Module 9A Patient Preparation and Administration of Contrast Media and Intravenous Solutions

1. Age-based dosing

2. Allometric Scaling

3. Body surface area-based dosing

4. Weight-based dosing

Medication dosing for pediatric patients:

Allometric Scaling

is the study of how biological traits change disproportionately with body size

Allometric Scaling

predicts drug dosages and pharmacokinetic parameters across different species or body sizes based on non-linear relationships with body weight

Allometric Scaling

modifying dose base on body size/body habitus

Allometry

association of shape with sizes

Weight-based dosing

most commonly used for calculating recommended medication dosing in pediatric clinical practice

Age

Body Weight

Body Surface Area

Development of growth and function of various organ system compared to adults

Pediatric pharmacokinetics and pharmacodynamics vary based on:

Clark's Rule

an equation used to calculate pediatric medication dosage based on known weight of a patient and a known adult dose of medication

150 lbs (68 kg)

average standard weight

(Patient Weight / 150 lbs (68 kg)) * Adult dose

Formula for Clark's Rule

Young's Rule

equation used to calculate pediatric medication dosage based on patient age and the known recommended adult dose

Young's Rule

a rule that can be applied quickly in situations where the current weight of the patient is unknown

(Age / Age + 12) * Adult dose

Formula for Young's Rule

1. Clark's Rule

2. Young's Rule

3. Webster's Rule

4. Fried's Rule

(4) Formula/Rules in calculating pediatric dose

1. Webster's Rule

2. Fried's Rule

(2) other pediatric dosing using age:

1. Fixed Dose Contrast Media

2. Total Body Weight (TBW)

3. Lean Body Weight (LBW)

(3) Current contrast media volume strategies:

Fixed Dose Contrast Media

simplest, easiest, and most widely prescribed technique

Fixed Dose Contrast Media

uses a fixed contrast medium dose and a fixed rate of contrast medium administration

over dosing or under dosing of contrast media for some patients

Fixed Dose Contrast Media can cause:

Too little contrast medium

may decrease sensitivity and specificity for detecting lesions in solid organs

Liver

Spleen

Pancreas

too little contrast medium may decrease sensitivity and specificity for detecting lesions in solid organs particularly the:

Too much contrast medium

contributes to unnecessary cost expenditure and increase the risk of renal toxicity

1:1 Linear Scale

(Total Body Weight) most commonly used scheme for adjusting the amount of iodine mass for the body weight

Double the iodine mass

(in 1:1 linear scale) Double the patient's body weight =

Lean Body Mass

is a component of body composition calculated by subtracting body fat weight from total body weight

Total Body Weight

Lean + Fat =

LBM = Body Weight - Body Fat

formula for lean body mass

60 % - 90 %

percentage of lean body mass in total body mass

2 mL/kg

Most common formula used in LBM

Men (😕)

Which have higher LBM: men or women

1. Physically separating medications with look-alike/sound-alike names in storage areas

2. Using "tall man" or mixed cased lettering to emphasize drug name differences

Recommendations in storing contrast solutions/medications

2001 ASRT survey, 19% of RTs, INCREASED WORKLOADS caused by PERSONNEL SHORTAGE had led to ERGONOMIC PROBLEMS

In a _________ survey on work place issues, _____% of ____ indicated that _____ workloads caused by _______ had led to _______.

REPETITIVE MOTION ACTIVITIES and LIFTING PATIENTS

Radiologic technologists risk injury from _______ and _____

Carpal Tunnel Syndrome

Back Pain

Tendonitis

Common problems/injuries from repetitive motion activities and lifting patients:

Polymer contrast bottles

are 50% lighter than glass bottles when full and 80% lighter when empty

50% when full

80% when empty

Polymer contrast bottles are ______ % lighter than glass bottles when full and _______% lighter when empty

Intravenous intermittent infusion

is an infusion of a volume of fluid/medication over a set period of time at prescribed intervals and then stopped until the next dose is required

Piggyback medication

Secondary medication

Mini bag medication

Intravenous intermittent infusion is also called:

25 to 250 mL

30 mins every 4 hrs

IV medications may be given in small amounts (_____ to _____ mL) and infused over a desired amount of time (given for ______ mins every _____ hours)

Gravity or Electronic Infusion Device (EID), also known as Infusion Pump

Intermittent medication may be administered by _____ or ______

Infusion Pump

Electronic Infusion Device is also known as:

IV infusion pump

The best practice for piggyback infusions is to use an ___________.

