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Patient Care in CT

Patient Care in CT. By Prof. Jarek Stelmark. Patient Monitoring Vital sign assessment is the measurement of basic body functions to monitor critical information regarding the patient's physical condition . 2. Vital signs are temperature, pulse, blood pressure, and respirations :

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Patient Care in CT

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  1. Patient Care in CT By Prof. Jarek Stelmark

  2. Patient Monitoring • Vital sign assessment is the measurement of basic body functions to monitor critical information regarding the patient's physical condition. • 2. Vital signs are temperature, pulse, blood pressure, and respirations: • a.Normal body temperature is 97.7° to 99.5° F (36.5° to 37.5° C). • b.Pulse rate for adults ranges from 60 to 100 beats per minute. Pulse rate for children ranges from 70 to 120 beats per minute. • c.Systolic blood pressure indicates the pressure within arteries during cardiac contraction and should be less than 120 mm Hg. Diastolic pressure is measured during relaxation of the heart and should be less than 80 mm Hg. • d.Normal respiration rate for an adult is 12 to 20 breaths per minute, and that for a child is 20 to 30 breaths per minute.

  3. PULSE DETECTION SITES • APICAL • RADIAL • CAROTID • FEMORAL • POPLITEAL • TEMPORAL • DORSALIS PEDIS

  4. AVERAGE PULSE RATE IN: • ADULT MAN OR WOMAN - 60-90 BEATS/MIN • CHILD 4-10 YEARS - 90-100 BEATS/MIN • INFANT - 120 BEATS/MIN

  5. PULSE ASSESSMENT • TACHYCARDIA • BRADYCARDIA

  6. RESPIRATION RATES: • 10-20 B/MIN – ADULT • 20-40 EARLY CHILDHOOD • 30-60 NEONATAL • < 10 B/MIN FOR ADULT CYANOSIS

  7. CYANOSIS

  8. Normal Assesment Values:

  9. Laboratory Values

  10. Blood urea nitrogen (BUN) and creatinine level are laboratory values used to indicate renal function. • Normal BUN values in adults range from 7 to 25 mg/dL. Range may vary depending on laboratory testing reference. By itself, BUN is not a sufficient indicator of renal insufficiency. • b. Normal creatinine levels range from 0.5 to 1.5 mg/dL. Range may also vary with lab reference. An elevated creatinine value (>1.5 mg/dL) may not always indicate renal function compromise, because this value can vary widely with different populations. Recent changes in a patient's creatinine level are thought to be more informative as a renal function indicator. • c. The BUN/creatinine ratio may also be used to evaluate renal function. Normal BUN/creatinine ratio is approximately 6:1 to 22:1.

  11. Glomerular filtration rate (GFR) is a more accurate measure of renal function. GFR is an approximation of creatinine clearance or the rate by which creatinine is filtered from the blood stream. GFR is calculated using the patient's measured serum creatinine level and takes into account the patient's age, sex, and race. The normal range of GFR is 70 ± 14 mL/min/m2 for men and 60 ± 10 mL/min/m2 for women.

  12. Prothrombin time (PT) is a measure of blood coagulation. The normal range for PT is approximately 12 to 15 seconds.  Prothrombin time (PT) is measured in the lab after the addition of a protein called tissue factor to a patient's blood sample. Owing to the inherent differences in manufactured batches of tissue factor, the International Normalized Ratio (INR) is calculated to standardize PT results. The INR compares a patient's PT with a control sample for a more accurate result. The normal range for INR is 0.8 to 1.2. Partial thromboplastin time (PTT) is an additional lab value used to detect abnormalities in blood clotting. Normal range for clotting time is generally 25 to 35 seconds. Platelet count is also used to assess the patient's clotting ability. Normal platelet count is 140,000 to 440,000 per mm3 (or μL) of blood.

  13. D-dimer testing is utilized for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism. Although nonspecific, the presence of elevated amounts of D-dimer in the bloodstream may indicate recently degraded blood clots. If the D-dimer value is elevated, additional testing such as CT angiography of the pulmonary arteries may be indicated.

  14. There are generally two approaches to IV administration of iodinated contrast agents: a.Drip infusion, whereby the volume of contrast agent is administered at a slow rate over a long period. Because this method results in a slow rise in blood iodine concentration, it is no longer typically used in most CT procedures. b.Bolus injection, whereby the iodinated contrast agent is “pushed” into the bloodstream at a rapid rate over a short period. This results in a sharp peak of iodine concentration in the blood, yielding a more pronounced pattern of contrast enhancement. Bolus administration may be accomplished by hand, meaning that the volume of contrast agent is manually injected into the bloodstream.

