BALLARAT HEALTH SERVICES
BASE HOSPITAL
Radiology Department Information
Procedures and Preparations
This document is intended as a resource for nursing and medical staff. It describes preprocedure requirements and post procedure care. Please note that indications are a guideline
only and although it lists most of the procedures performed in the department it is not an
exclusive list.
For any other procedures or enquires please contact the department for further
information.
Reviewed JANUARY 2010
Table of Contents
About The Radiology Department ............................................................. 5
Hours of Service ..........................................................................
Radiology Department Contact Details ......................................................
Services Provided .........................................................................
Booking Requirements ......................................................................
Availability of Results ...................................................................
Contrast Media ............................................................................
5
5
5
5
5
6
Contrast Media Protocols ................................................................... 6
Acute Renal failure Secondary to Contrast Media Nephrotoxicity ............................
Extravasation of Contrast Protocol ........................................................
Metformin and Contrast Media Protocol .....................................................
Premedication of patients with previous known Allergy to non-ionic Contrast Media .........
6
6
6
6
Interventional Procedures and anti-coagulation ............................................. 6
CT Scanning ................................................................................ 7
CT Abdomen and Pelvis ..................................................................... 7
CT Chest Abdomen and Pelvis ............................................................... 7
CT IV Cholangiogram ....................................................................... 7
CT Upper Abdomen .......................................................................... 8
CT Renal - Abdomen for Renal Stones ....................................................... 8
CT Brain (Routine) ........................................................................ 8
CT Brain (6 Years and Under) .............................................................. 8
CT Facial Bones .......................................................................... 10
CT Internal Auditory Meati ............................................................... 10
CT Orbits ................................................................................ 10
CT Pituitary Fossa ....................................................................... 10
CT Sinuses ............................................................................... 10
CT Larynx ................................................................................ 11
CT Neck - Soft Tissue .................................................................... 11
CT Chest (Routine) ....................................................................... 11
CT Chest - High Resolution ............................................................... 11
CT Pelvis - Bony ......................................................................... 12
CT Pelvis - Soft Tissue .................................................................. 12
CT Pelvimetry ............................................................................ 12
CT - Cervical, Thoracic or Lumbar (Non Contrast) ......................................... 12
CT - Cervical, Thoracic or Lumbar with Myelography ....................................... 12
Discogram ................................................................................ 13
Facet Joint Injection .................................................................... 13
Limited Epidural Injections .............................................................. 13
CT Shoulder .............................................................................. 13
CT of Bony Extremities ................................................................... 14
CT Angiography ........................................................................... 14
CT Guided Biopsy ......................................................................... 14
CT Guided Drainage ....................................................................... 14
CT COLONOSCOPY ........................................................................... 15
CT CORONARY ANGIOGRAM .................................................................... 15
Radiological Procedures ................................................................... 16
IVC (Intravenous Cholangiogram) .......................................................... 16
Percutaneous Biliary Drainage and Stenting ............................................... 16
Page 2 of 53
2
Sialogram ................................................................................
Pericardial Tap ..........................................................................
US Guided Thoracentesis - Pleural Tap ....................................................
Liver Biopsy – Ultrasound Guided ........................................................
US Guided Ascites Tap - Abdominal Paracentesis ...........................................
US Guided Breast Cyst Aspiration or Lesion Biopsy ........................................
US Guided Breast Hook Wire Localisation .................................................
US Guided Thyroid Cyst Aspiration or Lesion Biopsy .......................................
IVP (Intravenous Pyelogram) ..............................................................
Micturating Cysto Urethrogram (MCU) ......................................................
Nephrostogram ............................................................................
Percutaneous Nephrostomy .................................................................
Ultrasound Hysteroinflation. .............................................................
HSG (Hystero-Salpingogram) ...............................................................
Lumbar Puncture – Fluoroscopic Guidance .................................................
Medial Branch Nerve Ablation .............................................................
Myelogram - Cervical, Thoracic, Lumbar ...................................................
Nerve Root Injection .....................................................................
Neural Ablation ..........................................................................
Vertebroplasty ...........................................................................
Hip Injection ............................................................................
Arthrogram ...............................................................................
Armport Insertion ........................................................................
Angiography - DSA ........................................................................
IVC (Inferior Vena Cava) Filter ..........................................................
Leg Segmental Pressure Studies ...........................................................
Permacath Insertion ......................................................................
Permacath Check with/without Urokinase Lock ..............................................
Peripheral Angioplasty or Stenting .......................................................
PICC (Peripherally Inserted Central venous Catheter) Line Insertion ......................
ERCP-Endoscopic retrograde cholangiopancreatography ......................................
Percutaneous Biliary Drainage and Stenting ...............................................
Pericardial Tap ..........................................................................
Sialogram ................................................................................
Sinugram .................................................................................
16
17
17
17
18
18
18
19
19
19
19
21
21
21
21
22
22
24
24
24
25
25
25
25
26
26
26
27
27
27
28
28
28
29
29
Fluoroscopic procedures ................................................................... 30
Barium Enema (air or double contrast) ....................................................
Barium Follow Thorough ...................................................................
Barium Meal ..............................................................................
Naso-Jejunal Tube Insertion ..............................................................
Barium Swallow ...........................................................................
Video Fluoroscopy ........................................................................
30
30
30
30
30
31
Ultrasound Scanning ....................................................................... 32
Neonate Abdominal Ultrasound .............................................................
Upper Abdominal Ultrasound ...............................................................
Upper Abdomen and Pelvic Ultrasounds .....................................................
Bladder Ultrasound - Pre and Post Micturition ............................................
Prostatic Coil / Memokath Ultrasound .....................................................
Renal Ultrasound .........................................................................
Pelvic Ultrasound ........................................................................
Pelvic TV (Trans-vaginal) Ultrasound .....................................................
32
32
32
32
33
33
33
33
Transvaginal Ultrasound Information ....................................................... 34
Obstetric Ultrasound – less than 15 weeks gestation. .................................... 34
Obstetric Ultrasound - after 15 weeks gestation. ......................................... 35
Obstetric Ultrasound – 12 week / Nuchal Translucency ................................... 35
Page 3 of 53
3
Ultrasound of Small Parts ................................................................
Arterial Leg Doppler .....................................................................
A/V Fistulogram ..........................................................................
Aorta or IVC (Inferior Vena Cava) Ultrasound .............................................
Doppler Abdomen ..........................................................................
Doppler Renal ............................................................................
DVT Ultrasound - Leg Veins Doppler .......................................................
Echocardiogram ...........................................................................
Varicose Veins Ultrasound - Doppler ......................................................
Liver Biopsy – Ultrasound Guided ........................................................
US Guided Ascitic Tap - Abdominal Paracentesis ...........................................
US Guided Breast Cyst Aspiration or Lesion Biopsy ........................................
US Guided Breast Cyst Aspiration or Lesion Biopsy ........................................
US Guided Breast Hook Wire Localisation .................................................
US Guided Thoracentesis - Pleural Tap ....................................................
US Guided Thyroid Cyst Aspiration or Lesion Biopsy .......................................
35
36
36
36
37
37
37
37
38
38
38
39
39
39
39
40
MRI Scanning .............................................................................. 40
You must have a specialist provider number to order these scans. .......................... 40
What is MRI ..............................................................................
Preparing for the Test ...................................................................
Information on and Preparation for Sedation ..............................................
What Happens During the Scan .............................................................
After the Test ...........................................................................
40
40
41
41
42
Mammography ............................................................................... 43
Needle localisation of Breast Lesion ..................................................... 43
Restricted Medication ..................................................................... 44
Appendix (Contrast Protocols Ballarat Health
Services)………………………………………………….46-54
Page 4 of 53
4
About The Radiology Department
Hours of Service
Monday to Friday (excluding Public Holidays)
Saturday, Sunday and Public holidays
- 8am to 6pm
- 9am to 12noon
A twenty-four hour EMERGENCY Radiology service is available. Patients must attend via the
Emergency Department for their safety and to coordinate with the hospital’s needs. After 6pm
weekdays or after 12noon on weekends and public holidays all services must be arranged via the
Emergency Department. To arrange this service contact the Emergency Department on 03 5320
4000.
An emergency service only is available on Christmas Day.
Radiology Department Contact Details
Our direct numbers are:
Our Fax number is:
Our e-mail address is:
03 5320 4270 or 5320 4271.
03 5340 4830
radiology@bhs.org.au
Services Provided
Angiography
Ultrasound
CT
MRI
Fluoroscopy
OPG
and General X-ray.
Booking Requirements
All CT scans, Ultrasounds or procedures requiring preparation or contrast require an
appointment. Contact the department on 03 5320 4270 or 5320 4271 or the patient may book in
person at the department.
All general x-rays do not require an appointment and can be undertaken any time during the
office hours above. In-patients require an appointment time for the orderlies to collect them
from the ward area.
Children may require special preparation for procedures not listed in this book, please contact
the department for this information.
Please ensure that the department is made aware of any patient who has diabetes and is required
to fast for a procedure. Meals and administering of insulin can be arranged. If the patient
is on Metformin please read the section on Contrast Media.
Any further information or specific enquires please contact the department.
Availability of Results
We endeavour to have results available within 24-48 hours of the examination. Results should
be available on the hospital computer system prior to this. An ‘Unverified result’ means
that the radiologists have not yet validated the report.
Page 5 of 53
5
Urgent results are available via phone or fax. Please state clearly on the request form if
urgent notification of results is required. Images and results are available electronically
via the BHS intranet.
Contrast Media
All intra-vascular contrast media used is iodine based. If your patient has a previous known
reaction, please contact the department to discuss appropriate pre-medication to ensure that
the procedure is completed safely and without delay.
If your patient is on Metformin please ensure a recent renal function test is available.
Metformin is excreted via the same pathway as contrast media and it is recommended that
Metformin is ceased for 48 hours following contrast media injection.
