IV practical sessions

Question 1

steps to iv

Answer 1

• wash hands and wear gloves
• sterilise your equipment tray with a 70% alcohol wipe
• add equipment in preparation for cannulation
• apply tourniquet
• insertion site should be visually inspected and vein palpated in antecubital fossa
• wipe site with 70% alcohol and wait to dry
• open sterile cannula
• hold needle bevel over middle of vein
• insert needle at shallow angle then reduce once in vein
• secure cannula using tape/ dressing
• remove needle and dispose in a sharps box
• check for flashback
• remove tourniquet
• flush with 0.9% saline to check vein is patent
• check for pain, swelling, bruising, if extravasation STOP
• remove needle and apply pressure for 3 minutes

Question 2

what should you check with the patient for prior to removing the needle

Answer 2

if the patient takes anticoagulants (blood thinners)

Question 3

early detection pointers for extravasation

Answer 3

• pt complains of moderate or severe pain, burning, stinging or acute changes at injection site
• redness, swelling or leakage at injection site
• resistance experienced when attempting to flush cannula
• high pressure registered in injector system when administering medication
• no blood return is observed or aspiration - the presence of blood does not exclude extravasation

Question 4

what are the steps for initial first aid

Answer 4

• stop injector pump immediately (disconnect)
• explain to the pt what you think may have happened , inform radiologist on call to come and assess
• aspirate residual drug and blood from cannula
• apply cold compress
• elevate affected limb
• if over 20mls delivered, plastic surgeon on call consulted
• provide pt extravasation pt aftercare leaflet
• complete incident form

Question 5

PGD

Answer 5

patient group direction

Question 6

PSD

Answer 6

patient-specific direction

Question 7

why were PGDs and PSDs developed

Answer 7

to facilitate optimal service provision

Question 8

who can work under PGD

Answer 8

only professional groups such as radiographers, HCAs cannot

Question 9

what is a PSD

Answer 9

a direct written instruction for a named pt, unlike PGD is doesnt require assessment of patient
- the radiographer writes the type, strength and amount of contrast agent given to the named pt

Question 10

what should PSDs include

Answer 10

• name of pt
• route of administeration
• frequency
• date of treatment
• signature of prescriber

Question 11

what should radiographers be aware of when it comes to PGDs and PSDs

Answer 11

• associated literature like aftercare sheets
• the doctor available in case of adverse drug reactions
• inclusion and exclusion criteria
• recording of type, dosage and route of administration of contrast media

Question 12

PGDs and their future summed up

Answer 12

• has been audited from a number of trusts
• found that the decision making around PGDs were problematic and sometimes inconsistent
• agreed it isnt the suitable mechanism for administration of contrast media however no other mechanisms have been determined
• new PGD templates = reviewed by specialists, regularly updated and ensure clinical and legislative parameters are met

Question 13

what are new drugs to the market called

Answer 13

black triangle drugs

Question 14

what scheme should adverse drug affects be reported to?

Answer 14

yellow card scheme

Question 15

what is the yellow card scheme

Answer 15

collects information on suspected problems or incidents involving side effects, medical device adverse incidents, defective medicines, counterfeit/ fake medicines and safety concerns

Question 16

MHRA

Answer 16

medicines and healthcare products regulatory agency

Question 17

CM

Answer 17

contrast media

Question 18

what is an IV contrast agent

Answer 18

alters opacity of vessels, tissues and cavities within body when using imaging modalities and increase contrast difference between structures

Question 19

what is an active ingredient in omniopaque

Answer 19

ioxegol - 46% iodine
- a chemical compound in a solution specific to each modaliity

Question 20

what is the clinical significance of IV contrast media

Answer 20

• enhanced visibility of vascularised structures
• perfused
• allows enhanced localisation, visualisation and treatment of abnormalities. disease/ lesions

Question 21

why IV instead of IA contrast examinations

Answer 21

• depends on anatomy being visualised and treatment being done
• consider risks and which route is more high risk

Question 21

how does IV contrast function for x ray

Answer 21

alters attenuation

Question 21

how does IV contrast function for MRI

Answer 21

alters paramagnetic effects

Question 21

how does IV contrast function for US

Answer 21

alters echogenicity ( reflection of sound waves)

Question 21

what are the characteristics of IV contrast for X ray

Answer 21

- contains iodine (iodinated contrast) - eg omniopaque/ visipaque - effective contrast due to iodine high atomic number and ease of attachment to organic compounds

Question 21

how does IV contrast alter x-ray attenuation?

Answer 21

- body mostly made up of fat and water - contain lots of hydrogen, oxygen and carbon

Question 21

how does IV contrast affect x ray attenuation

Answer 21

IV contrast contains Iodine which has a high atomic number, absorbs more x rays

Question 22

why does a higher atomic number mean greater x ray absorption

Answer 22

atoms with higher atomic number have more and tightly bound electrons making x ray absorption more likely

Question 22

what contrast does MRI use?

Answer 22

gadolinium

Question 23

what does a t1 weighted image mean

Answer 23

- lower signal for water - high signal for fat

Question 24

what does a t2 T2-weighted image mean

Answer 24

- lower signal for fat - higher signal for water

Question 25

iv contrast for ultrasound

Answer 25

- contains the inert gas sulphur hexafluoride - eg sonovue - microbubbles increase the echogenicity of the anatomy - higher echogenicity appears lighter on images

Question 26

what does osmolality determine

Answer 26

the amount of fluid shift/ transfer across blood cell membranes

Question 27

low osmolar contrast medium

Answer 27

- causes minimal fluid transfer across membrane, out of RBCs

Question 28

iso osmolar

Answer 28

- causes no fluid transfer across membrane of RBCs is the least nephrotoxic contrast media

Question 29

high osmolar contrast medium

Answer 29

causes fluid transfer across RBCs due to the osmotic gradient caused by high osmolality of CM compared to blood

Question 30

contrast used for CT and its purpose

Answer 30

- iodinated IV - enhances vessels/ organs via XR absorption

Question 31

Contrast used for MRI and its purpose

Answer 31

- gadolinium - alters magnetic properties, improves signal

Question 32

contrast used for US and its purpose

Answer 32

- microbubble agents - reflect sound, used in echocardiography and liver imaging

Question 33

non ionic contrast media

Answer 33

- do not dissociate into ions in solution - lower osmolality --> fewer side effects - better tolerated in most patients

Question 34

ionic contrast media

Answer 34

- dissociate into charged particles - high osmolality --> more discomfort and higher risk of adverse reactions - less expensive, used in limited cases today