  15.  Automatic power injectors are commonly used for IV administration of contrast agents during CT examinations.  Power injectors are capable of consistently injecting large volumes of contrast agent at flow rates up to 5 to 6 mL/sec. Flow rate is determined by several factors, including clinical area of interest, contrast volume, venous access, patient condition, and pressure capacity of the IV materials utilized. IV administration of contrast agent by power injector should be performed through flexible plastic angiocatheters rather than standard metal needles. 22-gauge angiocatheters are sufficient for flow rates up to 3 mL/sec. 20-gauge or larger angiocatheters should be utilized whenever flow rates exceed 3 mL/sec.

  16. Care must be taken to remove air from the injector syringe and connective tubing to eliminate the risk of air embolism.  Proper “bleeding” of the tubing eliminates air, and the injector syringe should remain in a downward position before administration of the contrast agent.  Once the total volume of contrast agent has been administered, scanning proceeds at set intervals based on the anatomic area of interest and the rate at which enhancement occurs

  17. Many special radiographic procedures require an injection of contrast medium under specific controlled conditions. Performing these injections by hand would make it difficult to maintain a consistent flow rate. Maintenance of a sufficient dilution of contrast agent in the blood is also difficult to achieve with an injection made by hand.

  18. CT Angiography requires the delivery of a specific amount and concentration of contrast agent to the target area. As the contrast agent enters the bloodstream, it is diluted. This dilution effect is dependent on several factors, such as the injection site, size of the vessel, and type and iodine concentration of the contrast agent. The target site determines the speed (rate of flow) of the injection. Vessel size also affects the concentration of the contrast agent. The larger the vessel, the greater the flow rate must be to maintain the proper concentration of contrast medium so that the desired anatomic features can be visualized radiographically.

  19. All automatic injectors have certain components in common; each is equipped with a control panel, syringe, heating device, and high-pressure mechanism.

  20. Control Panel Each of the automatic injection devices has a control panel that is used to set the parameters of the injection sequence . Depending on the unit and the optional equipment purchased, the control panel will appear more or less intricate. The injector systems are equipped with a touch screen display for ease of programming. Almost all of the units available are digitally controlled and ergonomically designed for ease of use. Some of the systems allow the control panel to be removed from the unit and taken to the control area during the procedure.

  21. Syringe In all automatic injectors, the syringe is removable. Disposable syringes are available for use with all automatic injectors; these are presterilized and can be installed easily. The manufacturers also offer prefilled syringes for use with their systems. The syringes are completely disposable, thereby eliminating the possibility of cross-contamination from reusable parts. Syringe capacity varies with brand. The syringes come in a variety of sizes depending on the company and the automatic injector. These range from 60 ml to 200 ml with sizes of 125 ml, 130 ml, and 150 ml also available. The smaller syringes (60 ml) find wide usage in pediatric studies.

  22. Heating Device The heating system is an electronic device that heats and maintains the contrast medium at or near body temperature and reduces the viscosity of certain contrast agents, thereby facilitating the setting of certain flow rates from the injector. It is usually located on the injector head close to the syringe. The syringe temperature is thermostatically controlled and is usually preset at the factory to a nominal 37° C (approximately 98° F). Heating time varies with the injector being used. Most injection device heaters can only maintain the temperature of the contrast agent. Therefore, the contrast agent should be pre-warmed when using injection devices equipped with this type of heater.

  23. CONTRAST WARMER TO REDUCE ITS VISCOSITY

  24. Safety Devices Acceleration regulators and pressure-limiting devices can add optional safety features to the automatic injection device. The acceleration regulator allows the drive motor to be accelerated over a specific period of time, which reduces the possibility of catheter whip.

  25. Injector Operation When programming the automatic injector, the radiographer must be concerned with one primary factor—the flow rate. Flow rate can be defined simply as the delivery rate (amount delivered per unit of time). It is dependent on the viscosity of the contrast agent, the length and diameter of the catheter, and the injection pressure. The flow rate chosen for a specific procedure is governed by the procedure itself, the vessel entered, the patient, and the nature of the disease. Flow rates can vary from as low as 0.5 ml/s to as high as 10 ml/s, depending on these factors.

  26. Constant Flow Rate When constant flow injectors are used, the desired flow rate and injection time are set, and the selected volume in milliliters per second will be delivered regardless of the variables involved. For example, if a flow rate of 5 ml/s and a volume of 100 ml are required, they are programmed on the injector as 5 ml/s injection rate for 20 s. This setting will deliver the specific volume at the desired flow rate regardless of the viscosity of the contrast medium or any other parameters involved. Care must be exercised when flow rates are set because too high a flow rate may injure the patient or damage the catheter.

