GU imaging - INTERVENTIONAL Flashcards
(48 cards)
1
Q
Cystogram
A
Fluoroscopic study that images the bladder
2
Q
Patient indications for a cystogram
A
- Bladder outlet obstruction
- Haematuria
- Trauma
- Congenital anomalies of the GU tract
- Postoperative evaluation of urinary tract
3
Q
Contraindications of a cystogram
A
- Recent bladder surgery
- Blockage of the urethra, or damage or tearing of the urethra
- Acute phase of UTI
4
Q
Complications of a Cystogram
A
- UTI
- Trauma to tissues during catheterisation
- Bleeding
- Pain
5
Q
Patient Prep for a Cystogram
A
- Patient wears a gown
- Privacy and Dignity of the patient are upheld
- Patient is warned about sticky contrast
6
Q
AP Cystogram procedure
A
- patient is catheterised (if a catheter is not in situ)
- patient is given 200ml of Omnipaque contrast
- start contrast flow and take images to show the bladder filling
7
Q
Cystogram - 45 degrees oblique
A
- the detector is angled to the right of the patient and an image is taken
- the detector is angled to the left of the patient and an image is taken
8
Q
Cystogram left lateral
A
- the detector is by the patient’s left side
9
Q
Cystogram AP single shot
A
AP view taken after bladder is filled
10
Q
Micturating Cystourethrogram
A
- A fluoroscopic procedure to show filling AND emptying of the bladder
11
Q
micturating cystourethrogram (MCUG) child indications
A
- recurrent UTI’s
- Congenital abnormalities
- post op evaluation
12
Q
micturating cystourethrogram (MCUG) adult indications
A
- Recurrent UTI’s
- Dysfunction
- Fistula
- Post op evaluation
13
Q
micturating cystourethrogram (MCUG) contraindications
A
- Recent bladder emergency
- Blockage of the urethra, or damage or tearing of the urethra
- Acute phase of urinary tract infection
14
Q
micturating cystourethrogram (MCUG) complications
A
- patient can develop a Urinary tract infection
- There may be trauma to tissues during catheterisation
- bleeding
- pain
15
Q
micturating cystourethrogram (MCUG) patient prep and care
A
- patient is given a gown
- privacy and dignity is upheld
- contrast warning is given
- consider room temperature
16
Q
Female Paediatric MCUG imaging views
A
- AP view
- Oblique view
- Renal area
- Bladder emptying
17
Q
Male Paediatric MCUG views
A
- Bladder filling
- Oblique view - Reflux of contrast and hydroureter demonstrated
18
Q
Urethrogram
A
A contrast study of the urethra under fluoroscopic control
19
Q
Urethrogram Indications
A
- Fistula
- Strictures
- Obstruction
- Trauma
20
Q
Urethrogram complications
A
- Patient can develop a Urinary tract infection (UTI)
- Trauma to tissues during Catheterisation
- Bleeding
- Pain
- Contrast Intravasation
21
Q
Contrast Intravasation
A
Backflow of injected contrast into the adjoining vessels (mostly veins)
22
Q
Urethrogram contraindications
A
- Recent bladder surgery
- Acute phase of UTI
23
Q
Urethrogram patient prep and care
A
- Patient is given a gown
- privacy and dignity are upheld
24
Q
Urethrogram patient care
A
- communication
- consent
- modest covering
- Aseptic technique
- reassurance
- privacy dignity
- Gown
25
Urethrogram after care
- give warnings about sticky contrast
- patient should drink loads of fluids
- Information about where and how to get results
- How to deal with any possible issues post procedure
- paperwork
26
Percutaneous Nephrostomy
The insertion of a catheter through the skin and into the renal pelvis under the guidance of fluorography and/or ultrasound. to drain kidney externally
27
Nephrostomy indications
- Relief of urinary obstruction
- Access- therapeutic treatment
- Urinary diversion
- to drain kidney externally, if there is injury to the ureter
28
Nephrostomy contraindications
- coagulation INR >1.4
- Contraindications to contrast
- Contraindication to sedation
- Patient must be cooperative
29
Nephrostomy complications
- pain
- tube displacement
- Urine leak into abdomen
- pneumothorax
- infection/sepsis
- bleeding
- injury to other abdominal organs and structure
30
Nephrostomy patient presentation
- Hydronephrosis
- pain in flank
- nausea
- vomiting
- tiredness
- pain on urination
- UTI
- Sepsis/fever
31
Nephrostomy pre-imaging
- Ultrasound
| - CT ("stone prone" - non contrast, ?leak = contrast)
32
Nephrostomy patient preparation
- recent blood tests including INR
- overnight monitoring
- Nil by mouth for previous 6 hrs
- Appropriate antibiotics
- gown
- patent cannula in either arm
- completed consent form
33
nephrostomy procedure 1
- patient is positioned prone oblique, with affected side raised
- patient is monitored
- area is cleaned and prepped
- local anaesthetic...
- needle is positioned and probe is parallel, to image needle fully
- WHO check
34
Nephrostomy procedure 1- ultrasound of kidney
- is the renal pelvis dilated enough?
- Assess and mark access point
- position of ribs/ major vessels
- choose an avascular plane into minor calyx
35
Ureteric Stenting
The placing of a catheter between the kidney and the bladder, to affect the internal drainage of the urinary system.
- can be done retrograde or antegrade
36
The radio-opaque marker at the proximal end of the Ureteric stent aids..?
aids with positioning
37
Nephrostomy- fluoroscopy
- Access needle is moved into position, with guidance from fluoroscopy/nephrostogram - contrast is used
- A guidewire is inserted and the needed is taken out
- a dilator is put on
- A catheter is inserted over the guidewire
- once access hole is dilated, the dilator is taken off
- the nephrostomy catheter is put on and manipulated into position
- nephrostogram is checked and pigtail catheter is locked in place
- the site is cleaned and dried
- drainage bag is attached
38
Ureteric stenting procedure
- nephrostogram is taken
- contrast is injected, to see the level of the stricture/blockage
- wire and catheter are manipulated into PUJ
- then down the ureter and into the bladder
- stent is then deployed
- image is checked
39
Retrograde ureteric stenting performed under....
general anaesthetic
40
Retrograde ureteric stenting patient is positioned
supine, with leg rests
41
Retrograde ureteric stenting contrast is injected
in retrograde- against the flow
42
Retrograde ureteric stenting urologists do
a cystoscopy
43
Retrograde ureteric stenting - stent deploy
urologist deploys stent under fluoro control
44
Retrograde ureteric stenting procedure
- nephrostogram is checked - retrograde contrast injection
- wire is manipulated into renal pelvis
- stent is positioned over the wire under fluoro control
45
P.C.N.L - Percutaneous nephrolithotomy
this is where the lithotripter is passed through a small incision into the kidney
46
lithotripter
a noninvasive device that breaks up kidney stones - by passing electromagnetic shock waves.
47
P.C.N.L professionals involved
Radiologist, radiographer and IR Nurses.
Urologists and their team
Anaesthetics team
48
P.C.N.L
- Urologists cannulate the kidney via cystoscopy and contrast is injected
- The radiologist performs the nephrostomy under U/S guidance
- Dilators are passed over the wire
- An access cannula is positioned over the wire
- The stone is then broken up using a laser fibre, a lithoclast (small pneumatic drill) or an ultrasonic suction probe
- The fragments are then removed and the nephrostomy tube is placed and left for about 3 days
