1. Chapter 6 Diagnostic Agents Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc.

2. Background  Most of these agents are unique to surgery  Most are not found in PDR

3. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 1. Define  Contrast media  Pharmacologic agents used in certain diagnostic radiographic tests  Radiopaque chemicals

4. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 1. Define  Dyes  Solutions that color or mark tissue for identification

5. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 1. Define  Staining agents  Chemicals in solution that react differently with abnormal cells than with normal cells

6. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2 Give examples of contrast media and how each is used in radiographic studies in surgery.

7. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Examples: Contrast Objective 2. Examples: Contrast  Omnipaque  Hypaque  Visipaque  Isovue

8. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Discuss uses (OR) Objective 2. Discuss uses (OR)  Contrast media in general  Used in radiology and OR  Provides contrast on x-ray  Instilled into cavities or tubular structures

9. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Uses: Contrast  Iohexal (Omnipaque)  Intraoperative angiography Confirm removal of a blockage in a peripheral vessel, such as after a femoral embolectomy or laser atherectomy Confirm removal of a blockage in a peripheral vessel, such as after a femoral embolectomy or laser atherectomy

10. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Uses: Contrast  Iohexal (Omnipaque)  Retrograde urography Visualize renal structures Visualize renal structures Detect possible blockage Detect possible blockage

11. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Uses: Contrast  Hypaque  Operative cholangiograms  Detect presence of stones in common bile duct

12. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Uses: Contrast  Iodixanol (Visipaque)  Cardiography  Peripheral, visceral, and cerebral arteriography  CECT of the head and body  Excretory urography  Peripheral venography

13. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2. Uses: Contrast  Iopamidol (Isovue) – Cerebral angiography – Peripheral arteriography – Angiocardiography – Urography, arthrography, and computerized tomography (CT) enhancement

14. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3 Give examples of dyes and how each is used in surgical procedures.

15. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3. Examples: Dyes  Methylene blue  Isosulfan blue  Indigo carmine  Gentian violet

16. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. HINT: Make drug cards  Drug name:  Methylene blue  Category  Dye  Uses

17. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3. Uses: Dyes  Methylene blue  Detect bladder injury  Assess tubal patency  Mark skin incisions Being replaced by marking pens for this purpose Being replaced by marking pens for this purpose

18. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3. Uses: Dyes  Isosulfan blue (Lymphazurin 1%)  Delineate lymphatic vessels  Sentinal node biopsy

19. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3. Uses: Dyes Objective 3. Uses: Dyes  Indigo carmine  Color urine for verification  Cystoscopy Verify ureteral orifices Verify ureteral orifices Note: Given IV

20. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3. Uses: Dyes  Gentian violet  Mark skin incisions

21. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 4 Give examples of staining agents and how each is used in surgical procedures.

22. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 4. Examples: Staining agents  Lugol’s solution  Acetic acid

23. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 4. Uses: Staining agents  Lugol’s solution  Schiller’s test for cervical dysplasia  Do NOT confuse with Monsel’s solution  A chemical hemostatic agent

24. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 4. Uses: Staining agents  Acetic acid (vinegar)  Cervical dysplasia for laser excision

25. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Drug cards  Also have info on handling  Examples:  Keep out of light  Don’t confuse w/ Monsels  Etc.