Preparation, prior to contrast media injection, may be required for patients with abnormal
renal function.
If your patient has a Estimated Glomerular Filtration Rate below 50mls/hr please follow the
Radiology Department protocol for abnormal renal function or contact the department for further
information. Iodinated contrast media is nephrotoxic and excreted unchanged via the kidneys.
Contrast Media Protocols
(see appendix)
Acute Renal failure Secondary to Contrast Media Nephrotoxicity p.46
Extravasation of Contrast Protocol p.52
Metformin and Contrast Media Protocol p.48
Premedication of patients with previous known Allergy to non-ionic Contrast Media p.50
Interventional Procedures and anti-coagulation
Some interventional procedures require clotting times to be done prior to the procedure.
Ceasing anticoagulants prior to an interventional procedure should only be
done at the discretion of the treating medical officer.
General Guidelines: Please contact the department with any queries.
Warfarin should be ceased 4-5 days prior to procedure. Depending on indication for warfarin,
patients may or may not need to be heparinised. IV Heparin should then be ceased 4 hours prior
to the procedure.
Therapeutic doses of Clexane should be ceased 24 hours prior to a procedure.
Sub-therapeutic doses of clexane should be ceased 12 hours prior to a procedure.
Clopidogril should be ceased 10 days prior to a procedure in most patients depending on
indication.
Aspirin should be withheld on the day of the procedure
Page 6 of 53
6
CT Scanning
Multi-slice 3 dimensional scanning is performed at Ballarat Health services. This allows for
the isotropic reconstruction of the images in coronal, sagittal and the standard axial planes.
This allows for more accurate interpretation of the CT images.
Bookings are required for CT Studies, though exceptions are made for urgent requests.
CT Abdomen and Pelvis
Possible indications include:
Trauma, abdominal pain, appendicitis, tumour evolution/oncology.
Preparation:
Routine 4 hour fast.
1 hour prior to examination the patient must start drinking the dilute
Gastrografin or barium preparation. The drinking of the contrast fluid is
undertaken in the department to ensure that an appropriate quantity is taken over
an appropriate period of time.
The patient is then asked to change and given the opportunity to go to the toilet
prior to the procedure.
Post procedure care:
If IV contrast is given encourage oral fluids.
CT Chest Abdomen and Pelvis
Possible indications include:
Trauma, appendicitis/generalised abdominal pain, lymphoma, lymph node enlargement,
staging mass, hernia evaluation.
Preparation:
Routine 4 hour fast.
1 hour prior to examination the patient must start drinking the dilute gastrografin
or barium preparation. The drinking of the contrast fluid is undertaken in the
department to ensure that an appropriate quantity is taken over an appropriate
period of time.
The patient is then asked to change and given the opportunity to go to the toilet
prior to the procedure.
Post procedure care:
If IV contrast is given encourage oral fluids.
CT IV Cholangiogram
Possible indications include:
Visualisation of the Common Bile Duct, e.g. post cholecystectomy with continuing
pain.
This is undertaken in conjunction with a standard IV Cholangiogram.
Abnormal liver function tests may affect the absorption of the contrast media.
Preparation:
Low residue diet the day prior to the procedure and a laxative in the evening following
the evening meal. Nothing further to eat after this time. Drinking clear fluids is
important, as dehydration is a contraindication to the procedure.
Post procedure care:
Encourage fluids.
Page 7 of 53
7
CT Upper Abdomen
Possible indications include:
Upper abdominal pain, liver lesions.
Preparation:
Routine 4 hour fast.
1 hour prior to examination the patient must start drinking the dilute
Gastrografin or barium preparation. The drinking of the contrast fluid is
undertaken in the department to ensure that an appropriate quantity is taken over
an appropriate period of time. The patient is then asked to change and given the
opportunity to go to the toilet prior to the procedure.
If the patient is having a scan to follow up on a known liver lesion, oral
contrast is not required and the patient attends the department 15 minutes prior
to the examination.
Post procedure care:
If IV contrast is given encourage oral fluids.
CT Renal - Abdomen for Renal Stones
Possible indications include:
Renal colic, haematuria
Preparation:
Full bladder required.
IV and oral contrast are not required.
Post procedure care:
None.
CT Brain (Routine)
Possible indications include:
Trauma, CVA, infarct, hydrocephalus, headaches, seizures, possible pathology.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Brain (Infant or child)
Possible indications include:
Trauma ,possible pathology
Preparation:
Many children need sedation or a general anaesthetic for CT scans. The child will need to
be admitted to the hospital for the day. If required, anaesthetic care will need to be
organised.
FASTING: If the child’s procedure is in the morning they must not eat solid food or drink
milk after 4am and must have nothing else to drink after 6am. For an afternoon procedure,
the child must not eat solid food or drink milk after 9 am and they must not drink anything
after 11am. Between 9am and 11am small amounts of water or juice may be taken.
Breastfeeding must cease 4 hours prior to the scan.
Page 8 of 53
8
A CONSENT FORM is required.
Post procedure care:
As requested by Anaesthetist
Page 9 of 53
9
CT Facial Bones
Possible indications include:
Trauma
Preparation:
Nil required.
Post procedure care:
None.
CT Internal Auditory Meati
Possible indications include:
Vertigo, suspected acoustic neuroma.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Orbits
Possible indications include:
Visual disorders, proptosis, foreign bodies, trauma.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Pituitary Fossa
Possible indications include:
Hormonal disorders, visual disturbances.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Sinuses
Possible indications include:
Chronic sinusitis, polyps, trauma, bone destruction.
Preparation:
Nil required.
Post procedure care:
None.
Page 10 of 53
10
CT Larynx
Possible indications include:
Vocal chord abnormality, as directed by the radiologist.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Neck - Soft Tissue
Possible indications include:
Palpable neck mass.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Chest (Routine)
Possible indications include:
Lung Disease.
Preparation:
Routine 4 hour fast.
Post procedure care:
If contrast is given, encourage oral fluids.
CT Chest - Aortic Dissection
Possible indications include:
Dissecting aneurysm.
Preparation:
Routine 4 hour fast if the patient’s condition permits.
Post procedure care:
Encourage fluids if the patient’s condition permits.
CT Chest - High Resolution
Possible indications include:
Diffuse lung disease.
Preparation:
No fast required.
normal.
If the patient takes regular broncho-dilators these should be taken as
Post procedure care:
Page 11 of 53
11
None.
CT Pelvis - Bony
Possible indications include:
Fractured pelvis or hips, pathology
Preparation:
None required.
Post procedure care:
None.
CT Pelvis - Soft Tissue
Possible indications include:
Pelvic pathology
Preparation:
Routine 4 hour fast.
1 and a ½ hours prior to examination the patient must start drinking the dilute gastrografin
or barium preparation. The drinking of the contrast fluid is undertaken in the department
to ensure that an appropriate quantity is taken over an appropriate period of time. The
patient is then asked to change and given the opportunity to go to the toilet prior to the
procedure.
Post procedure care:
If IV contrast is given encourage oral fluids.
CT Pelvimetry
Possible indications include:
Post Partum evaluation.
Preparation:
None required.
Post procedure care:
None.
CT - Cervical, Thoracic or Lumbar (Non Contrast)
Possible indications include:
Trauma, neural deficit, back pain/ sciatica.
Preparation:
None required
Post procedure care:
None.
CT - Cervical, Thoracic or Lumbar with Myelography
Possible indications include:
Page 12 of 53
12
Back pain, disc lesion, canal stenosis, neural loss, previous surgery or previous scan
without contrast where further information may be gained with Myelography.
An MRI scan may be the procedure of first choice.
Preparation:
See Myelography.
Discogram
Possible indications include:
Evaluation of the structure and functional integrity of the nucleus/annulous.
useful in assessing the severity of disc herniation or degeneration.
Especially
Preparation:
Light diet for the meal prior to the examination.
patient home following the procedure.
An escort is required to drive the
Post procedure care:
The patient meeds to rest for 24 hours post procedure, standing as much as possible in the
first 12 hours. Standing aids the reabsorption of the fluids injected into the disc.
Facet Joint Injection
Possible indications include:
To determine if a facet joint is causative in patients’ back or leg pain.
Preparation:
Light diet for the meal prior to the examination.
patient home following the procedure.
An escort is required to drive the
Post procedure care:
Return to usual activities.
Limited Epidural Injections
Possible indications include:
Therapeutic procedure for symptomatic central disc herniation or degeneration.
Preparation:
Light diet for the meal prior to the examination.
patient home following the procedure.
An escort is required to drive the
Post procedure care:
As for a myelogram.
CT Shoulder
Possible indications include:
Recurrent dislocations, rotator cuff injuries, tendon tears, fractures, bony abnormality
Preparation:
If for bony examination, no preparation is required.
If soft tissues are to be studied the patient should have a shoulder arthrogram prior to CT.
Post procedure care:
None.
Page 13 of 53
13
CT of Bony Extremities
Possible indications include:
Trauma/pathology.
Preparation:
None required.
Post procedure care:
None.
CT Angiography
Possible indications include:
Pathology of major arteries - pulmonary, carotid, renal and intra-cranial and aorta.
Preparation:
4 hour fast.
Post procedure care:
Encourage fluids.
CT Guided Biopsy
Possible indications include:
Known lesion visible and accessible under CT for pathology assessment.
Preparation:
Routine 6 hour fast. The region should have had previous imaging and these films and
reports must be available.
Patient may be booked into the hospital at the discretion of the requesting medical
practitioner. Some biopsies may be appropriate to be performed on an outpatient basis. The
patient must be aware of the risk of having to stay in hospital overnight and resting for
the remainder of the day if they return home.
Clotting times are required for all biopsies and should be done the day before.
Post procedure care:
In-patients are returned to the ward with a post biopsy care sheet.
If the procedure is being performed on an outpatient basis the patient is kept in the
department resting and monitored for at least an hour prior to being released into the care
of another person. Lunch or a drink will be provided.
