Venipuncture and Pharmacology for Radiologic Technologists RTEC 93

Venipuncture and Pharmacology for Radiologic Technologists RTEC 93 10: 30 am- 12: 40 pm Monday 1 pm – 3: 10 pm Wednesday

SB 571 VENIPUNCTURE • Chaptered 97 -0384 • Radiologic Technologic: Venipuncture • 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.

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

CALIFORNIA HEALTH AND SAFETY CODE SECTION 106955 -107111

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

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.

CONTRAST MEDIA § CONTRAST § X-RAY “DYE” § COLORLESS OR WHITE

Contrast Media § Negative contrast § (AIR OR CO 2) § Positive contrast § (all others) § Radiolucent § Radiopaque § Low atomic # material § High atomic # material § Black on film § White on film

2 BASIC TYPES OF CONTRAST § BARIUM Z# 56 § IODINE § NON WATER SOLUABLE § GI TRACT ONLY INGESTED OR RECTALLY § KVP 90 – 120* § § § Z# 53 POWDER LIQUID INTRAVENOUS OR GI TRACT KVP BELOW 90*

Water Soluble Iodine § High atomic # 53 § Radiopaque § Used to radiograph § § Vessels Arteries Veins Function of internal organs

KVP TYPE OF CONTRAST USED DETERMINES KVP RANGE § IODINES 70 – 80 k. Vp (Ionic / Nonionic Water or Oil)

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

ISOVUE-M 200 OR 300 (iopamidol) § Intrathecal Injection § Myelography § Pediatric Myelography § Enhancement of CT spine images

IODINE WATER BASED CONTRAST § IONIC § LESS $$$ § NON-IONIC § MORE $$$ § MORE REACTIONS § LESS REACTIONS § *NON-IONIC PART 2 § § ISOMOLAL EVEN LESS REACTIONS

IODINATED Contrast Agents IONIC NON-IONIC § High Osmolality (Higher § Low Osmolality (Lower risk of complications) § Gadodiamide (Omniscan) § Diatrizoate sodium § Iodixanol (Hypaque) (Visipaque) § Iothalamate § Iopamidol (Isovue) meglumine (Conray) § Iopromide (Ultravist) § Ioversol (Optiray)

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

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

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

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

Ionic Iodine Contrast

Non-ionic Contrast

Non-ionic Contrast: Isosmolar

Dose standards for intravenous contrast agents § Adults § Typically 100 ml to 150 ml 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.

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. )

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?

Contrast Dose Calculation § 35 lbs X 0. 45 = 15. 75 kg § 15. 75 X 2 = 31. 5 ml of contrast