1. Contrast media 2

2. CONTRAST MEDIA CHEMICAL PROPERTIES TRIIODINATED COMPOUNDS TRIIODINATED COMPOUNDS BASED ON THE BENZOID ACID RING BASED ON THE BENZOID ACID RING IODINE IS USED DUE TO THE HIGH ATOMIC NUMBER IODINE IS USED DUE TO THE HIGH ATOMIC NUMBER

4. CONTRAST MEDIA IONIC CONTRAST IONIC CONTRAST NON IONIC CONTRAST NON IONIC CONTRAST

5. Iodine Contrast Material Ionic Contrast Ionic Contrast – Anion - – Cation + – More patient allergic reactions Ionic contrast media dissociates into two molecular particles in blood plasma = Ionic contrast media dissociates into two molecular particles in blood plasma = Causing pt reactions Causing pt reactions Non-Ionic Contrast Less patient allergic reactions

6. Iodine Contrast Material ANIONS ANIONS - CHARGE IONS - CHARGE IONS Responsible For Stabilizing And Detoxifying The Contrast Media Responsible For Stabilizing And Detoxifying The Contrast Media CATIONS CATIONS + CHARGED IONS + CHARGED IONS Responsible For Increasing The Solubility Of The Medium Responsible For Increasing The Solubility Of The Medium

7. What contributes to discomfort, side effects, reactions: VISCOSITY VISCOSITY – (thick, sticky) thicker – harder to inject, more heat and vessel irritation (higher = greater viscosity) Warming contrast will help TOXICITY TOXICITY - (higher = greater viscosity) MISCIBILITY MISCIBILITY - easily mixes with blood

8. Iodinated CONTRAST AGENTS Adverse Reactions Osmolarities higher than body fluids Viscous Greater chance for contrast reactions Anaphylatic shock is the most severe

10. CONTRAST MATERIAL ADVERSE REACTIONS ALWAYS ANY ALWAYS GET PATIENT’S HISTORY BEFORE ANY CONTRAST MEDIA IS GIVEN SEE Ch. 19 Table 19-7 pg 296 Carlton Pt Care (3 RD ed)

11. General Factors for Contrast Reactions Nonionic vs ionic Risk Factors Severity of Reactions Renal toxicity Risk Factors Severity of Reactions Renal toxicity Glucophage Diabetic? Glucophage Screening Creatinine Pretreatment

12. CONTRAST MEDIA & ADVERSE REACTIONS RISK Any foreign substance introduced in the body Chance the body will react negatively to the material Minor to Life Threatening Minor = 5% Major 0.1%

13. GOOD PATIENT HISTORY Kidney problems Kidney problems Diabetes Diabetes Heart conditions Heart conditions Allergies Allergies Asthma Asthma Previous reaction Previous reaction Current medications Current medications Beta Blockers Beta Blockers Antihypertensive medications Antihypertensive medications VITAL SIGNS VITAL SIGNS

14. CONTRAST REACTIONS General > 10 million diagnostic procedures per year Conventional ionic contrast reactions - 10% 1 in 1000 severe

15. Contraindiatons for Contrast Renal Failure (Check BUN & Creatinine) Elevated levels could cause renal shutdown Anuria (no urine production) Asthma (possible allergies) Hx of Contrast Allergy / Reactions Diabetes - get a hx of medications taken – glucophage must be stopped 48 hrs before contrast injection Multiple Myeloma

16. MORE Risk Factors for Contrast Reaction Older patient age Allergic Rhinitis, medication or Food Allergy Allergic RhinitisFood Allergy Cardiovascular disease

17. CONTRAINDICATIONS Pregnancy (risk of fetal Thyroid toxicity)Thyroid + Radiation concerns Allergic Reaction Pathologic Conditions Infection

18. Allergic to Iodine General Rule: No Iodine Contrast will be given – Pre – medication is available May or may not react if previous iodine given

19. Aseptic Technique for injection betadine scrub Contains iodine

21. REACTIONS & TreatmentTreatment USUALLY** WITHIN FIRST 5 MINUTES Nausea & Vomiting & Urticaria Hypotension (bradycardia) Hypotension (tachycardia) Bronchospasm Anaphylactoid Seizures Extravasation

22. Catagories of Adverse Reactions MILD Ch. 19 pg 297 Pt Care – nausea, vomiting – Uticaria (hives) rash – itching – Flush face – feeling of warmth – Headace, Chills, Anxiety – Diaphoresis Treatment – does not usually get worse Watch patient and reassure (cool cloth on forehead, emesis basin

