Lesson 1
Anatomy and Procedures of the Urinary System
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Urinary System
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Slide 2

Anatomy: Urinary System

Includes
 Two kidneys
 Two ureters
 One urinary bladder
 One urethra

Often called the excretory system
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Slide 3

Anatomy: Kidneys

Bean-shaped bodies
 Convex lateral borders
 Concave medial borders


Divided into upper and lower poles
Measure about 4.5

(11.5 cm) long, 2
 to 3

(5 to 7.6 cm) wide, and 1.25

(3 cm) thick
 Left kidney slightly longer and narrower
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Slide 4

Anatomy: Kidneys

Located retroperitoneal in contact with posterior abdominal wall

Superior aspect more posterior than inferior

Lie in oblique plane about 30 degrees anteriorly toward the aorta

Extend from about T12 to L3
 Right kidney slightly lower than left
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Slide 5

Anatomy: Kidneys





Renal capsule = outer covering
Renal cortex = outer layer of renal tissue
Renal medulla = inner layer of renal tissue
 Composed of 8 to 15 cone-shaped segments of collecting tubules = renal pyramids
Renal columns = extensions of cortex between renal pyramids
Nephron = essential microscopic component of kidney
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Slide 6

Anatomy: Kidneys
Midcoronal section of kidney
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Slide 7

Anatomy: Nephron

Each contains about one million nephrons

Nephron consists of
 Renal corpuscle
 Renal tubule

Renal corpuscle consists of
 Glomerular capsule (Bowman’s capsule)
 Glomerulus
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Slide 8

Anatomy: Nephron

Glomerulus formed by tiny branch of renal artery entering capsule and dividing into capillaries

Capillaries unite to form a single vessel leaving capsule

Afferent arteriole = vessel entering capsule

Efferent arteriole = vessel exiting capsule
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Slide 9

Anatomy: Nephron



Glomerulus is a filter for blood, allowing fine particles and water to pass into the capsule
Renal tubule is continuous with capsule



Proximal convoluted tubule
Nephron loop (loop of Henle)
Distal convoluted tubule
Distal convoluted tubule opens into the collecting ducts
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Slide 10

Anatomy: Nephron
Diagram of nephron and collecting duct
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Slide 11

Anatomy: Kidneys

Collecting ducts converge to form a central tubule within the pyramid
 Opens at renal papilla
 Drains into minor calyx

Calyces = cup-shaped stems that enclose one or more papilla
 Usually fewer calyces than pyramids

Minor calyces unite to form major calyces
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Slide 12

Anatomy: Kidneys

Major calyces unite to form renal pelvis

Renal pelvis lies within hilum

Hilum = longitudinal slit in medial border for transmission of blood vessels, nerves, lymphatic vessels, and ureter

Renal pelvis is continuous with ureter
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Slide 13

Anatomy:
Midcoronal section of kidney
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Slide 14

Anatomy: Ureter

10
 to 12

(25 to 30 cm) long

Enters posterolateral surface of bladder

Conveys urine from renal pelvis to bladder via peristaltic contractions
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Slide 15

Anatomy: Urinary Bladder

Musculomembranous sac

Serves as a reservoir for urine

Located immediately posterior and superior to pubic symphysis
 Anterior to rectum in males
 Anterior to vaginal canal in females

Apex is anterosuperior aspect

Neck is lowest part
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Slide 16

Anatomy: Urinary Bladder

Trigone = triangular area of bladder base between three openings
 Two for ureters
 One internal urethral orifice
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Slide 17

Anatomy: Urinary Bladder
Anterior view
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Slide 18

Anatomy: Urethra



Conveys urine out of the body
About 1.5

(3.8 cm) long in females
About 7
 to 8

(17.8 to 20 cm) long in males
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Slide 19

Anatomy: Prostate

Small glandular body surrounding the proximal part of the male urethra


Considered part of the male reproductive system, but due to location, is often described with the urinary system
Measures about 1.5

(3.8 cm) transversely,
¾ 
(1.9 cm) at its base, and 1

(2.5 cm) vertically
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Slide 20

Overview

Contrast studies

Contrast media

Adverse reactions to contrast media

Preparation of intestinal tract

Patient preparation

Equipment
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Slide 21

Contrast Studies

To demonstrate the renal parenchyma, contrast media is needed, followed by imaging by either x-ray or CT

Two filling techniques
 Antegrade
 Retrograde
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Slide 22

Contrast Media

Lower concentrations required for bladder studies due to large amount required to fill bladder