CT Guided Drainage
Possible indications include:
Drainage of an abscess or fluid filled structure requiring CT guidance.
therapeutic, diagnostic or both.
This may be
Preparation:
Routine 6 hour fast. The region should have been previously imaged and these films and
reports must be available.
Page 14 of 53
14
Patient may be booked into the hospital at the discretion of the requesting medical
practitioner. Some drainages may be appropriate to be performed on an outpatient basis.
The patient must be aware of the risk of having to stay in hospital overnight and resting
for the remainder of the day if they return home.
Clotting times are required for all drainages and should be done the day prior.
Post procedure care:
In-patients are returned to the ward with a post drainage care sheet.
left insitu.
A drain tube may be
If the procedure is being performed on an outpatient basis the patient is kept in the
department resting and being monitored for at least an hour prior to being released into the
care of another person. Lunch or a drink will be provided.
CT FISTULOGRAM
No preparation .Needs to be booked by nurses.
CT COLONOSCOPY
Possible indications include:
Diagnostic test for polyps and other lesions in the bowel. It is a minimally invasive
procedure using air and
is a good alternative for patients at risk of complications due to anaesthetic.
Preparation:
Needs to be booked by a nurse. Need Picolax preparation as for colonoscopy.
Post procedure:
Can return to normal activities after procedure. May have some abdominal discomfort.
CT CORONARY ANGIOGRAM
Needs to be booked by a nurse.
Preparation:
4 hour fast. need to come an hour early. May need a betablocker to slow the heart rate.
Post procedure care:
Need someone to drive them home.
Page 15 of 53
15
Radiological Procedures
Routine non-contrast examinations do not require appointments or preparation. In-patients
require an appointment time for the orderlies to arrange collect the patient from the ward
area.
All interventional procedures require an appointment.
IVC (Intravenous Cholangiogram)
Possible indications include:
When visualisation of the Common Bile Duct is required, e.g. post cholecystectomy with
continuing pain. This is undertaken in conjunction with a CT reconstruction.
Preparation:
Low residue diet the day prior to the procedure. Nothing further to eat after this time.
Drinking clear fluids is important, as dehydration is a contraindication to the procedure.
Post procedure care:
Encourage fluids.
Percutaneous Biliary Drainage and Stenting
Possible indications include:
Failure of stenting at ERCP with a sound therapeutic reason to undertake this procedure due
to the morbidity and mortality associated with Percutaneous Biliary Drainage.
Preparation:
Routine 6 hour fast. Recent CT scan of the liver showing the dilated biliary tree and any
other liver pathology.
Patient must be an in-patient. The patient must be aware of the risks involved and a
consent form must be signed. An anaesthetist should be arranged.
Clotting times and IV antibiotics are required prior to the procedure.
The initial stage is to drain the biliary system only. If the lesion is crossed, an
internal/external drain tube will be positioned. This may not be possible.
Seven to ten days later the second stage of the procedure may be performed.
the lesion is crossed or a permanent internal stent is positioned.
This is where
This may take up to three visits to complete.
Post procedure care:
The drain tube needs to be checked and the volume of bile draining measured.
If the drain tube falls out the Radiology Department needs to be contacted urgently to
attempt to reinsert the tube before the tract closes. If the drainage tract is not well
developed replacement would have to wait until the biliary tree was again dilated.
Sialogram
Possible indications include:
Pain and swelling in salivary glands or ducts
Preparation:
None required.
This procedure may be undertaken in conjunction with an ultrasound or CT.
Post procedure care: None.
Page 16 of 53
16
Pericardial Tap
Possible indications include:
Cardiac tamponade.
Preparation:
This may be undertaken under either CT or ultrasound and needs to be discussed with the
Radiologist on duty. It may be performed in ITU if necessary.
Echocardiogram is essential.
Fasting and clotting profile are preferable if time permits.
There must be a nurse or doctor available to monitor the patient during this procedure as
well as the nurse to assist the Radiologist.
Post procedure care:
Continue close monitoring, as prior to the procedure.
insitu, to maintain drainage.
Care of the drain tube, if it is left
US Guided Thoracentesis - Pleural Tap
Possible indications include:
Pathology, symptomatic relief.
Preparation:
Four hour fast.
Patient may be booked into the hospital at the discretion of the requesting medical
practitioner. It may be performed on an outpatient basis. The patient must be aware of the
possibility of having to stay in hospital overnight and needing to rest for the remainder of
the day if they return home.
Clotting times are required.
Post procedure care:
Chest x-ray, See Nursing Service Clinical Practice Guidelines.
If the procedure is being performed on an outpatient basis, the patient is kept in the
department resting for approximately an hour prior to being released into the care of
another person. Lunch or a drink will be provided.
Liver Biopsy – Ultrasound Guided
Possible indications include:
Pathological review of liver structure.
Preparation:
Four hour fast.
Patient is booked as a day procedure.
Clotting times are required. If there is any risk of an abnormal clotting profile this
should be checked prior to the biopsy being performed.
Post procedure care:
Patient returns to the ward with a post care instructions.
hour stay following the procedure.
Page 17 of 53
There is a minimum of a four (4)
17
US Guided Ascites Tap - Abdominal Paracentesis
Possible indications include:
Pathology, symptomatic relief.
Preparation:
Four hour fast.
Patient may be booked into the hospital at the discretion of the requesting medical
practitioner. This is often performed on an outpatient basis. The patient must be aware of
the need to rest for the remainder of the day if they are returning home.
If there is any risk of an abnormal clotting profile this should be checked prior.
Post procedure care:
See Nursing Service Clinical Practice Guidelines.
albumin replacement should be arranged.
If ongoing drainage has been requested
If the procedure is being performed on an outpatient basis the patient is kept in the
department resting for approximately an hour prior to being released into the care of
another person. Lunch or a drink will be provided.
US Guided Breast Cyst Aspiration or Lesion Biopsy
Possible indications include:
Pathology. Pain relief.
Preparation:
Previous breast ultrasound / mammograms and reports must be available.
Four hour fast.
An US Guided breast Biopsy is performed as an Outpatient.
Post procedure care:
Family member / friend to drive patient home if required.
bruising.
Ice may be applied to decrease
US Guided Breast Hook Wire Localisation
Possible indications include:
Breast mass.
Preparation:
Patient must be an inpatient and due for theatre that day if a Hook Wire Localisation is
being performed.
Previous breast ultrasound, with or without a mammogram must have been undertaken. The
previous films and reports must be available. The lesion must be clearly visible under
ultrasound. The patient will leave the radiology department with the hook wire insitu.
Post procedure care:
Continue preparation for theatre.
Page 18 of 53
18
US Guided Thyroid Cyst Aspiration or Lesion Biopsy
Possible indications include:
Thyroid mass
Preparation:
Four hour fast.
Previous thyroid ultrasound must be available.
Clotting profile is required.
Post procedure care:
A post procedure instruction sheet will be given to the patient.
Family member / friend to drive patient home if required.
bruising.
Ice may be applied to decrease
IVP (Intravenous Pyelogram)
Possible indications include:
Renal colic (if CT scan is insufficient), haematuria, hypertension, suspected pathology.
Not indicated for patients’ with renal failure.
Preparation:
Low residue diet the day prior to the procedure and a laxative is given following the
evening meal. Nothing further to eat after this time. Nothing to drink for 12 hours prior
to the examination.
Post procedure care:
Encourage fluids.
Micturating Cysto Urethrogram (MCU)
Possible indications include:
Post renal tract infection, to check for ureteric reflux.
Preparation:
None Required. Any education the parent or carer can give the child about the procedure
helps the child during the procedure. They can contact the department for specific
information. The parent or carer may stay with the child during the procedure providing
that they are not pregnant.
Post procedure care:
There is a risk of infection post MCU and the child should be observed for signs and
symptoms of a UTI. A treat may be considered as a way of rewarding the child after the
procedure.
Nephrostogram
Possible indications include:
To check the patency of the ureter following stone extraction.
Preparation:
None required.
Post procedure care: None.
Page 19 of 53
19
Page 20 of 53
20
Percutaneous Nephrostomy
Possible indications include:
Ureteric blockage leading to a dilated collecting system, patient unsuitable for
anaesthesia.
Preparation:
Consent form. IV access and IV antibiotics prior to arrival in the department. 4 hour
fast. Anaesthetic assistance, for patient comfort, may be considered. Ultrasound may be
considered.
Post procedure care:
Care of a drain tube or post care of a nephrostomy.
Ultrasound Hysteroinflation.
Possible indications include:
Polyps, bleeding, fibroids, infertility.
Preparation:
Light diet prior. Drink 3 cups water 1 hour prior to arrival in department to fill bladder.
Or as directed by the referring physician.
Performed at any time whilst not menstruating.
Post procedure care:
Lower abdominal pain may be experienced post procedure, analgesic as required. A sanitary
pad may be required after the procedure.
An escort to drive the patient home may be
appreciated.
HSG (Hystero-Salpingogram)
Possible indications include:
Check of tubal patency, infertility.
Preparation:
Light diet prior, 2 Ponstan capsules an hour prior to the procedure.
referring physician.
Or as directed by the
HSG must be undertaken following menstruation but before day 12-14 of the cycle.
Post procedure care:
Lower abdominal pain may be experienced post procedure, analgesic as required. A sanitary
pad may be required after the procedure.
An escort to drive the patient home may be
appreciated.
Lumbar Puncture – Fluoroscopic Guidance
Indication:
Where lumbar puncture has failed due to access, previous surgery or inability to find
landmarks.
Page 21 of 53
21
Preparation:
See Nursing Services Clinical Practice Guidelines –
Lumbar Puncture.
Post procedure care:
As indicated in Nursing Services Clinical Practice Guidelines.
Medial Branch Nerve Ablation
Possible indications include:
Ablation of the medial branches of the posterior primary rami. This is undertaken in
chronic low back pain where posterior element nociception is a key symptom. This is a
procedure equivalent to chemical rhizolysis.
