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

ANSWERS

Q:-Can contrast be injected into this implanted port?

Before giving a contrast the nirse should make sure about which port is implanted and if it is a power injectable port then we can provide the contrast through it.

When you have your implanted port placed, your nurse will let you know if you have a power-injectable port. They will also give you a wallet card with information about your implanted port which must be with you at all times.

Q:-Who must access the port?

A well trained radiology department Nurse or a Radiologist can access the port. The port must be only accessed by a trained well known person and all athe asceptic precautions should be followed

When the client needs IV fluids or contrast or medication, the nurse will place a needle through the access point on your implanted port and this process is called accessing your port

The fluid or medication will move from your implanted port through the catheter and into your bloodstream or to the vein which the catherter acess is and it is then supplied to bloodstream.

Q:-List methods of identifying if a port is power injectable?

The Power Injectable Implantable Infusion Port is an implantable access device designed to provide repeated access to the vascular system.
This port can be identified by its features like

*It consists of two primary components: an injection port with a self-sealing silicone septum and a radiopaque catheter.
*An implantable Infusion Ports can be identified subcutaneously by feeling the top of the septum and the top rim of the port housing.
*This port can also be identified by the letters “CT” under radiographic imaging.

these are the methods to identify the Power injectable port

Q:-What precautions must be addressed following the injection of contrast media?

As the patient is having previous hitory of allergy and her BUN levels are raised and creatinine up to mark these are the precautions to be taken
Before proceeding anything follow institutional protocol to verify correct catheter tip position via radiographic image prior to power injection and look for the patient reports creatinine and BUN levels and identify the patient by the demographic data
-Access the port with an appropriate non-coring needle. Make sure that needle tip is inserted fully within the port.
-Provide a comfortable position for the client
-Instruct the patient to assume the position they will be in during the power injection procedure, before checking for patency. If possible, the patient should receive power injection with his or her arm vertically above the shoulder with the palm of the hand on the face of the gantry during injection. This allows for uninterrupted passage of injected contrast through the axillary and subclavian veins at the thoracic outlet.
-Make sure that you aspirate for adequate blood return and vigorously flush the port with at least 10ml of sterile normal saline.
-Make sure that the contrast is warm to the clients body temperature.
-Attach the power injection device to the needle ensuring connection is secure. Check indicated flow rate and confirm CT settings.
-Flow rate should be set for 5 ml /s for 19 and 20 gauge needle and 2ml/s for 22 gauge needle
-Advice the patient to respond immediately to any reaction felt.
-Make sure that there is no exceed in the flow rate limits.

-look for any reactions and if local pain, swelling or signs of extravasation are noted, the injection should be stopped immediately.
-Perform heparin lock procedure. Remember that some patients may be hypersensitive to heparin or suffer heparin induced thrombocytopenia (HIT). These patients must not have their port primed with heparinized saline.
-After procedure the port must be flushed.

Q:-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?

-The patient with known hypersensitivity must be taken care properly and must be adressed properly

-Pretreatment of patients who have such risk factors with a corticosteroid and diphenhydramine decreases the chance of allergic reactions, including anaphylaxis, renal failure, or a possible life-threatening emergency.
-Awareness of the different types of risk factors and prescreening for their presence allows for early recognition and prompt treatment. And a proper history must be taken to know whether the patient have any previous history of contrast indution and any side efffects.
-Prophylactic treatment before administration of contrast material can prevent potential adverse reactions.
-Any such reactions which occur during procedure must take prompt recognition allows them to be treated immediately.
-By using the smallest amount of contrast material possible and low-molecular, nonionic agents also decreases the relative risk of reactions.

-Renal insufficiency induced by contrast material may be prevented by ensuring adequate hydration and discontinuing other nephrotoxic medications before the procedure.