Higher concentrations used for excretory urography

Nonionic media less likely to cause an adverse reaction
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Slide 23


Usually mild and of short duration
 Severe reactions can occur, but are rare

Characteristic reactions
 Feeling of warmth
 Flushing
 A few hives, sometimes
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Slide 24





Occasional reactions
 Nausea
 Vomiting
 Edema of respiratory mucous membranes
Check clinical history carefully
Observe patient closely after contrast administration
Emergency equipment and medication must be readily available
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Slide 25

Preparation of Intestinal Tract

Clear demonstration of urinary system requires intestinal tract to be free of gas and fecal material

Bowel prep is not attempted in infants and children

Adult prep is dependent on patient condition
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Slide 26

Patient Preparation

When time permits, low-residue diet for
1 to 2 days before examination


Light evening meal on day before examination
Non –gas-forming laxative, when indicated, the day before the examination

Nothing by mouth after midnight the day of the examination
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Slide 27

Patient Preparation



Patient should be well hydrated
Hydration particularly important for patients with
 Diabetes
 Multiple myeloma
 High uric acid levels
These conditions put patient at increased risk for contrast medium-induced renal failure if dehydrated
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Slide 28

Patient Preparation

For retrograde urography, patient should drink 4 to 5 cups of water several hours before examination

No prep usually required for examinations of the lower urinary tract
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Slide 29

Equipment

Standard radiographic room sufficient for excretory urography and most retrograde studies of the bladder and urethra

Combination cystoscopic-radiographic unit needed for retrograde urographic procedures that require cystography

Tomography unit required for infusion nephrourography
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Slide 30

Equipment

Time-interval and body position markers should also be used

Sufficient number of proper size IRs

Emergency cart
 Check to make sure stocked
 Know location

Venipuncture supplies
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Slide 31

Procedure

Image quality

Motion control

Ureteral compression

Respiration

Preliminary examination

Radiation protection
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Slide 32

Image Quality

Contrast and density is the same as for abdominal radiographs

Soft tissues that must be defined
 Kidneys
 Lower border of liver
 Lateral margin of psoas muscles

Bone detail varies according to thickness of abdomen
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Slide 33

Motion Control

Immobilization not recommended due to interference with fluid flow through ureters and distortion of canals

Motion control dependent on
 Exposure time
 Patient cooperation

Important to inform patient of sensations caused by contrast injection
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Slide 34

Ureteral Compression

In excretory urography, compression is sometimes applied over the distal ends of the ureters

Purpose is to retard the flow of opacified urine into the bladder to ensure filling of renal pelves and calyces

Compression centered over level of ASIS
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Slide 35

Ureteral Compression


Apply and remove slowly to reduce patient discomfort caused by changes in intraabdominal pressure
Contraindicated in patients with
 Urinary stones





Abdominal mass
Aortic aneurysm
Colostomy
Suprapubic catheter
Traumatic injury
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Slide 36

Respiration

Exposures should be made at the end of expiration, unless otherwise requested

Due to kidney excursion during respiration, it is possible to differentiate kidneys from other shadows by making exposure on different phase of respiration

Image should be marked if exposed on phase of respiration other than expiration
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Slide 37

Preliminary Examination

Abdominal images made before specialized urinary tract studies

Examination used to reveal extrarenal lesions that could cause symptoms, making urinary studies unnecessary

Scout AP radiograph, supine position, demonstrates location of kidneys, their contour, and opaque calculi, if present
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Slide 38

Preliminary Examination

Scout image also serves to check GI tract preparation and exposure factors
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Slide 39

Radiation Protection

Radiographer is responsible for observing guidelines for radiation protection

Gonadal shield used if it does not interfere with examination objective

Close collimation should be used

Avoid repeat exposures

Shield males for all urinary studies, except when urethra is of primary interest
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Slide 40

Radiation Protection

Shield females when IR centered over kidneys

Rule out chance of pregnancy before examination
 Emergency cases may not allow time
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Slide 41

Urinary System Procedures
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Slide 42

Urinary System Procedures

Intravenous urography (IVU)

Nephrotomography

Nephrourography

Retrograde urography

Cystography

Cystourethrography
 Male
 Female
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Slide 43

Intravenous Urography

Also called excretory urography

Demonstrates structure and function of kidneys
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Slide 44