Preparation:
This procedure is always proceeded by a nerve block without ablation to ensure the relief of
symptoms and assess the affected area.
A four (4) hour fast is required. All previous imaging must be available. Good family
support is required post procedure or hospital admission must be arranged prior.
Post procedure care:
Observation, in the Radiology Department, until symptoms are established. If there is good
family support, discharge into their care with follow-up by the requesting medical
practitioner.
.
Myelogram - Cervical, Thoracic, Lumbar
Possible indications include:
Back pain, neural deficit, usually performed in conjunction with a CT scan.
MRI is the test of first choice.
Preparation:
4 hour fast from food, however a litre of water must be drunk 1-2 hours prior to the
procedure. A full bladder is not necessary, so they may go to the toilet as desired.
consent form and hospital bed are required.
A
Medications which lower the seizure threshold must be avoided for 48 hours prior to the
procedure (see the restricted medication list in the back of this book).
Post procedure care:
Drink plenty of water or cordial. Two cups per hour over the first two hours, then one cup
per hour after this time is the minimum recommended. No alcohol.
Ensure that the patient is aware that their head is not to be lower than their body at any
time. This includes putting on shoes or picking up something.
They stay in hospital overnight as minimal to no activity is recommended for 16 hours.
must be aware that they will need to rest quietly in a sitting position. In bed it is
recommended that they sleep on 2 - 3 pillows.
They
We recommend paracetamol (or their usual analgesic) for any headache that may occur
following this procedure.
Medication ceased prior to this procedure may be recommenced 24 hours after the procedure.
A follow up CT of the area of interest can be performed 3-6 hours post myelogram.
Page 22 of 53
22
Page 23 of 53
23
Nerve Root Injection
Possible indications include:
To determine if abolition of sensation in a nerve root abolishes a patient’s altered
sensation (this may be due to disc herniation, spinal canal stenosis or nerve irritation).
Perineural fibrosis.
Preparation:
Light diet for the meal prior to the examination.
patient home following the procedure.
An escort may be required to drive the
Post procedure care:
Diminished motor/sensory function in the nerve root will mean that the patient will require
assistance for up to 8 hours. This can be undertaken on an outpatient basis.
Neural Ablation
Possible indications include:
As a permanent form of pain relief where there is pathological involvement of a nerve root
eg. Pancoast tumour in T1 or rarely an upper lumber tumour involving the extra foraminal
nerve root in L1.
Preparation:
This procedure is always proceeded by a nerve block without ablation to ensure the relief of
symptoms and assess the affected area.
A four (4) hour fast is required. All previous imaging must be available. Good family
support is required post procedure or hospital admission must be arranged prior.
Post procedure care:
Observation, in the Radiology Department, until symptoms are established. If there is good
family support, discharge into their care with follow-up by the requesting medical
practitioner.
Vertebroplasty
Possible indications include:
Intractable pain due to crush fracture of a vertebral body, this may be secondary to
osteoporosis or malignancy.
Preparation:
A 3D reconstructed CT scan of the affected area is required pre-procedure to determine
access to the affected vertebral body. MRI scanning of the affected region is useful to
determine the fractured vertebra is symptomatic. A pre-procedure consultation with the
interventional radiologist may be required.
Four (4) hour fast is required pre-procedure, as sedation will be given. The patient must
be an admitted to the hospital. All previous films must accompany the patient.
Post procedure care:
Close observation for any motor/sensory function loss at the affected area. Pain relief as
required. The patient may be able to ambulate, or stand out of bed, later in the day.
Check the post procedure care notes.
Page 24 of 53
24
Hip Injection
Possible indications include:
Temporary relief of hip pain.
Preparation:
Light diet for the meal prior to the examination.
patient home following the procedure.
An escort may be required to drive the
Post procedure care:
Temporary pain relief may be required after the effects of the long acting local anaesthetic
have dissipated. The intra-capsular injection of steroid will become effective in 8-12
hours.
Arthrogram
Possible indications include:
Pain, decreased mobility in a synovial joint.
Preparation:
Light diet for the meal prior to the examination.
patient home following the procedure.
An escort may be required to drive the
Post procedure care:
Oral pain relief may be required. The joint should be rested for 1-2 days as some increased
joint pain and stiffness may be experienced for 24 hours or so. In knee arthrography there
will be gas in the joint for 1-2 days.
Armport Insertion
Possible indications include: chemotherapy
Preparation: Admission for a day case is required but patients can usually be discharged about
1 hour after the procedure. A 4 hour fast is required in case sedation needs to be given.
Clotting times may be necessary. Check with Department. Upper arm veins are used.
Post Procedure Care: Port may be accessed depending on patient’s requirements for
chemotherapy. Intermittent icepacks are recommended for first few days to reduce swelling. The
arm should be rested as much as possible. Needs to be checked for infection within 1 week of
insertion for by LMO or Oncology clinic.
Angiography - DSA
Possible indications include:
Arterial disease, ischaemia, graft evaluation, aneurysm, haemorrhage.
Cardiac angiography is not undertaken at this hospital.
Preparation:
4 hour food fast, continue to drink clear fluids before the procedure.
well hydrated. Recent U&E’s and clotting profile are required.
A day stay in hospital is required.
The patient must be
A consent form needs to be arranged.
Page 25 of 53
25
Warfarin must be ceased and an INR needs to be performed the day prior to ensure that
clotting time is satisfactory. Hospital admission and alternate therapy may be considered.
Clopidogrel hydrogen sulfate (Plavix, Iscover) must be ceased 10 days prior to angiography
depending on the indication. Contact the Radiology Department if in doubt.
Post procedure care:
The patient is kept in the department for 30-50 minutes after haemostasis has been obtained.
After this time they are returned to their ward area and rest in bed for a further 3 ½ hours
with frequent observations being performed. After this time (if there are no complications)
the patient may be discharged. They require someone to drive them home and must rest for
the remainder of the day. Care should be taken with heavy lifting, strenuous activity or
driving for 48 hours following the procedure.
IVC (Inferior Vena Cava) Filter
Indication:
Persistent pulmonary emboli, from a known venous lower limb focus, with inability to control
the embolisation with medication.
Prior to surgery, where there is a known risk of pulmonary infarction and a contraindication
to anti-thrombolitic therapy.
Preparation:
Four (4) hour fast preferred. Clotting times appreciated but therapeutic times are not a
contraindication to proceeding.
Access can be achieved via a femoral or jugular vein, this may need to be discussed with the
Radiologist prior to the procedure.
A temporary IVC Filter is available with 24 hours notice in cases where filtration is
required for a period of up to 10 days.
Post procedure care:
Frequent observation of the puncture site and resting in bed for two (2) hours following the
procedure is required. If the site is satisfactory after this time normal activities may
resume.
If the procedure is a day case the patient will require someone to drive them home.
Leg Segmental Pressure Studies
Indication:
Claudication.
Preparation:
None required.
This procedure takes about an hour.
Post procedure care:
None.
Permacath Insertion
Indication:
Renal Dialysis
Preparation: Patients are admitted for a day case. Sedation is required so a 4 hour fast is
necessary. Clotting times will need to be done.
Post Procedure care: Patients are often transferred to the Dialysis Unit for Dialysis.
Page 26 of 53
26
Permacath Check with/without Urokinase Lock
Indication:
Decreased flows noticed during haemodialysis.
If a Urokinase lock is required this must be asked for specifically on the Radiology
Request.
Preparation:
None required, if patient is known to tolerate contrast media.
If a Urokinase lock is required then the procedure must take place approximately four (4)
hours prior to haemodialysis. If this is not possible the patient must attend the dialysis
unit to have the Urokinase withdrawn and a Heparin lock attended to.
Post procedure care:
Withdrawal of the Urokinase four (4) hours following the procedure.
Peripheral Angioplasty or Stenting
Possible indications include:
Significant stenosis of a relatively short duration, or patient who is an unsuitable
candidate for surgery with an amenable stenosis.
Preparation:
4 hour fast. This requires an overnight stay in hospital. The procedure is generally
undertaken in the afternoon. Recent U&E’s and clotting profile are required.
Warfarin must be ceased and an INR needs to be performed the morning of or day prior to
check the clotting time. Hospital admission and alternate therapy may be considered.
Clopidogrel hydrogen sulfate (Plavix, Iscover) must be ceased 10 days prior to angiography.
See product information for further details.
Post procedure care:
As for Angiography except the patient rests in bed until the following morning.
PICC (Peripherally Inserted Central venous Catheter) Line Insertion
Indication:
For the intravenous administration of nutrient fluids, chemotheraputic agents, anti-biotics
or other irritant drug therapies over a period of 4-12 weeks. The treating unit must
organise the ongoing care of these lines for the patient when they are discharged from the
hospital.
Preparation:
The Radiology Department utilises ultrasound guidance to access the large veins in the upper
arm to decrease the risk of phlebitis or catheter fracture due to elbow movement.
A section of upper arm must be available without any signs of infection and with a chance of
some intact veins being present.
A light diet prior is suggested and a clotting profile may be beneficial. However,
therapeutic clotting times are not necessarily a contraindication to the insertion of a PICC
line. This should be discussed with the Radiologist.
Post procedure care:
As indicated in Nursing Services Clinical Practice Guidelines.
Page 27 of 53
27
ERCP-Endoscopic retrograde cholangiopancreatography
Possible indications include:
Diagnostic or therapeutic procedure outlining the bilary tree and allowing treatment of
some
conditions such as common bile duct stones and jaundice These conditions may require stone
removal or
stent insertion. It combines the use of endoscopy and fluoroscopy.
Preparation:
6-8 hour fast, may need LFT’s and coags. A consent form is required. Check for allergies.
Post procedure care:
Routine post anaesthetic obs. IV fluids. Oral fluids only.diet next day . Pain relief.
