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

SB 571 VENIPUNCTURE Chaptered 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 HEALTH AND SAFETY CODE SECTION

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 CO2)  Radiolucent  Low atomic # material  Black on film  Positive contrast  (all others)  Radiopaque  High atomic # material  White on film

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*

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 kVp (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 $$$  MORE REACTIONS  NON-IONIC  MORE $$$  LESS REACTIONS  *NON-IONIC PART 2  ISOMOLAL  EVEN LESS REACTIONS

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)

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 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.

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 = kg  X 2 = 31.5ml of contrast