Intravenous Urography

Indications for IVU
 Evaluation of abdominal masses, renal cysts, and tumors
 Urolithiasis = stones of the urinary tract or kidneys
 Pyelonephritis = infection of the upper urinary tract
 Hydronephrosis = abnormal dilation of pelvicaliceal system
 Evaluation of trauma effects
 Preoperative evaluation of function, location, size, and shape of kidneys and ureters
 Renal hypertension
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Slide 45

Intravenous Urography

Contraindications relate to
 Ability of kidneys to filter contrast medium from the blood
 Patient’s allergic history

Some contraindications can be overcome by use of nonionic contrast

High-risk patients may be evaluated with other modalities
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Slide 46

Intravenous Urography

Some contraindications can be overcome by use of nonionic contrast

Risk factors include
 Asthma
 Previous contrast reaction
 Circulatory or cardiovascular disease
 Elevated creatinine level
 Sickle cell disease
 Diabetes mellitus
 Multiple myeloma
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Slide 47

Intravenous Urography

Before procedure, patient must empty bladder, remove clothing, and put on a gown

Review blood chemistry
 Normal creatinine = 0.6 to 1.5 mg/100 mL
 Normal BUN = 8 to 25 mg/100 mL
 Elevated levels indicative of renal dysfunction

Make scout radiograph
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Slide 48

Intravenous Urography



Perform venipuncture
Administer 30 to 100 mL of contrast for adult patient of average size
 Dosage for infants and children is adjusted according to age and weight
Produce radiographs at specified time intervals
 Procedure varies according to department protocol
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Slide 49

Intravenous Urography



Most common radiographs for IVU examinations are AP projections at time intervals ranging from 3 to 20 minutes
AP oblique projections in 30-degree posterior oblique positions often taken at 5- to 10minute intervals
Unless bladder or voiding urethrograms are to be made, the patient is sent to lavatory to void
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Slide 50

Intravenous Urography

Postvoid radiograph of bladder may be taken
 Used to check for small tumor masses or enlarged prostate in male patients

After the procedure, patient is instructed to drink extra fluids to aid in flushing contrast
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Slide 51

AP Urinary System

Patient position
 Supine
 Support at knees to reduce back strain
 Upright position used to demonstrate opacified bladder and kidney mobility
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Slide 52

AP Urinary System


Part position
 MSP aligned to midline of grid device
 Move arms out of field
 Center IR to level of iliac crests
 Two IRs may be required to demonstrate all anatomy on tall patients
CR
 Perpendicular to center of IR at level of iliac crests
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Slide 53

AP Oblique Urinary System

Patient position
 Supine
 Support elevated side
 Kidney closer to IR will be perpendicular to plane of IR
 Kidney farther from IR will be parallel with IR
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Slide 54

AP Oblique Urinary System

Part position
 Rotated so that MCP forms 30-degree angle from
IR
 Shoulders and hips in same plane
 MSP aligned to midline of grid device
 Move arms out of field
 Center IR to level of iliac crests
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Slide 55

AP Oblique Urinary System

CR


Perpendicular to center of IR
Enters about 2

(5 cm) lateral to midline on elevated side at level of iliac crests
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Slide 56

Lateral Urinary System

Patient position
 Lateral recumbent on right or left side

Part position
 Knees flexed for patient comfort
 MCP centered to midline
 Flex elbows and place hands under head
 Center IR to level of iliac crests
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Slide 57

Lateral Urinary System

CR
 Perpendicular to IR
 Enters MCP at level of iliac crests
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Slide 58


Patient position
 Supine, without rotation
 Right or left side in contact with grid device
 Arms above head or across upper chest

Part position
 Adjust height of vertical grid device so that long axis of IR is centered to MCP
 Place level of iliac crests in center of IR
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Slide 59


CR
 Horizontal and perpendicular to center of IR
 Enters patient at MCP at level of iliac crests
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Slide 60


Tomography performed immediately after contrast administration

Demonstrates renal parenchyma (nephrons and collecting tubes)

Indications
 Renal hypertension
 Renal cysts and tumors
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Slide 61


Contraindications
 Renal failure
 Contrast media allergy
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Slide 62

Retrograde Urography





Requires catheterization of ureters
Contrast injected directly into pelvicaliceal system
Provides improved opacification of renal collecting system
Little physiologic information provided
Indicated for evaluation of collecting system in patients with renal insufficiency or contrast sensitivity
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Slide 63

Retrograde Urography

Classified as an operative procedure

Carried out under aseptic conditions
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Slide 64

Cystography

Radiologic examination of the urinary bladder

Usually performed via retrograde contrast administration
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Slide 65