Usually overnight stay.
Percutaneous Biliary Drainage and Stenting
Possible indications include:
Failure of stenting at ERCP with a sound therapeutic reason to undertake this procedure due
to the morbidity and mortality associated with Percutaneous Biliary Drainage.
Preparation:
Routine 4 four fast. Recent CT scan of the liver showing the dilated biliary tree and any
other liver pathology.
Patient must be an in-patient. The patient must be aware of the risks involved and a
consent form must be signed. An anaesthetist should be arranged.
Clotting times and IV antibiotics are required prior to the procedure.
The initial stage is to drain the biliary system only. If the lesion is crossed, an
internal/external drain tube will be positioned. This may not be possible.
Seven to ten days later the second stage of the procedure may be performed.
the lesion is crossed or a permanent internal stent is positioned.
This is where
This may take up to three visits to complete.
Post procedure care:
The drain tube needs to be checked and the volume of bile draining measured.
Close observation is required due to the risk of septic shock.
If the drain tube falls out the Radiology Department needs to be contacted urgently to
attempt to reinsert the tube before the tract closes. If the drainage tract is not well
developed replacement would have to wait until the biliary tree was again dilated.
Pericardial Tap
Possible indications include:
Cardiac tamponarde.
Preparation:
Page 28 of 53
28
This may be undertaken under either CT or ultrasound and needs to be discussed with the
Radiologist on duty. It may be performed in ITU if necessary.
Echocardiogram is essential.
Fasting and clotting profile are preferable if time permits.
There must be a nurse or doctor available to monitor the patient during this procedure as
well as the nurse to assist the Radiologist.
Post procedure care:
Continue close monitoring, as prior to the procedure.
to maintain drainage.
Care of the drain tube, if it is left
Sialogram
Possible indications include:
Pain and swelling in salivary glands or duct obstruction.
Preparation:
None required.
This procedure may be undertaken in conjunction with an ultrasound or CT.
Post procedure care:
None.
Sinugram
Possible indications include:
Investigation of a sinus or fistula.
Preparation:
Usually none or as required by the Radiologist.
Post procedure care:
None.
Page 29 of 53
29
Fluoroscopic procedures
Barium Enema (air or double contrast)
Possible indications include:
Change in bowel habits, bleeding, inflammatory bowel disease, pathology, failed
colonoscopy.
Preparation:
Follow instructions on “X-Prep Kit” which begins 20 hours before the examination.
X-Prep Kits may be obtained from the Radiology Department, kits can be supplied to
general practices on request.
Post procedure care:
Encourage fluids and high fibre diet as constipation may occur.
Barium Follow Thorough
Possible indications include:
Small bowel obstruction, inflammatory bowel disease.
Preparation:
12 hour fast. Patient should be warned that the procedure may take a number of hours
and a good book (walkman, or something to do lying down) is recommended. The delay is
due to the wait for the barium to pass through the small bowel to the colon for the test
to be completed.
Post procedure care:
Encourage fluids and high fibre diet as constipation may occur.
Barium Meal
Possible indications include:
Dyspepsia, obstruction, suspected pathology.
Preparation:
Routine 12 hour fast
Post procedure care:
Encourage fluids and a high fibre diet as constipation may result.
Naso-Jejunal Tube Insertion
Indication:
To rest the stomach while maintaining enteral feeding.
Preparation:
Four (4) hour fast is preferred but not essential.
Post procedure care:
Maintenance of the tube.
Please ensure that the tube is flushed at least every four hours with warm water.
Do not use soft drink or acidic fluids as this has been proven to coagulate the
proteins and cause tube blocking.
Do not remove a tube that has become blocked prior to talking to the radiology
staff as we are sometimes able to unblock tubes with the assistance of
fluoroscopy.
Barium Swallow
Possible indications include:
Page 30 of 53
30
Dysphagia, oesophageal pathology.
Preparation:
12 hour fast.
Post procedure care:
Encourage fluids and a high fibre diet as constipation may result.
Video Fluoroscopy
Possible indications include:
Dysphagia, assessment following CVA.
This procedure is booked via the Speech Pathology Department of the Base Hospital.
information can be obtained from the speech pathologists. No fast is required.
Page 31 of 53
Further
31
Ultrasound Scanning
All Ultrasound (US) scans require an appointment within office hours. For emergency bookings
within office hours (0830 – 1700) contact the Sonographers directly on Ext 94718. After hours
scans / weekend scans need to be discussed with the On-call Radiologist who may be contacted
through switchboard.
Neonate Abdominal Ultrasound
Possible indications include:
Pyloric stenosis, abdominal mass.
Preparation:
Pyloric stenosis : Feed 20 mins prior to scan.
Abdominal US : 2 hour fast.
Post procedure care:
None.
Upper Abdominal Ultrasound
Possible indications include:
Upper abdominal pain, gallbladder pathology eg. cholelithiasis , cholecystitis,
choledocholithiasis. pancreatitis, suspected pathology, hepato or spleno megaly, portal
hypertension.
Preparation:
12 hour fast.
Post procedure care:
None.
Upper Abdomen and Pelvic Ultrasounds
For outpatients these scans cannot be performed on the same day due to Medicare guidelines
and the different preparations required.
Bladder Ultrasound - Pre and Post Micturition
Possible indications include:
Frequency, retention, bladder pathology, prostate pathology.
Preparation:
A full bladder is required for this procedure. 4 glasses of water drunk over the two hours
prior to the procedure is recommended. If a catheter is insitu within the bladder it should
be clamped 2 hours prior to the appointment.
Post procedure care:
None.
Page 32 of 53
32
Prostatic Coil / Memokath Ultrasound
Possible indications include:
Coil position, urinary retention, frequency.
Preparation:
A full bladder is required for this procedure.
prior to the procedure is recommended.
4 glasses of water drunk over the two hours
Post procedure care:
None.
Renal Ultrasound
Possible indications include:
Loin pain, haematuria, renal stones, renal pathology, hydronephrosis / obstruction,
polycystic disease, congenital anomalies.
Preparation:
4 hour fast from food. 2 hours prior to the procedure the patient should empty their
bladder and then drink 4 glasses of water between this time and the time of their
appointment. Their bladder should be full on arrival in the department. If a catheter is
insitu within the bladder it should be clamped 2 hours prior to the appointment.
Children: 1-2 glasses of water prior is adequate.
Post procedure care:
None.
Pelvic Ultrasound
Possible indications include:
Lower abdominal pain, uterine pathologies eg. fibroids, irregular / painful menses, ectopic
pregnancy, ovarian pathologies. eg. cysts, appendicitis.
A trans-vaginal scan will be offered to all suitable patients after a transabdominal
examination, and after gaining informed consent. See notes below.
Preparation:
Two hours prior to the procedure the patient should empty their bladder and then drink 4
glasses of water between this time and the time of their appointment. IV fluids should be
considered if the patient is an inpatient and unable to drink. Their bladder should be full
on arrival in the department. The transvaginal scan is performed immediately after emptying
the bladder. If a catheter is insitu within the bladder it should be clamped 2 hours prior
to the appointment.
Post procedure care:
None.
Pelvic TV (Trans-vaginal) Ultrasound
Possible indications include:
This examination is offered for some pelvic examinations as a transvaginal scan provides
more detailed information. It will not be performed on patients in an altered conscious
state or after medication for pain relief. Informed consent from the patient is compulsory.
See notes below.
Indications as for pelvic ultrasound.
Page 33 of 53
33
Preparation:
2 hours prior to the procedure the patient should empty their bladder and then drink 4
glasses of water between this time and the time of their appointment. IV fluids should be
considered if they are an inpatient and unable to drink. Their bladder should be full on
arrival in the department. If a catheter is insitue within the bladder it should be clamped
2 hours prior to the appointment.
The transvaginal scan is performed immediately after emptying the bladder.
Post procedure care:
None.
Transvaginal Ultrasound Information
This examination will only be performed with the patient’s consent. The transvaginal
examination gives increased detail compared to the transabdominal scan.
A transvaginal scan will be offered to all suitable patients after a transabdominal
examination. Transvaginal scans may be performed on patients older than 18 years of age (
as a general rule ) and those able to give informed consent. (Those patients given pain
relief using certain medications may not be able to give adequate informed consent. Please
consider this prior to medicating patients).
Transvaginal scanning uses a specially designed, sterile-covered transducer, which is about the
size of a large tampon. This transducer is lubricated and inserted into the vagina, usually by
the patient themselves whilst being fully covered by a sheet or blanket. The procedure is
normally painless and not as uncomfortable as a pap smear. The examination will be stopped at
any time if requested. A nurse may accompany the patient during the procedure at the
patient’s request.
Transvaginal scanning has a number of advantages:
1. The patient does not require a full bladder.
2. More detailed images are obtained as the transducer is closer to the organs being scanned.
3. The scanning time is reduced as the organs can be quickly identified.
The patient has the option to refuse this technique or discuss it with their doctor.
NOTE: During the scan the transducer will be moved and rotated to ensure adequate images are
obtained. The patient may feel some slight pressure while the ovaries are being scanned.
However, most women who have had both trans-abdominal and transvaginal scan find the
transvaginal scan not too uncomfortable.
Obstetric Ultrasound – less than 15 weeks gestation.
Possible indications include:
Staging, pregnancy morphology, pain, bleeding, trauma
A trans-vaginal scan may be occasionally indicated in addition to trans-abdominal scanning.
This will only be performed on suitable patients after gaining informed consent. See above
for details regarding the transvaginal scan.
Preparation:
A full bladder is required.
glasses of water.
Empty the bladder 2 hours prior to the procedure then drink 2-3
No videos of the ultrasound are performed.
weeks gestation.
Photos are provided free of charge after 12
Page 34 of 53
34
If twins are suspected please inform the Radiology Department as the examination will take
longer to perform.
Post procedure care:
None
Obstetric Ultrasound - after 15 weeks gestation.
