1. Patient Education & Assessment RTEC 93 Venipuncture

2. Question? The patient’s doctor ordered the exam, therefore the patient must be able to have contrast material

3. Question? The patient must have been told by an ordering physician or nurse about what is going to happen during this examination in x-ray.

4. Patient Education The way we are told is directly related to the way we will react to the information

5. Patient Education Careful explanation and a confident, understanding attitude can help the patient relax. A relaxed patient makes venipuncture easier. Vasoconstriction

6. Information A consent must be provided in terms the patient can understand. In a language they can understand. The patient’s questions must be answered in “layman’s” language.

7. Procedure Explain the steps in the procedure Expected duration Any limitations or restrictions Address any “horror” stories the patient may have heard Post care instructions Results of the Exam

8. Never, Never, Never, Never Never tell the patient that inserting a needle for venipuncture does not hurt. Especially children, they will never trust the medical staff again.

9. Always be truthful The technologist must tell the truth and explain that the amount of pain experienced varies with each patient. You will do your best to keep the discomfort to a minimum and TRY to get it right the first time.

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

13. Reactions to Contrast Let the patient know what is normal (expected) or abnormal reactions to contrast material Expected: Flash of heat from head to toe –Strange or metallic taste in the mouth –Feeling like they have to urinate or are urinating –Increased heart rate

14. Let me know if…… You have difficulty breathing You feel itchy You feel nauseous You feel faint Your arm starts to hurt or burn

15. Contrast Reactions If a patient is going to have a contrast reaction it will happen within the first 1-5 minutes after injection. If the patient is going to have a life threatening reaction it will happen almost immediately

16. Patient Assessment The patient must be assessed before any medication is administered. Information about a history of allergy must be obtained and documented. The patient must be screened thoroughly by the technologist for contraindications of contrast media.

17. Venipuncture Before venipuncture is performed, the technologist needs to be aware of: –Potential for an allergic reaction –Contraindications for contrast material –Site preparation for injection –Adverse reaction to contrast –How to deal with medical emergencies

18. Patient Assessment You need to clear EVERY patient for contrast administration. Every time with no exceptions!

19. Check List Do you have any allergies?

20. Patient Assessment Check List

21. BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast WATCH THE UPPER LIMITS BUN = BLOOD UREA NITROGEN Merrills pg 214 range is 8 to 25 pg 242 range is 10 - 20 always check with RAD when level above 20 CREATINE levels range: pg 214 (0.6 - 1.5) pg 242 (0.05 - 1.2) always check with RAD when level above 1.2 Indicates function of kidneys Diseases / dehydration / kidney failure

22. BUN & Creatinine BUN – Blood urea nitrogen –Measure the amount of urea nitrogen in the blood –Could be elevated due to dehydration –Normal = 8-25 mg/dl Creatinine –Measures the amount of creatine in the blood –Normal = 0.05-1.5 mg/dl (milligrams per deciliter)

23. Creatinine clearance vs Creatinine In general, creatinine clearance is the removal of creatinine from the body. In renal physiology, creatinine clearance (CCr) is the volume of blood plasma that is cleared of creatinine per unit time.renal physiology blood plasma The result of this test is an important gauge used in assessing excretory function of the kidneys

24. Creatinine clearance vs Glomerular filtration rate (GFR) Clinically, creatinine clearance is a useful measure for estimating the glomerular filtration rate (GFR) of the kidneys. glomerular filtration rate kidneys creatinine clearance overestimates actual GFR by 10-20%. This margin of error is acceptable considering the ease with which creatinine clearance is measured

26. Normal ranges *According to wikipedia.org For most patients, a GFR over 60 ml/min is adequate. But, if the GFR has significantly declined from a previous test result, this can be an early indicator of kidney disease requiring medical intervention.

27. Normal ranges *According to wikipedia.org Normal reference ranges for creatinine clearance are:reference ranges Low High Male 55 146 ml/minute/1.73m2 Female 52 134 ml/minute/1.73m2

28. Patient Assessment Check List Have you had an exam like this before? Have you had iodine before, x-ray dye, contrast, or an x-ray exam where they have put something in your vein? If Yes – did anything bad happen after the injection?

29. Allergic to Iodine General Rule: No Contrast –Pre – medication is available

30. Check List Check for Diabetes –Glucophage or Metphormin –Renal failure Renal Failure –Diabetic –Removal of Kidney Anyone over the age of 50 or anyone with a history of renal failure must have there BUN level and creatinine level evaluated. To determine renal function.

31. Renal Failure Patients General rule: No Iodine –Renal insufficiency –Renal failure 2 types of patients

35. Post Care Drink plenty of H20 for the rest of the day At least 8 glasses today Other types of fluids are good as well

36. Take Good Care of Your Patient’s!