Cystography

Indicated for
 Vesicoureteral reflux
 Recurrent lower urinary tract infection
 Neurogenic bladder
 Bladder trauma
 Lower urinary tract fistulae
 Urethral stricture
 Posterior urethral valves
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Slide 66

Cystography

Contraindications related to catheterization of urethra
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Slide 67

AP Axial Bladder

Patient position
 Supine
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Slide 68

AP Axial Bladder

Part position
 MSP centered to midline
 Shoulders and hips in same plane and equidistant to IR
 Arms moved out of anatomy of interest


Legs extended
Center IR 2

(5 cm) above upper border of pubic symphysis
•
At level of symphysis for voiding studies
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Slide 69

AP Axial Bladder

CR


Angled 10 to 15 degrees caudad to center of IR
Enters 2

(5 cm) above upper border of pubic symphysis
 CR angle depends on lumbar lordosis (greater = less angle)
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Slide 70

PA Axial Bladder

Patient position
 Prone

Patient position
 MSP centered to midline
 Shoulders and hips in same plane and equidistant to IR
 Arms out of anatomy of interest
 IR centered to CR
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Slide 71

PA Axial Bladder

CR


Angled 10 to 15 degrees cephalad
Enters about 1

(2.5 cm) distal to coccyx
 Exits just above superior border of pubic symphysis
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Slide 72

AP Oblique Bladder

Patient position
 40- to 60-degree posterior oblique position
 RPO or LPO depends on physician preference
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Slide 73

AP Oblique Bladder

Part position
 Align pubic arch closer to IR to midline


Extend and abduct thigh of elevated side to prevent superimposition on bladder
Center IR 2

(5 cm) above upper border of pubic symphysis and about 2

(5 cm) medial to upper
ASIS
•
Level of pubic symphysis for voiding studies
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Slide 74

AP Oblique Bladder

CR


Perpendicular to center of IR
CR will fall 2

(5 cm) above the upper border of pubic symphysis and 2

(5 cm) medial to upper
ASIS
 If bladder neck and proximal urethra is of interest,
10-degree caudal angle of CR will project pubic bones below them
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Slide 75

Lateral Bladder

Patient position
 Lateral recumbent, right or left side

Part position
 Knees flexed for comfort
 MCP aligned to midline


Flex elbows and place hands under head
Center IR 2

(5 cm) above upper border of pubic symphysis at MCP
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Slide 76

Lateral Bladder

CR


Perpendicular to IR
Enters patient on MCP at level 2

(5 cm) above upper border of pubic symphysis
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Slide 77

Male Cystourethrography

May be performed via endoscopic examination

Essential projection = AP oblique
 Demonstrates bladder neck and urethra with as little bony superimposition as possible

Patient position = recumbent 35- to 40degree posterior oblique

IR centered to superior border of pubic symphysis
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Slide 78

Male Cystourethrography

Elevated pubis centered to midline

Image should demonstrate superimposed pubic and ischial rami of down side and body of elevated pubis anterior to bladder neck, proximal urethra, and prostate
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Slide 79

Image Critique
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Slide 80

Essential Projections
Urinary System
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Slide 81

AP and PA Projections





Entire renal outlines
Bladder and pubic symphysis
 Separate radiograph may be needed
No motion
Short scale radiographic contrast to demonstrate contrast medium in renal area, ureters, and bladder
Compression devices, if used, centered over upper sacrum
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Slide 82

AP and PA Projections

Vertebral column centered

No artifacts from elastic in clothing

Prostatic region inferior to the pubic symphysis on older male patients

Time marker

PA projection demonstrating lower kidneys and entire ureters (bladder included if patient size permits)
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Slide 83

AP and PA Projections

Superimposing intestinal gas in the AP projection moved for the PA projection
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Slide 84

Projection? Anatomy?
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Slide 85

AP Bladder

Bladder

No rotation of pelvis

Prostate area in male patients

Postvoid radiographs clearly labeled and demonstrating only residual contrast medium
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Slide 86

Projection? Anatomy?
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Slide 87

AP Oblique Projections

Patient rotated about 30 degrees

No superimposition of kidney remote from IR on vertebrae


Entire down-side kidney
Bladder and lower ureters on 35× 43-cm IRs if patient’s size permits

Time marker
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Slide 88

Projection? Anatomy?
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Slide 89

Lateral Urinary System

Entire urinary system

Bladder and pubic symphysis

Short scale contrast clearly demonstrates contrast medium in renal area, ureters, and bladder