Possible indications include:
Pregnancy Morphology, gestational staging.
A trans-vaginal scan may be occasionally indicated in addition to trans-abdominal scanning.
This will only be performed on suitable patients after gaining informed consent. See Pelvic
TV above for details regarding the transvaginal scan.
Preparation:
A full bladder is required.
glasses of water.
Empty the bladder 2 hours prior to the procedure then drink 2-3
No videos of the ultrasound are performed.
Photos are provided free of charge.
If twins are suspected please inform the Radiology Department as the examination will take
longer to perform.
Post procedure care:
None.
Obstetric Ultrasound – 12 week / Nuchal Translucency
Possible indications include:
Fetal growth anomaly scan.
Fetal age must be between 12 weeks and 13.5 weeks. The examination gives risk factors for
Trisomy 13 / 18 / 21. Other anomalies are also assessed.
The Nuchal Translucency may be combined with a Blood Test. The blood test is best performed
during the 10th week of pregnancy. This will give a combined risk factor for Trisomy
13/18/21 and is a more sensitive test than just the Ultrasound alone.
A trans-vaginal scan may be occasionally indicated in addition to trans-abdominal scanning.
This will only be performed on suitable patients after gaining informed consent. See Pelvic
TV Ultrasound for details of the transvaginal scan.
Preparation:
Two hours prior to the procedure the patient should empty their bladder and then drink 4
glasses of water between this time and the time of their appointment. Their bladder should
be full on arrival in the department.
Post procedure care:
None.
Ultrasound of Small Parts
This covers a wide range of anatomical areas.
These include : Neonatal hips, neonatal head (cranial), Shoulder (rotator cuff), tendons, eg.
Achilles, soft tissue, eg. muscles, foreign body, thyroid, breast, salivary gland or testes
(scrotal).
Page 35 of 53
35
Possible indications include:
As indicated.
Preparation:
None required.
Post procedure care:
None.
Arterial Leg Doppler
Possible indications include:
Claudication, ischaemia, acute arterial thrombosis, follow-up of arterial interventional
procedures. Eg. bypass graft surgery.
Preparation:
One Leg.
12 hour fast.
1 hour scan
Both Legs.
12 Hour fast.
1. 5 hour scan.
Post procedure care:
None.
A/V Fistulogram
Possible indications include:
Pre op work up.
Assessement of flow of an A/V fistula either during or prior to haemodialysis. Eg. loss of
“thrill”.
Preparation:
None.
Post procedure care:
None.
Aorta or IVC (Inferior Vena Cava) Ultrasound
Possible indications include:
AAA, thrombus, tumour, dissection.
Preparation:
12 hour fast.
Post procedure care:
None.
Page 36 of 53
36
Doppler Abdomen
Possible indications include:
AAA, portal hypertension, mesenteric disease.
Preparation:
12 hour fast.
If mesenteric disease is indicated a scan after food may be undertaken.
Post procedure care:
None.
Doppler Renal
Possible indications include:
Hypertension, suspected renal artery stenosis, transplant.
Preparation:
12 hour fast.
This procedure may take up to one hour.
of the preparation
Laxatives should be given the night before as part
Post procedure care:
None.
DVT Ultrasound - Leg Veins Doppler
Possible indications include:
Suspected DVT, follow-up for known DVT.
Preparation:
One Leg.
No preparation required.
Half hour scan
Both Legs.
12 Hour fast.
One hour scan.
Post procedure care:
None.
Echocardiogram
Possible indications include:
Valvular / myocardial disease, congenital abnormalities, TIAs, tumours.
Preparation:
None required.
This procedure takes about an hour.
Post procedure care:
None.
Page 37 of 53
37
Varicose Veins Ultrasound - Doppler
Possible indications include:
Marking of veins prior to surgery, checking of perforator veins, venous ulcers, venous
incompetence.
Preparation:
None required. One leg may take up to ninety minutes to scan.
scanned at least two hours are required.
If both legs are to be
Preoperative scans may be used to mark on the patient’s skin for the location of veins. Eg.
Prior to bypass surgery
Post procedure care:
None.
Liver Biopsy – Ultrasound Guided
Possible indications include:
Pathological review of liver structure.
Preparation:
Four hour fast.
Patient is booked as a day procedure.
Clotting times are required. If there is any risk of an abnormal clotting profile this
should be checked prior to the biopsy being performed.
Post procedure care:
Patient returns to the ward with a post care instructions.
hour stay following the procedure.
There is a minimum of a four (4)
US Guided Ascitic Tap - Abdominal Paracentesis
Possible indications include:
Pathology, symptomatic relief.
Preparation:
Four hour fast.
Patient may be booked into the hospital at the discretion of the requesting medical
practitioner. This is often performed on an outpatient basis. The patient must be aware of
the need to rest for the remainder of the day if they are returning home.
If there is any risk of an abnormal clotting profile this should be checked prior.
Post procedure care:
See Nursing Service Clinical Practice Guidelines.
albumin replacement should be arranged.
If ongoing drainage has been requested
If the procedure is being performed on an outpatient basis the patient is kept in the
department resting for approximately an hour prior to being released into the care of
another person. Lunch or a drink will be provided.
Page 38 of 53
38
US Guided Breast Cyst Aspiration or Lesion Biopsy
Possible indications include:
Pathology. Pain relief.
Preparation:
Previous breast ultrasound / mammograms must be available.
Four hour fast.
Post procedure care:
Family member / friend to drive patient home if required.
bruising.
Ice may be applied to decrease
US Guided Breast Cyst Aspiration or Lesion Biopsy
Possible indications include:
Pathology. Pain relief.
Preparation:
Previous breast ultrasound / mammograms and reports must be available.
Four hour fast.
An US Guided breast Biopsy is performed as an Outpatient.
Post procedure care:
Family member / friend to drive patient home if required.
bruising.
Ice may be applied to decrease
US Guided Breast Hook Wire Localisation
Possible indications include:
Breast mass.
Preparation:
Patient must be an inpatient and due for theatre that day if a Hook Wire Localisation is
being performed.
Previous breast ultrasound, with or without a mammogram must have been undertaken. The
previous films and reports must be available. The lesion must be clearly visible under
ultrasound. The patient will leave the radiology department with the hook wire insitu.
Post procedure care:
Continue preparation for theatre.
US Guided Thoracentesis - Pleural Tap
Possible indications include:
Pathology, symptomatic relief.
Preparation:
Four hour fast.
Page 39 of 53
39
Patient may be booked into the hospital at the discretion of the requesting medical
practitioner. It may be performed on an outpatient basis. The patient must be aware of the
risk of having to stay in hospital overnight and needing to rest for the remainder of the
day if they return home.
Clotting times are required.
Post procedure care:
See Nursing Service Clinical Practice Guidelines.
If the procedure is being performed on an outpatient basis, the patient is kept in the
department resting for approximately an hour prior to being released into the care of
another person. Lunch or a drink will be provided.
US Guided Thyroid Cyst Aspiration or Lesion Biopsy
Possible indications include:
Thyroid mass
Preparation:
Four hour fast.
Previous thyroid ultrasound must be available.
Clotting profile is required.
Post procedure care:
Family member / friend to drive patient home if required.
bruising.
Ice may be applied to decrease
MRI Scanning
Magnetic Resonance Imaging (MRI) is available on site by Ballarat MRI. The direct phone number
is 03 5320 4311 for an appointment time. Office hours are 8.00am to 5pm Monday to Friday.
You must have a specialist provider number to order these scans.
What is MRI
Magnetic Resonance Imaging (MRI) uses radio waves and a very strong magnetic field to make
detailed images of the body’s internal structures.
There are no known harmful effects from either the radio waves or the magnetic field on the
human body. No X-rays are used.
However, if the patient has had an electronic device (such as a pacemaker) or certain types of
metal prosthesis implanted, the magnetic field may disturb these, with possible adverse
effects. If your patient has any implants of any kind please talk to the MRI staff to ensure
their safety. Many metal objects (like joint replacements) are quite safe.
If the patient is unable to communicate and you are unsure of implant status, please arrange
for some plain X-rays prior to scanning the patient to check for any implanted or foreign
objects.
Metal fragments in the eyes can move and cause permanent vision loss. If the patient thinks
they may have metal fragments in their eyes, they will need a plain x-ray of the orbits to
check prior to scanning.
Preparing for the Test
The patient, or a staff member on behalf of the patient, must fill out a ‘Patient Safety
Questionnaire’ prior to scanning. If a staff member is entering the MRI scanning room they
must also complete a Safety Questionnaire.
Page 40 of 53
40
All people entering the MRI scanning room must remove any watches, metallic jewellery and
patients should be in a hospital gown. Hair pins must be removed prior to scanning. Items such
as credit cards, pages and mobile phones CANNOT be taken into the MRI scan room.
Patient Preparation for MRI Scanning - All Areas Except Abdomen
The patient may eat and drink normally on the day of the test.
medication as normal.
The patient should take any
Patient Preparation for Abdominal Scanning
A six(6) hour fast is required prior to MRI scanning of an Abdomen.
Patient Preparation if Sedation is Required
A four(4) hour fast is required when the patient believes they will require IV sedation to
enable the scan to occur. Sedation needs to be booked with the MRI appointment to ensure that
the necessary time and staff are available.
If the patient has pain please give normal pain medication prior to MRI scanning, as the
patient must remain still for a considerable period of time.
Information on and Preparation for Sedation(sedation is not recommended for abdominal
scanning)
To ensure your safety, during and following sedation, please observe the following:
1. No food or drink for four (4) hours prior to your appointment.
2. You will require someone to drive you home.
you.
They must come into Ballarat MRI to collect
3. Please bring a list of any medications you currently take.
4. Inform the staff of any allergies prior to attending for your appointment.
5. Following your scan you will need to rest.
drive a car for 12 hours.