  27. Catheter diameter. The catheter with the larger overall internal diameter (ID) (lumen) will provide less resistance against the flow of contrast media and require less pressure to maintain a selected flow rate. • 2. Catheter length. The catheter with the overall greater length will provide more resistance to flow than one that is shorter because the resistance is applied over a longer length of catheter tubing

  28. CT procedures require a high degree of control over the injection and its parameters to maximize the accuracy of the study. Injection systems used for CT have the same basic components as those used for angiography. The injector head can be either floor mounted or track mounted on an overhead system. In many cases, the console is mounted inside the control booth for maximum operator safety. The Liebel-Flarsheim CT 9000 ADV (Fig. 3-8) allows a variable flow rate, from 10 ml/hr to 10 ml/s. This unit also allows programming injection delays from 0 to 255 s in 0.01-s intervals for use during multiphasic studies.

  29. CT Empower injector has the same safety systems as the previously discussed injectors, including pressure limitation, tilt sensor lockout to prevent air embolism, voice prompts to alert operators to potential problems, and an extravasation detection accessory. The extravasation detector monitors the patient's skin impedance and alerts the technologist to the potential extravasation and also pauses the injection to further protect the patient (Fig. 3-10). The unit is also equipped with a feature that permits a pause in the injection; the injection can then be resumed on command. The parameters of the pause, such as the phase number, pause mode, elapsed time, and volume remaining, are displayed on the console. The display is a high-contrast electroluminescent display that is easily seen under ambient lighting conditions from a variety of different angles The Empower CT is also capable of storing more than 50 anatomically referenced preprogrammed procedures that can be recalled when needed. It also has a touch screen display allowing rapid system control by the technologist

  30. The E-Z-EM Empower injector system is manufactured with a dual-barrel injector head specifically designed for saline chase injections. The routine use of a saline bolus “chaser” for certain CT studies may yield cost savings in terms of the contrast agent and present a decreased risk of contrast nephropathy. The chaser is administered immediately following the injection of the contrast agent. The purpose of the chaser is to provide better vessel enhancement while utilizing a lower dose of contrast medium.

  31. Automatic power injectors offer advantage a. Consistent, reproducible flow rates. b. Precise volume/dosage control. c. Higher injection rates for optimal contrast enhancement. d. Automatic delays for proper enhancement patterns and multiphase imaging.

  32. Pharmacology is the study of drugs and their origins, chemical composition, preparations, and use. Pharmacokinetics refers to the mechanisms of bodily absorption, distribution, metabolism, and excretion of drugs. Pharmacodynamics is the action that various drugs have with body tissues.

  33. The route of administration will vary not only with the drug used but also the purpose that it has been designed for. The drugs used in vascular and cardiac diagnostic and interventional radiography fall into two major classifications: local and systemic. The local medications are usually administered at a specific site and are injected into the tissues only in that particular area. The route is by direct injection, and the purpose of the drug is the reduction of sensation (pain) in the tissues of the surrounding area. These drugs are used at the beginning of the procedure, and they have an anesthetic and analgesic effect at the puncture site. The anesthetic effect of the “local” medication is almost immediate and is well tolerated by most adult patients. Local medications can also be administered by inhalation and topical application to the skin and other mucous membranes. Inhaled medication is used to produce a rapid response to local respiratory conditions.

  34. Systemic medications produce a wide variety of effects to the patient. These drugs are usually used before the procedure begins, at times during the procedure, and often in emergency situations to alleviate a problem. The four major routes of administration for the systemic agents are oral, rectal, sublingual, and parenteral. The first three routes are self-explanatory, and their use will appear obvious. Inhalation can also be considered as a means of administering systemic medications as in the case of general anesthesia.

  35. Oral medications are taken by mouth. The rectal route of administration is used if the patients are unable to take oral medication. This could be due to the inability to retain the drug in the stomach or because the drug would be adversely affected by the gastric contents. Sublingual administration of certain medications is used when quick action of the drug is required. These drugs are manufactured to dissolve quickly when placed under the tongue to provide a rapid effect. It can be seen that these three routes of administration of medication all utilize the digestive system to introduce the medication into the body. The parenteral route pertains to the administration of a medication other than the gastrointestinal tract. This is usually accomplished by injection

  36. When any medication is administered it is important to follow some basic principles, known as the “Six Rights.” These basic rules should be followed whenever any medication is dispensed to a patient. • Administer the drug to the RIGHT PATIENT • 2. Administer the RIGHT DRUG • 3. Administer the RIGHT DOSAGE • 4. Use the RIGHT ROUTE to administer the drug • 5. Provide the drug at the RIGHT TIME • 6. Complete the RIGHT DOCUMENTATION

  37. Summary of Drug Types

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