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Patient Care-CTBC > Contrast Administration (29/30) > Flashcards

Contrast Administration (29/30) Flashcards

1
Q

Most common IV contrast injection complications (4)

A

Extravasation
Air Embolism
Adverse Reactions
Contrast-Induced Nephrotoxicity

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2
Q

Extravasation: Acute local inflammatory response (time)

A

may peak at 24-48h

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3
Q

Extravasation: Next Steps (3)

A

Notify Radiologist
Elevate extremity
Apply hot/cold to encourage good blod flow/accelerate resorption/relieve Pn

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4
Q

Air Embolism

A

Clinically significant: large-volume (potentially fatal, but rare)
Clinically insignificant: small-volume (common)

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5
Q

Air Embolism: SE (9)

A

Air hunger
Dyspnea
Cough
CP
Pulmonary edema
Tachycardia
Hypotention
Expiratory wheezing
Neurologic deficits from stroke d/t decreased cardiac output or paradoxical air embolism (from rt–>lt side of heart occluding a instead of v)

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6
Q

Air Embolism: Treatment (3)
Admin…
Position…
Initiate…

A

Admin 100% O2
Position in left lateral decubitus
Initiate CPR if indicated

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7
Q

Adverse Reactions: Mild (7)

A

Scattered urticaria (hives)–most commonly reported
Pruritis (itching)
Rhinorrhea (runny nose)
Nausea, brief retching (“dry heaving”) and vomiting
Diaphoresis (sweating)
Coughing
Dizziness

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8
Q

Adverse Reactions: Dizziness

A

Mild

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9
Q

Adverse Reactions: Coughing

A

Mild/Air Embolism

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10
Q

Adverse Reactions: Diaphoresis

A

Mild

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11
Q

Adverse Reactions: Nause/Dry Heave/Vomiting

A

Mild

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12
Q

Adverse Reactions: Rhinorrhea

A

Mild

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13
Q

Adverse Reactions: Pruritis

A

Mild

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14
Q

Adverse Reactions: Scattered urticaria

A

Mild

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15
Q

Adverse Reactions: Moderate (10)

A

Persistent vomiting
Diffuse urticaria
Headache
Facial edema
Laryngeal edema-moderate
Bronchospasm/dyspnea-moderate
Palpitations-moderate Tachycardia,Bradycardia
Hypertension
Abdominal cramps

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16
Q

Adverse Reactions: Persistent Vomiting

A

Moderate

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17
Q

Adverse Reactions: Diffuse Urticaria

A

Moderate

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18
Q

Adverse Reactions: Headache

A

Moderate

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19
Q

Adverse Reactions: Facial Edema

A

Moderate

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20
Q

Adverse Reactions: bronchospasm or dyspnea

A

Moderate or Severe

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21
Q

Adverse Reactions: Palpitations, tachycardia, bradycardia

A

Moderate

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22
Q

Adverse Reactions: Hypertension

A

Moderate

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23
Q

Adverse Reactions: Abdominal cramps

A

Moderate

24
Q

Adverse Reactions: Severe (7)

A

Life-threatening arrhythmias (i.e., ventricular tachycardia)
Altered mental status
Severe hypotension
Severe bronchospasm
Laryngeal edema
Pulmonary edema
Seizures, syncope, death

25
Q

Adverse Reactions: Life-threatening arrhythmias (i.e., ventricular tachycardia)

A

Severe

26
Q

Adverse Reactions: Altered Mental Status

A

Severe

27
Q

Adverse Reactions: Hypotension

A

Marked Hypotension: Severe
Hypotension also indicative of possible air embolism

28
Q

Adverse Reactions: Laryngeal Edema

A

Moderate/Severe

29
Q

Adverse Reactions: Pulmonary Edema

A

Severe

30
Q

Adverse Reactions: Siezures, Syncope

A

Severe

31
Q

Adverse Reaction: Next Steps (6)

A

D/C contrast admin
Call for RN/MD support
Assess ABCs
Acquire vitals
Have contrast reaction kit/O2 mask on-hand
Call code PRN

32
Q

Observation time for Mild Adverse Reaction (3)

A

20-30 min
May evolve into moderate/severe
Hypotension may be clinically silent while patient is supine