Make no plans to work, sign legal documents or
6. Before sedation is given, you will be asked to give consent.
For further information please contact a member of the nursing staff on 03 5320 4270
What Happens During the Scan
MRI is like a doughnut, with the patient lying on a table that passes into a tunnel (“bore”)
that is in the centre of the machine (similar to a CT). The antenna(“coil”), which receives
the radio waves used in MRI, will be placed next to the body part being examined. Special
glasses and mirrors will be provided to see outside the bore of the magnet.
During the examination a series of fairly loud tapping or buzzing will be heard. This is quite
normal. Each series of images may last for a time between a few seconds and a few (up to 10)
minutes. The normal total examination time is between 15 and 45 minutes.
The patient must keep as STILL as possible otherwise the images will be blurred. (Remember the
images are taken over a space of seconds to minutes) Pads and supports will be provided where
possible to aid in the patient staying still.
Headphones or ear plugs will be provided to minimise the noise and the patient is welcome to
bring in a CD or tape of their own choice to listen to during scanning. This is not possible
during abdominal imaging.
There is an intercom system allowing the patient to talk to the person scanning and for them to
talk to the patient and check how they are going. A friend or relative may sit in the scanning
room, with the patient, if desired.
Page 41 of 53
41
Some patients will require an injection of gadolinium (an MRI contrast agent) as part of the
test. This is given via a small needle into an arm vein. It is not iodinated contrast and side
effects are extremely rare however it can cause Nephrogenic Systemic Fibrosis (NSF).
THEREFORE:
A current estimated glomerular filtration rate (eGFR) is required in the following patients
before gadolinium can be given.



Patients over 70 years of age
Patients with pre-existing renal impairment
Patient with diabetes
After the Test
There are no after-effects from the test. Patients who have required sedation need observation
for this and will be provided with instructions.
The images take time to interpret and results may take from 3-5 working days.
Page 42 of 53
42
Mammography
Mammograms are performed at Ballarat Health Services by the staff of Lake Imaging.
this procedure please call 132050
To book
Possible indications include:
Routine check,strong family history of breast disease, palpable lump, follow-up of known
lesion.
Preparation:
No Talcum powder, deodorant or perfume to be worn around the chest or underarm area.
Patients will feel more comfortable if they wear a skirt and blouse or trousers and a shirt.
Asymptomatic, pre-menopausal women should be booked to coincide with the first ten days of
their period.
Post procedure care:
None.
Needle localisation of Breast Lesion
Possible indications include:
Mass shown on mammogram which is not palpable.
Preparation:
Patient must be an inpatient and due for theatre that day.
Post procedure care:
Continue preparation for theatre.
Page 43 of 53
43
Restricted Medication
It is recommended that the following drugs are ceased 48 hours before a Myelogram or CT spine
with intra thecal contrast examination is undertaken and should not recommence until 24 hours
after the examination. This is not an exhaustive list and is only an indication of the
medications which may lower the seizure threshold.
Tricyclic Antidepressants
Generic Name
Desipramine
Amitriptyline
Doxepin
Mianserin
Trimipramine
Clomipramine
Dothepin
Imipramine
Nortriptyline
Trade Names
Pertofran
Endep Mutabon D Tryptanol
Deptran Sinequan
Tolvon
Surmontil
Anafranil
Dothep Prothiaden
Melipramine Tofranil
Allegron Nortab
Phenothiazines and related Medications
Generic Name
Thiothixene
Fluphenazine Decanoate
Fluphenazine Hydrochlorice
Perphenazine
Prochloroperazine
Promethazine
Thioridazine
Trifluoperazine
Droperidol
Haloperidol
Pericyazine
Pimozide
Chlorpromazine
Thiethylperazine
Trimeprazine
Promazine
Trade Names
Navane
Modecate
Anatensol Dalmane
Mutabon D Trilafon
Compazine Sternatil
Avomine Phenergan Prothazine
Aldazine Melleril
Parstelin Stelabid Stelazine
Droleptan
Serenace Haldol
Neulactil
Orap
Largactil
Torecan
Vallergan
Sparine
Mono Amine Oxadise Inhibitors (MAOI)
Generic Name
Tranylcpromine
Phenelzine
Central Nervous System Stimulants
Trade Names
Parnate
Nardil
Generic Name
Trade Names
Methylphenidate
Tacrine
Ritalin
Page 44 of 53
THA
44
APPENDIX:
PROTOCOLS
Renal insufficiency and contrast media.
Metformin and contrast media.
Premedication of patients with known iodinated contrast
reaction.
Extravasation of contrast media.
Page 45 of 53
45
PROTOCOL
Renal Insufficiency & Contrast Media
SCOPE (Area): Radiology & Acute
SCOPE (Staff): Radiology , Medical & Nursing Staff
BACKGROUND/RATIONALE
Contrast-induced renal failure is a major potential side-effect of radiographic
contrast injection
Principles of safe contrast administration include:
Contrast should only be given when necessary and the dose should be as low
as possible
High risk patients such as those with diabetes mellitus, myeloma or preexisting renal disease have a known incidence of contrast induced real failure which
may be as high as 50%
Reduction of Risk of Contrast Administration:
Acetylcysteine (Mucomyst) administration was believed to significantly
lower the risk of renal failure in high risk patients but results of subsequent studies
have been inconsistent and its current position is not completely resolved. However,
the relative safety and inexpensive cost of acetylcysteine favour its use at the
present time.
Intravenous hydration is most widely recommended prophylactic measure,
to reduce the incidence of contrast induced renal failure, however there is little
clinical data to support timing and amount of hydration.
Iso-osmolar contrast media Visipaque (Iodixanol) may lower the risk of
contrast induced renal failure. This may be due to reduced renal vasoconstriction
because it has the same osmolarity as plasma.
Estimated Glomerular Filltration Rate (eGFR) is now considered to be the
most accurate indicator of renal function, as it factors – in the patients age and sex.
NOTE: eGFR is considered unreliable in the following: Children <18 years,
Aboriginal, Torres Straight Islanders, Asian populations, acute renal failure and
dialysis dependant patients, extremes of body size, severe liver disease, diseases
of skeletal muscle, paraplegia, amputees, pregnancy.
The injection of radiographic contrast agents is completely containdicated in
renal failure, when the eGFR is less than 30mls/min, with the exception of
patients where renal dialysis has been scheduled post procedure or a
nephrologist or physician has been consulted.
EXPECTED OUTCOME
Patients with an eGFR < 50ml/min will be administered iso-osmolar contrast
media Visipaque.
Page 46 of 53
46
Preparation is recommended (see below) for patients who have pre-existing
renal failure with a eGFR below 50mls/min and other co-morbidities such as
diabetes, cardiac failure, myeloma, thyrotoxicosis and increased age (above 65 yrs)
All Patients having contrast media need to be encouraged to increase their
fluid intake in the short term.
ACTIONS
1 . Saline intravenously, at a rate of 1ml per kilogram of body weight per hour, for the 12 hours
prior to and the twelve hours following administration of the contrast agent.
2. Optional- Acetylcysteine (Mucomyst) orally, at a dose of 600mg twice a day on the
day prior and the day of administration of the contrast agent.
3. The patient should continue to be encouraged to drink extra fluid if possible.
4. Nonionic, iso-osmolar contrast agent (Visipaque) is used in the smallest
possible
dose for the procedure (preferably not greater then 75ml if the study allows)
5. Occasionally, due to renal failure or other causes such as cardiac failure,
rehydration is not possible. In such an event, the lowest possible dose of
Visipaque may be used, providing the eGFR remains above 30ml/min.
We understand that there would be an increased cost associated with the patient
being admitted to hospital for a 24 hour period. The true saving is the decrease in
the risk of patient morbidity and decreasing the risk of patients requiring an
increase in the length of their hospital stay or admission following outpatient
injection of contrast agent without preparation.
To assist us in our efforts to reduce the complications of administration of contrast
media please have a recent eGFR available and inform our staff of any patient who
has an eGFR below 50ml/min. We want to offer the best available service to your
patients.
RELATED DOCUMENTS
Internal
Radiology – Procedures & Preparations – MAN/004/V1
REFERENCES
Tepel M., Aspelin et al, (2006). Contrast induced nephropathy- A clinical and
evidence based approach. Circulation, April 11
Issues in the use of contrast media in patients at high risk for contrast-Induced
Nephrotoxicity (Joint activity sponsored by Interlink Healthcare
communications) June 2003.
Trivedi HS. et al, (2003). A randomised prospective trial to assess the role of saline
hydration on the development of contrast nephrotoxicity. Nephron Clinical
Pract:93.
Y-C Hsieh et al, (2006). Iso-osmolar contrast medium better preserves short and
long term renal function after cardiovascular catheterisation in patients with
severe baseline insufficiency. International Journal of Cardiology
Page 47 of 53
47
Lameire N, (2007). Screening of Renal Fuction Prior to Administration of
Iodiated Contrast Medium C212. Volume V Issue 2.
Reg. Authority: CEO, Executive Directors-Nursing,
Date Effective: Sept 2007
Medicine, Allied Health & Psychiatric Services.
Date Revised: May 2009
Director of Radiology.
Date for Review: May 2012
Review Responsibility: Radiology
Original Author: Director of Radiology & NUM – Radiology (2007)
Updated by: Director of radiology & NUM – Radiology (2009)
PROTOCOL
Metformin & Contrast Media
SCOPE (Area):
SCOPE (Staff):
Radiology
Radiology Staff
BACKGROUND/RATIONALE
Following the review of the available literature and taking into consideration the Royal
Australian and New Zealand Collage of Radiologists Policy on this subject, the following
protocol is recommended for the care of patients prescribed Metformin Hydrochloride and being
given contrast media.
ACTIONS
RENAL FUNCTION PRIOR TO CONTRAST MEDIA
The ordering medical practitioner is responsible for ensuring that the renal
function has been checked prior to the patient attending the Radiology
Department. This may be undertaken by recording on the radiology request a
normal eGFR that has been obtained within the previous 12 months, or by
undertaking a new eGFR. Please record the pathology laboratory undertaking this
test on the request slip.
