Venipuncture and Pharmacology for Radiologic Technologists

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Venipuncture and Pharmacology for Radiologic
Technologists

• RTEC 93
• 1pm 6pm Wednesday

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SB 571 VENIPUNCTURE

• Chaptered 97-0384
• Radiologic TechnologicVenipuncture
• SB 571 authorizes a radiologic technologist,
  under the general supervision of a physician and
  surgeon to perform venipuncture in an upper
  extremity to administer contrast materials
  manually or by using a mechanical injector if the
  radiologic technologist has received specified
  training and education and has been issued a
  certificate from an approved school of radiologic
  technology or an instructor indicating
  satisfactory completion of the required training.

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Central Line Injections by RT

• The California Law does not address arterial
  injection by RT
• Employers policies
• Saline flush

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CALIFORNIA HEALTH AND SAFETY CODEHEALTH AND
SAFETY CODE SECTION 106955-107111
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ECC CONTRAST MEDIA INJECTION POLICY

• "STUDENT RADIOLOGIC TECHNOLOGISTS MAY NOT, UNDER
  ANY CIRCUMSTANCES INJECT CONTRAST MEDIA".
• HEALTH AND SAFETY CODE CHAPTER 554 STATUTES OF
  1995 SENATE BILL 1334

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SENATE BILL 1334

• The above mentioned senate bill as of January
  1996 allows TECHNOLOGISTS to complete the
  injection of a contrast media which was started
  by Authorized personnel. This bill did not
  address and was not meant to include STUDENT
  Radiologic Technologists.
• Students who violate this policy shall be
  immediately suspended for two days and possible
  further action.

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CONTRAST MEDIA

• CONTRAST
• X-RAY DYE
• COLORLESS OR WHITE

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Contrast Media

• Negative contrast
• Radio_____
• ____ atomic material
• _______ on film

• Positive contrast
• (all others)
• Radio_____
• ____ atomic material
• ______ on film

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Contrast Media

• Negative contrast
• (AIR OR CO2)
• Radiolucent
• Low atomic material
• Black on film

• Positive contrast
• (all others)
• Radiopaque
• High atomic material
• White on film

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2 BASIC TYPES OF CONTRAST

• BARIUM Z 56
• NON WATER SOLUABLE
• GI TRACT ONLY INGESTED OR RECTALLY
• KVP 90 120

• IODINE Z 53
• WATER SOLUABLE
• POWDER
• LIQUID
• INTRAVENOUS OR
• GI TRACT
• KVP BELOW 90

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Water Soluble Iodine

• High atomic 53
• Radiopaque
• Used to radiograph
• Vessels
• Arteries
• Veins
• Function of internal organs

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KVP TYPE OF CONTRAST USED DETERMINES KVP RANGE

• IODINES 70 80 kVp
• (Ionic / Nonionic Water or Oil)

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IONDINATED CONTRAST

• WATER BASED
• INJECTED
• VESSELS/DUCTS
• INGESTED
• OPEN WOUNDS
• ISOVUE 200(41), 300(61) or 370 (76)

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ISOVUE-M 200 OR 300 (iopamidol)

• Intrathecal Injection
• Myelography
• Pediatric Myelography
• Enhancement of CT spine images

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IODINATED Contrast Agents

• IONIC
• High Osmolality (Higher risk of complications)
• Diatrizoate sodium (Hypaque)
• Iothalamate meglumine (Conray)

• NON-IONIC
• Low Osmolality (Lower risk of complications)
• Gadodiamide (Omniscan)
• Iodixanol (Visipaque)
• Iopamidol (Isovue)
• Iopromide (Ultravist)
• Ioversol (Optiray)

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Shell fish allergies Too bad for the patient
Not important in Radiology!
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Adverse Reactions

• Caused By Osmolality of the Media
• Osmolality The number of particles when in a
  solution form.
• The more particles in solution the more water is
  drawn toward the molecule. This causes a change
  in the electrolyte balance in the body beginning
  the adverse reaction

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Iodine Contrast Material

• Ionic Iodine Contrast
• Anion -
• Cation
• More patient allergic reactions
• Non-Ionic Contrast
• Less patient allergic reactions

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IODINE WATER BASED CONTRAST

• IONIC
• LESS
• MORE REACTIONS

• NON-IONIC
• MORE
• LESS REACTIONS
• NON-IONIC PART 2
• ISOMOLAL
• EVEN LESS REACTIONS

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Visipaque (iodixanol)

• Isosmolar, Non-ionic
• Water-soluble
• Addition of electrolytes
• Not to be used for intrathecal injection
• 270 (49) or 320 (63)
• Better for patients with renal problems

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Ionic Iodine Contrast
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Non-ionic Contrast
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Non-ionic Contrast Isosmolar
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Dose standards for intravenous contrast agents

• Adults
• Typically 100ml to 150ml is used for all patients
  regardless of body weight
• 200 ml used for angiography or CT angiography
• Maximum of 200 ml can be used in one day must
  test BUN Creat again prior to next contrast
  injection.

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Dose standards for intravenous contrast agents

• Pediatrics
• Standard of 2.0 ml/kg for pediatrics
• Sometimes a simpler division of patients into 2
  or 3 categories is used.  (eg. small/medium/large.
  )

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Converting Pounds to Kilograms

• 1 pound (lbs) 0.45 kilograms
• 1 kg 2.2 lbs (pounds)
• Patient wt 35 lbs
• How much contrast do you give?

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Contrast Dose Calculation

• 35 lbs X 0.45 15.75 kg
• 15.75 X 2 31.5ml of contrast
• little less than 1ml per lb

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CALIFORNIA HEALTH AND SAFETY CODE

• general supervision of a physician and surgeon to
  perform venipuncture
• What does general supervision mean?
• What else does the law specify for scope of
  practice?

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IONDINATED CONTRAST

• ISOVUE 200(41), 300(61) or 370 (76)
• What does the tell
• You?

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Contrast Dose Calculation

• Patient wt 60 lbs
• How much contrast should you administer?