Question

A 65-year-old patient is recovering from a recent total Rt. knee replacement. The patient was complaining of dyspnea /shortness of breath. The patients RN has mentioned the following test results; elevated d-dimer, low O2 sats, and a Rt. Lower leg DVT seen on a doppler ultrasound done earlier today. The patient’s Dr. fears the patient may have a pulmonary embolism. Please address the following elements;

The patient has a 24 gauge IV in the back of the hand. The patient also has an implanted mediport. Can contrast be injected into this implanted port? Who must access the port? List methods of identifying if a port is power injectable. What precautions must be addressed following the injection of contrast media?

The patient has the following lab values BUN 40, Creatinine 1.6 mg/dl.

The patient states a history of mild hypersensitivity (mild hives and itchy watery eyes) to iodinated contrast media. What concerns do you have regarding this order and the patient’s medical history?

Answer 1

Implanted Port overview: An implanted port also known as a 'port' is a flexible tube that is placed into a vein about 1 inch (2.5 centimeters) below the center of the right collarbone. It will make it easier for healthcare team to:

• Give intravenous medication or fluids
• Take blood samples.
• Give medications continuously for several days.

Question:  Can contrast be injected into this implated port?

Answer: Usually contrast can be injected through implantated mediport. But in the above patient scenario, The BUN level and creatinine are increased , so high risk is involved.

Question: Who must access the port?

Answer: A registered nurses who are trained to handle implanted ports can access the port.

Question:List methods of identifying if a port is power injectable.

Answer:

1.One way to identify by determining the injectable port volume.   For power injectable implantable infusion port devices, during insertion the port volume will be determined and this will be recorded in a card. This will be handed over to the patient and patient needs to carry this always. So the information in the card will give you the information that it is power injectable or not.

2. Secondly, the most reliable method, Power Injectable Implantable Infusion Ports can be identified by the letters 'CT' under radiographic imaging.

Question: What precautions must be addressed following the injection of contrast media.

Answer:

1. As the patient in the above scinario is already having the history of allergy to iodinated contrast, there is high risk for contrast reactions like anaphylactic reactions. Precautions should be taken to manage this. So all emergency drugs should be available.

2. Monitoring BP frequently for early identification of contrast reations.

3. Fluid intake and out put should be closely monitored to make sure that the  contrast is flushing out.

Question: What concerns do you have regarding the order and patients medical history?

Answer:

1. Patient is suspected to have pulmanary embolism, so it is not safe to give more volume by injecting contrast.

2. Patient creatinine and BUN value is elevated, so there is high risk for kidney damage.

3. Patient has the history of allergic reactions to iodinated contrast, so high risk for contrast reactions like anaphylactic reactions can occur.