NORMAL RENAL FUNCTION AND METFORMIN
There is a theoretical risk of Metformin induced lactic acidosis following
intravenous contrast being given. Metformin is to be ceased for 48 hours
following injection with contrast media to allow for full clearance of the
contrast prior to the recommencement of Metformin. No medical follow-up is
recommended.
Page 48 of 53
48
ABNORMAL RENAL FUNCTION AND METFORMIN
Metformin will be ceased for 48 hours following injection with contrast media.
At 48 hours the patient requires a review by their medical practitioner, and
their eGFR levels rechecked. Metformin should not be recommenced before normal
eGFR levels have been confirmed. (Metformin and Contrast Media are excreted
through the same pathway in the kidney.)
The Radiologist will record in the report and contact the local medical
practitioner about Metformin being ceased.
Patient Information
Patients will be given a post contrast care sheet.
can recommence their Metformin.
This will explain when they
For patients with abnormal renal function the sheet will also contain a followup appointment with their medical practitioner and an attached pathology request
slip for a check eGFR level, which is to be undertaken prior to this
appointment.
Note
Metformin includes: Chem Mart Metformin, Diabex, Diaformin, Gen Rx Metformin,
Glucohexal, Glucomet, Glucophage, Metformin_BC, Terry White Chemists Metformin,
healthsense Metformin
RELATED DOCUMENTS
Internal
Radiology – Procedures & Preparations – MAN/004/V1
REFERENCES
The Royal Australian and New Zealand College of Radiologists “Policies –
Contrast 1.2 Metformin Hydrochloride and Intravenous Contrast Media
Guidelines”
http://www.ranzcr.edu.au/open/poll_2.htm
Product information available via: MIMS Australia, Australian Prescription
Products Guide and Australian Medicines Handbook.
Reg. Authority: CEO, Executive DirectorsDate Effective: June 2003
Nursing, Medicine, Allied Health & Psychiatric Date Revised: Oct 2007
Services. Director of Radiology
Date for Review: Oct 2010
Review Responsibility: Radiology
Original Author:
Director & NUM of Radiology (2003)
Updated by: Director & NUM of Radiology (2007)
Page 49 of 53
49
PROTOCOL
Premedication of Patients with known
Iodinated Contract Reaction
SCOPE (Area):
SCOPE (Staff):
Radiology
Radiology Staff
BACKGROUND/RATIONALE
Overseas Findings
Studies undertaken by Laser et al. have demonstrated a decrease in reactions
when two doses of oral steroids were administered prior to contrast injection.
This showed that two doses of oral steroids prior to administration of contrast
media did decrease the number and severity of the reactions. There was also a
demonstrated decrease in allergic reactions when non-ionic contrast media was
used.
A study by Freed et al.
medication) following a
if the initial reaction
breakthrough reaction.
considered.
looked into breakthrough reactions (oral steroid preknown reaction to iodinated contrast. They found that
had been anaphylactoid there was a high risk of
They recommended that other forms of imaging be
These studies must remind us that even if we pre-medicate our patients, with a known history of
contrast reaction, there is no guarantee of further reaction not occurring. The patient must
be watched carefully and other methods of imaging considered.
EXPECTED OUTCOME
Following review of a number of articles relating to the area of contrast media
reactions, the following information has been formulated to assist in the care
of patients with a past history of reaction.
DEFINITIONS
Anaphylactoid Reaction: this reaction is triggered without prior sensitisation
of the patient. Anaphylactoid reactions are not triggered by an IgE response.
The reaction is identical to anaphylaxis.
Anaphylaxis: this reaction is triggered by prior sensitisation of the patient, to a known
allergen, causing the subsequent release of IgE.
Categories of Reactions:
Grade I –
a single vomit, nausea, sneezing and vertigo.
Grade II – hives, erythema, repeated vomiting, fever and/or chills.
Page 50 of 53
50
Grade III – clinical shock, bronchospasm, laryngospasm, laryngeal oedema, loss of
consciousness, convulsions, decrease in blood pressure, cardiac arrhythmia, angina,
angioedema, pulmonary oedema.
ACTIONS
For patients with a known previous reaction especially of a grade II or higher level the
following protocol should be observed.
Oral prednisolone 25mg - 12 hours and 2 hours prior to the examination.
If there is a history of a grade III reaction, an IV injection of hydrocortisone 100-500mg
prior to injection of contrast should be considered.
Patient observation is critical.
RELATED DOCUMENTS
Internal
Radiology – Procedures & preparations – MAN/004/V1
REFERENCES
Lasser EC, Berry CC, Talner LB, Santini LC, Lang EK, Gerber FH, Stolberg HO. (1987).
“Pretreatment with corticosteroids to alleviate reactions to intravenous contrast
material” The New England Journal of Medicine Oct. 1, Vol: 317 No: 14 pp: 845-849
Lasser EC, Berry CC, Mishkin MM, Winiamson B, Zheutlin N, Silverman JM. (1994). “Pretreatment
with Corticosteroids to Prevent Adverse Reactions to Nonionic Contrast Media” The American
Journal of Roentgenology March Vol: 162 pp:523-526
Freed KS, Leder RA, Alexander C, DeLong DM, Kliewer MA. (2001). “Breakthrough Adverse
Reactions to Low-Osmolar Contrast Media after Steroid Premedication” The American Journal
of Roentgenology June Vol: 176 pp: 1389-1392
Australian Medicines Handbook –
sections on Allergy and Anaphalaxis.
Reg. Authority: CEO, Executive DirectorsDate Effective: May 2002
Nursing, Medicine, Allied Health & Psychiatric Date Revised: Oct 2007
Services. Director of Radiology
Date for Review: Oct 2010
Review Responsibility: Radiology
Original Author:
Director & NUM of Radiology (2002)
Updated by: Director & NUM of Radiology (2007)
Page 51 of 53
51
Ballarat Health Services
PROTOCOL
Extravasation of Contrast Media
SCOPE (Area):
SCOPE (Staff):
Radiology
Radiology Staff
EXPECTED OUTCOME
Following the review of the available literature, the following protocol is recommenced in the
care of patients following extravasation of contrast media.
ACTIONS
Initial Treatment:
Aspirate any contrast, via the cannula, if possible.
Elevate the affected extremity, ensuring maintenance of blood flow.
Ice packs (15-60 minute applications three times per day for 1-3 days)
Close observation for 2-4 hours (if the volume exceeds 5ml)
Phone call to the local doctor or hospital unit (if volume exceeds 5ml)
Document all care on a Frequent Observation Chart (this is to be filled in the
patient’s history or Radiology file)
Surgical Consult (plastics if possible) if any of the following occur:
Extravasated volume exceeds 100ml of nonionic contrast media
Skin blistering
Altered tissue perfusion (decreased capillary refill over or distal to the
injection site)
Increasing pain after 2-4 hours
Change in sensation distal to site of extravasation.
Surgical treatment may include: fasciotomy, irrigation with saline or
hyaluronidase infiltration.
Follow-up:
If the out-patient has recovered a sufficient amount to go home then they are
given a sheet listing the symptoms to be aware of (listed below):
Residual pain
Blistering
Redness or other skin colour change
Hardness
Increased or decreased temperature of skin at the extravasation site
(compared to skin elsewhere)
Change in sensation
If these have not resolved or are worsening with-in a 24 hour period they should
contact their local doctor or attend at the Emergency Department for review.
Page 52 of 53
52
Documentation:
Frequent observation chart commenced documenting symptoms, treatment and
discharge plan.
Volume of extravasation, symptoms and treatment is documented in the Radiology
Report.
Post care sheet given and explained to the patient including when to call for
follow-up.
Notes:
Conservative treatment should be all that is required. However, documentation
is essential. In-patient – extravasation site care is undertaken by the
referring unit. If the patient is an out-patient - the care is patient focused
ensuring the general practitioner is aware of the incident.
RELATED DOCUMENTS
Internal
Radiology – Procedures & Preparations – MAN/004/V1
REFERENCES
Cohan Richard H, Dunnick N Reed, Leder Richard A, Baker Mark E. (1990).
“Extravasation of Nonionic Radiologic Contrast Media: Efficacy of
Conservative Treatment” Radiology Vol 176 Pp65-67
Cohan Richard H, Ellis James H, Garner Warren L. (1996). “Extavasation of Radiographic
Contrast Material: Recognition, Prevention, and Treatment” Radiology Vol 200 Pps 593-604
Federle Michael P, Chang Paul J, Confer Scharmen, Ozgun Bertan. (1998).
“Frequency and Effects of Extravasation of Ionic and Nonionic CT Contrast
Media during Rapid Bolus Injection” Radiology Vol 206 Pps 637-640
Lang Elvira V, Valls Carlos. (1996). “What is the suggested treatment to minimize skin or
subcutaneous injury if extravasation occurs when dynamic bolus CT is performed?” AJR Vol
167 Pp 277-8
Memolo Mark, Dyer Ray, Zagoria Ronald J, Pond Gerald D, Dorr Robert. (1993).
“Extravasation Injury with Nonionic Contrast Material” AJR Vol 160 Pp 203-4
Sistrom Christopher L, Gay Spencer B, Peffley Linda. (1991). “Extravasation of
Iopamidol and Iohexol during Contrast-enhanced CT: Report of 28 Cases”
Radiology Vol 180 Pp 707-710
Reg. Authority: CEO, Executive DirectorsDate Effective: May 2003
Nursing, Medicine, Allied Health & Psychiatric Date Revised: Oct 2007
Services. Director of Radiology
Date for Review: Oct 2010
Review Responsibility: Radiology
Original Author:
Director & NUM of Radiology (2003)
Updated by: Director & NUM of Radiology (2007)
Page 53 of 53
53