No rotation
 Check pelvis and lumbar vertebrae

Time marker
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Slide 90

Projection? Anatomy?
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Slide 91


Entire urinary system

Bladder and pubic symphysis

Short scale contrast clearly demonstrates contrast medium in renal area, ureters, and bladder
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Slide 92


No rotation
 Check pelvis and lumbar vertebrae

Time marker

Patient elevated so that entire abdomen is visible
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Slide 93

Projection? Anatomy?
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Slide 94

AP Axial Bladder

Region of distal end of ureters, bladder, and proximal portion of the urethra

Pubic bones projected below the bladder neck and proximal urethra

Short scale of contrast clearly demonstrating contrast medium in bladder, distal ureters, and proximal urethra
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Slide 95

Projection? Anatomy?
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Slide 96

AP Oblique Bladder




Region of distal end of ureters, bladder, and proximal portion of the urethra
Pubic bones projected below the bladder neck and proximal urethra
Short scale of contrast clearly demonstrating contrast medium in bladder, distal ureters, and proximal urethra
No superimposition of bladder by uppermost thigh
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Slide 97

AP Oblique Bladder

For voiding studies
 Entire contrast-filled urethra visible
 Urethra overlapping thigh on oblique projections for improved visibility
 Urethra lying posterior to superimposed pubic and ischial rami on the side down in oblique projections
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Slide 98

Projection? Anatomy?
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Slide 99

Lateral Bladder
• Region of distal end of ureters, bladder, and proximal portion of the urethra
• Pubic bones projected below the bladder neck and proximal urethra
• Short scale of contrast clearly demonstrating contrast medium in bladder, distal ureters, and proximal urethra
• Bladder and distal ureters visible through pelvis
• Superimposed hips and femur
Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 100

Projection? Anatomy?
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Slide 101

Lesson 3
Venipuncture and Contrast
Administration
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Slide 102



Radiographers must know the professional recommendations, state regulations, and facility policies for administration of medications
ASRT Standards of Practice for Radiography support administration of medication by technologists
 State laws and facility policy determine legality
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Slide 103

Medications


Imperative for radiographer to be knowledgeable of all medications administered in the department, including
 Name
 Dosages
 Indications
 Contraindications
 Adverse reactions
See Table 18-1 in Merrill’s Atlas
Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 104

Patient Education



Important to explain
 Procedural steps
 Expected duration
 Limitations and restrictions associated with procedure performance
Anxiety can cause vasoconstriction making venipuncture more painful
Information can ease patient’s fear and reduce discomfort of procedure
Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 105

Patient Education

Provide honest, factual, and appropriate information

Be honest about pain that might be felt and note that pain experience is different for each patient
Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 106

Patient Assessment

Must occur before the contrast is administered

Assess and document
 History of allergies
 Current medications
 Surgical procedures
 Past and current disease processes
 Lab values for BUN and creatinine
Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 107

Patient Assessment

History of allergies
 Include food and medication allergies
 Used to determine potential for adverse reaction to contrast

Current medications
 Some medications for diabetes interact adversely with contrast
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Slide 108

Patient Assessment

Surgical procedures
 Used to determine site for venipuncture

Past and current disease processes
 Used to determine appropriate amount of contrast

Lab values for BUN and creatinine
 Indicators of normal kidney function
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Slide 109

Infection Control

Venipuncture may cause infection if performed incorrectly

Strict aseptic techniques and universal precautions must be used

IV filters can reduce the risk of infection
 Reduces rate of injection, too
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Slide 110


Supplies

Needles

Syringes

Medication preparation
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Slide 111


Tourniquet

Tape

Gauze pads

Skin prep
Supplies
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Slide 112

Needles

All are single-use only, disposed of properly after one use

Parts
 Hub = attaches to syringe
 Cannula or shaft = length of needle
 Bevel = slanted portion at tip
Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 113

Needles

Gauge = diameter of needle bore

Types
 Hypodermic
 Butterfly sets
 Angiocatheters
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Slide 114

Needles

Butterfly sets and angiocatheters usually used by radiographers for IV administration

Needle type depends on
 Patient assessment
 Institutional policy
 Technologist’s preference
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Slide 115

Syringes


Types
 Plastic = disposable, single-use
 Glass = must be sterilized between uses
Parts
 Tip = where needle attaches
 Barrel = has calibration markings and holds medication
 Plunger = fits snugly inside barrel and allows user to instill medication
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Slide 116