33
Q

Moderate/Severe Adverse Reaction: Medical Interventions (6)

A

O2 by mask
Antihistamine for hives/itching/running nose
Beta agonist inhaler for bronchospasm
Epinephrine for hypotension
Epinephrine for laryngeal edema
Furosemide for pulmonary edema

34
Q

Adverse Reaction: Tx for Urticaria/Pruritis/Rhinorrhea

A

Benadryl/Antihistamine

35
Q

Adverse Reaction: Tx for Bronchospasm

A

Albuterol/Beta Agonist Inhaler

36
Q

Adverse Reaction: Tx for Laryngeal Edema

A

Epinephrine

37
Q

Adverse Reaction: Tx for Pulmonary Edema

A

Lasix/Furosemide

38
Q

Contrast-Induced Nephropathy: definition

A

Sudden deterioration in renal function d/t IV admin of iodine contrast
Noted by sharp degradation in renal function lab values: creatinine, BUN, GFR

39
Q

Contrast-Induced Nephropathy: Risk Factors (9)

A

Mult Iodine Admins in short interval
Pre-existing renal insufficiency
Dehydration
Advanced age
Multiple myeloma
Diabetes
Cardiovascular Ds
Diuretic use
HTN

40
Q

Contrast-Induced Nephropathy: Max lab values

A

No agreed-upon threshold of serum creatinine or eGFR
Contrast admin always implies a risk-benefit analysis

41
Q

Iodine Contrast: Strict Contraindications (3)

A

Iodine Allergy
Renal failure
Recent contrast admin

42
Q

Iodine Contrast: Relative Contraindications (3)

A

Pregnancy
Lactation
Dialysis

43
Q

Iodine Contrast Relative Contraindication: Pregnancy

A

Iodine contrast shown to cross human placenta and enter fetus in clinical doses
In-vivo animal testing shows no evidence of mutagenic/teratogenic effects w/LOCM

44
Q

LOCM

A

Low-Osmolality Contrast Media

45
Q

Iodine Contrast Relative Contraindication: Lactation

A

Less than 1% of admin’d maternal dose excreted into breast milk in 1st 24h
Less than 1% of contrast medium ingested by infant is absorbed from GI tract
Expected systemic dose absorbed by infant: <0.01%

46
Q

Iodine Contrast Relative Contraindication: Lactaion-Pump&Dump

A

Often encouraged by Radiologists d/t nearly 100% excretion cleared from her bloodstream within 24h
Ultimate choice lies w the mother

47
Q

Iodine Contrast Relative Contraindication: Dialysis-Anuric ESCKD

A

No risk of further damaging kidneys (which are no longer functioning)

48
Q

Iodine Contrast Relative Contraindication: Dialysis-Oliguric

A

Speculative risk of converting Pt to anuric

49
Q

Oliguria

A

Urine output of 80-400/500 mL per day

50
Q

Oliguria: Children

A

Less than 0.5 mL/kg/h

51
Q

Oliguria: Infants

A

Less than 1 mL/kg/h

52
Q

Iodine Contrast Relative Contraindication: Dialysis-Theoretical Risk (2)

A

Intravascular volume from IV iodine osmotic load may not be readily cleared & may result in
Pulmonary Edema
Anasarca

53
Q

Anasarca

A

General accumulation of serous fluid in various tissues and body cavities characterized by swelling of the whole body.

54
Q

Iodine Contrast Relative Contraindication: Dialysis-Dose Mitigation

A

Use of LOCM or Iso-osmolar Contrast w/dosing as low as necessary to achieve Dx

55
Q

Iodine Contrast Relative Contraindication: Dialysis-When to dialyze immediately (2)

A

Cardiac dysfunction
Volume overload

56
Q

Iodine Contrast Strict Contraindication (3)

A

Iodine Allergy~adverse reactions commonly avoided via use of corticosteroids/anti-histamines
Renal Failure~sometimes urgency outweighs risk
Recent Contrast Admin (d/t POSS of inducing renal failure)~sometimes urgency outweigh risk

57
Q

Adverse Reaction: Tx for Hypotension

A

Epinephrine

Patient Care-CTBC (4 decks)

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