23. Catagories of Adverse Reactions MODERATE Ch. 19 pg 297 Pt Care Hypotension (bradycardia) Hypertension (tachycardia) Dyspnea Bronchospasms /wheezing Laryngeal Edema TREATMENT: Needs immediate treatment –GET RN/RAD Needs Meds* – (Keep IV line in) could lead to severe reactions

24. Catagories of Adverse Reactions SEVERE Ch. 19 pg 297 Pt Care Laryngeal edema Convulsions Profound hypotension Clincally manifested arrhythmias Unresponsiveness Cardiopulmonary Arrest PROMPT TREATMENT – CODE BLUE!

25. Rx for REACTIONS have ready on Emergency cart or Crash Cart UTICARIA (HIVES) – Benadryl (diphenhydramine) Vistaril (hydorxyzine) Tagament or Zantac Facial/Laryngeal Edema/Bronchospasms Epinephrine, Oxygen

26. Contrast Reactions/MYTHS not caused by iodine – Ionic vs non ionic - binding elements not related to shellfish not true allergy (no drug-antibody) mechanism remains unknown

27. Anaphylactoid (idiosyncratic) unpredictable dose independent prevalence 1-2% (0.04 - 0.22% severe) fatal 1 in 75,000

28. RENAL TOXICITY (increased serum creatinine > 0.5 mg%) 2-7% 5 – 10 x increase with pre-existing renal insufficiency direct relationship between serum creatinine and likelihood nephrotoxicity Hydrate 100 ml/hr Normal saline 4 hrs prior to procedure, continue for 24 hours

29. GLUCOPHAGE Pt is DIABETIC = oral diabetic agent MUST STOP __ DAYS BEFORE EXAM withhold drug for 48 hrs after contrast administration patients with renal insufficiency may develop lactic acidosis The signs of lactic acidosis are deep and rapid breathing, vomiting, and abdominal pain

30. PreMedications Steroids (Prednisone) Benadryl (diphenhydramine) Epinephrine

31. EXTRAVASATION Contrast material has seeped outside of vessel Local redness and swelling Apply WARM Compress 1 st 24 hours Cool compress for swelling

32. Extravasation of Contrast into soft tissue of arm

34. Contrast leaking from bladder

35. SCHEDULING CONSIDERATIONS Diabetics – first – (Insulin= low blood sugar occurs while fasting) After Nuclear Medicine Tests – (iodine goes to thyroid and will alter results) Iodine BEFORE Barium BE before UGI ( IVP before BE) WATER – OIL - BARIUM

36. SPECIAL PROCEDURS CONTRAST MEDIA ARTHROGRAMS – Injected into JOINT SPACES – IODINE (positive contrast) WATER soluble (Ionic or Non-Ionic) – AIR (negavitve contrast)

37. SPECIAL PROCEDURS CONTRAST MEDIA MYELOGRAMS – Injected INTRATHECALLY (into the subarachnoid space) – Nonionic – Nonionic water-soluble contrast – (NO IONIC CONTRAST)

38. 31 y/o male DIES after Myelogram Procedure Myelography is safely performed using nonionic water-soluble radiographic contrast media nonionic water-soluble radiographic contrast media intended for this route of administration intrathecally Misadministration of ionic contrast media intrathecally can result in a syndrome of spasms and convulsions, often leading to death ISOVUE –M ( 20 or 30 cc) ISOVUE –M ( 20 or 30 cc)

39. mix-up between look-alike vials HYPAQUE ionic HYPAQUE (diatrozoate meglumine) OMNIPAQUE nonionic OMNIPAQUE 300 (iohexol) Each type of contrast media should be stored separately, based on its use.

40. SPECIAL PROCEDURS CONTRAST MEDIA SIALOGRAPHY – injected into Salivary Ducts IODINE – – WATER (ionic or nonionic) – OR OIL BASED – SINOGRAPHIN (OIL) – RENOVUE (WATER)

41. PATIENT PREP COVERED WITH EACH EXAM

42. REVIEW SPECIAL PROCEDURS CONTRAST MEDIA ONLY Water ONLY Water sol. Arthrograms Myelograms Angio/Arterio grams Cardiac Cath Venograms Water or OIL Hysterosalpingogram Sialogram Lymphangiograms Lasts longer – may cause FAT EMBOLI

43. REVIEW (Bontrager Slides)