Syringes

Syringe size should be one size larger than volume to be injected
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Slide 117

Medication Preparation




IV administration cannot be retrieved and medication effects are almost instant
For this reason, safety precautions must be followed
Verify patient identity
Verify correct medication three times
 Before preparation
 During preparation
 Before administration
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Slide 118

Medication Preparation



Containers
 Single-dose vials do not require prep before withdrawal
 Multiple-dose vials must be cleaned before drawing into syringe
Needle inserted into rubber stopper to hub
Air equal to amount of contrast needed injected into vial above fluid level
 Reduces air bubbles in contrast
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Slide 119

Medication Preparation

After air is injected, pull needle back to below fluid level

Pull back on plunger until needed amount of fluid is aspirated into barrel

Lightly tap on syringe barrel to remove air bubbles
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Slide 120

Medication Preparation

Infusions may be prepped from
 Glass bottle
 Plastic bag

Glass requires vented tubing

Plastic requires nonvented tubing
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Slide 121


Site selection

Site preparation

Venipuncture

Administration
Procedure
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Slide 122

Site Selection

Prime factors to consider
 Suitability of location
 Condition of vein
 Purpose of infusion
 Duration of therapy
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Slide 123

Site Selection


Veins most often most often used for IV injection in radiography located
 Anterior forearm
 Posterior hand
 Radial aspect of wrist
 Antecubital space of elbow
General rule: Select most distal site that can accept the needle size and can tolerate injection rate and solution
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Slide 124

Site Selection
Veins easily accessed for venipuncture
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Slide 125

Site Preparation

Skin must be prepared and cleaned

If hair is present, shaving is not recommended
 Clip hair for better visualization of vein

Antiseptic used for cleaning should be in contact with skin for at least 30 seconds
 Iodine tincture 1% to 2%
 Isopropyl alcohol 70%
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Slide 126

Site Preparation

Skin cleaned in circular motion from center of injection site to about a 2
 circle

Once cleaning swab is placed on skin it should not be lifted off until cleaning is complete

Local anesthetic may be used before IV access
 Administered topical or by injection
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Slide 127

Venipuncture



Two methods
Direct or one-step entry
 Indirect method
1)
2)
3)
Steps
Radiographer puts on gloves and cleans skin
Local administered (optional)
Tourniquet applied 6
 to 8
 above puncture site
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Slide 128

Venipuncture

4)
5)
6)
7)
Steps – cont’d
Hold limb with nondominant hand and anchor vein with thumb
Using dominant hand, position needle bevel side up at 45-degree angle to skin surface
Enter skin with quick, sharp, darting motion and decrease angle to 15 degrees after entering vein
Release tourniquet
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Slide 129

Venipuncture

8)
9)
Steps – cont’d
10)
11)
Look for blood return
If no blood return, pull back on plunger slowly to aspirate blood and verify placement in vein
Anchor needle with tape
Administer medication
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Slide 130

Administration

Must occur at established rate

During injection, site should be observed and palpated proximal to puncture site for signs of infiltration

Infiltration or extravasation means fluid has entered tissues instead of vein

After contrast administration, remove tape or dressing
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Slide 131

Administration

Hold gauze pad over injection site and remove needle by pulling straight from vein

Apply pressure to site with gauze

Discard gloves, needles, and gauze in appropriate manner
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Slide 132

Administration

If patient has established IV site, check compatibility before using for contrast administration

To administer contrast in existing IV line, stop infusion of medication

Flush IV line with saline before and after contrast administration

Restart infusion
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Slide 133

Reactions and Complications

Categorized as
 Mild
 Moderate
 Severe

Mild reactions include
 Sensation of warmth
 Metallic taste
 Sneezing
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Slide 134

Reactions and Complications

Moderate reactions include
 Nausea
 Vomiting
 Itching

Severe reactions, or anaphylactic reactions, can cause cardiac or respiratory crisis
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Slide 135

Reactions and Complications

Infiltration is a complication and its symptoms include
 Swelling
 Redness
 Burning
 Pain

Treatment
 Application of ice within 30 minutes of occurrence
 Application of warmth if more than 30 minutes since occurrence
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Slide 136

Documentation

Adhere to and document the five “rights” of medication administration
 Right patient
 Right medication
 Right route
 Right amount
 Right time
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Slide 137

Conclusions

Medications are intended to benefit patient with minimum harm

Because medications carry inherent risk, proper administration is critical

Radiographers must be knowledgeable and competent, and practice within their local scope of practice
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Slide 138