside the vessel”
Due to - vein rupturing or fluid passing through the walls of an intact vein due to high pressure injection given
May be painful and or dangerous
What is infiltration
The fluid a has diffused into the surrounding tissues
May be painful or dangerous as some cm/meds are considered a vesicant agent (cause blisters)
Preventing possibility of infiltration
- check for back flow of blood to be sure catheter is properly inserted before starting injection
- immobilization/secure the catheter correctly at the injection site
- stop IV injection immediately if pt complains of pain/discomfort at injection site
- power injectors give a test run of saline first, have a monitor that shows the amount of pressure and resistance occurring in the vein
Treatment for infiltration
- remove needle and treat prior to staring another
- inform pt pain is only temporary
- maintain pressure on vein until bleeding has stopped, reduce formation of hematoma
- apply cold pack to affected area, keeps infiltration localized
- ice pack applied for 20-60 mins and repeated 3 times a day till swelling is gone
- rad informed and provide treatment orders
- know the estimated amount of cm infiltrated before talking to rad
- fill out an incident report and pt sent home with written care instructions
Rate of Bolus injection it controlled by
- gauge of needle and connecting tubing
- amount of contrast required for injection
- viscosity of agent
- stability of vein
- power injector use a set PSI to regulate force injection, hand injection force applied depends on the individual giving injection
What is a bolus injection
Rapid introduction of cm into the vascular system
Common contrast agents used in GI, biliary, circulatory, UT imaging
Omnipaque Optiray Visipaque Isovue Conray Cysto-Conray Hypaque Hypaque-cysto Gastrografin Sinografin Barium sulfate