Drip Infusion

small dosages at selected intervals

Bolus Injection

large dosage at one time

Isotonic

most drugs used for treating illness that are administered intravascularly are _______

higher, highly viscous

Contrast agents have osmolalities _______ than body fluids. They are ______ and when administered intravascularly, they prompt a sudden shift in body fluids.

Acute Care Hospitals

Intravenous replacement of fluid, electrolytes, and nutrients is part of the medical care of most patients treated in ________

True

(True or False) it is NOT in the radiographer's scope of practices to select the intravenous solution to be administered

Parenteral Solutions

Used as replacement agents or as simple solutions containing dextrose in various concentrations and normal saline.

Electrolytes or Nutrients

Parenteral Solution is when patients needs an IV line available but does not require _______ or ______

Isotonic Solutions

5% dextrose in water

0.9% NaCl (normal saline)

5% dextrose in water

0.9% NaCl (normal saline)

Isotonic Solutions percentage of dextrose and NaCl

Hypotonic Solutions

Lactated Ringer's Solution (0.33 % NaCl, 0.45% NaCl)

Lactated Ringer's Solution (0.33 % NaCl, 0.45% NaCl)

Hypotonic Solution percentage of NaCl

Hypertonic Solutions

5% dextrose in 0.45% NaCl

10% dextrose in water

5% dextrose in 0.9% NaCl

Intravenous

Intramuscular

Oral Route

replacement of electrolytes may be prescribed by:

Sodium (Na+)

controls and regulates the volume of fluids

Potassium (K+)

chief regulator of cellular enzyme activity and water content

Calcium (Ca2+)

necessary for nerve impulse transmission and blood clotting

Magnesium (Mg2+)

important for the metabolism of carbohydrates and proteins

Chloride (Cl), sodium

acts with ______ to maintain osmotic pressure of blood

Bicarbonate (HCO3)

Essential for acid-base balance.

Phosphate (PO4)

Helps maintain the body's acid-base balance.

Nausea

Anxiety

Hypotension

Coma

Death

adverse reactions to any one of the electrolytes may lead to (5):

Provitamins

precursor of vitamins

Vitamins and Minerals

maintenance of good health requires an adequate daily intake of

Vitamin:

A

B complex

B12

Folate

Niacin (B3)

Pantothenic Acid

Pyridoxine (B6)

Riboflavin (B2)

Thiamine (B1)

C

D

E

K

Vitamins

Minerals

are inorganic substances needed to maintain health and are only needed in minute amounts

Calcium

Chloride

Magnesium

Phosphorus

Iodine

Zinc

Copper

Potassium

Sodium-Sulfur

Manganese

Selenium

Primary Minerals

Central Venous Access Device (CVAD)

is a venous catheter designed to deliver medications and fluids directly into the SVC, IVC, or RA

Superior Vena Cava

Inferior Vena Cava

Right Atrium

CVAD is a venous catheter designed to deliver medications and fluids directly into the:

Open ended peripherally inserted central catheters (PICCS)

most common CVAD

Heparinized Saline Flush

flush used in PICCs to maintain catheter's patency

Saline flush

flush used in close ended catheters to maintain catheter's patency

Close-end catheters

contain valve that controls fluid flow and prevents reflux of blood into the catheter

Open-end peripherally inserted central catheters (PICCs)

catheter that must be clamped when not used

1906 Food and Drug Administration (FDA)

established as an agency of the department of health and human services

Center for Drug Evaluation and Research (CDER)

Controls whether prescription and OTC drugs may be used for therapy.

Center for Biologics Evaluation and Research (CBER)

Regulates the use of biologics including serums, vaccines, and blood products

1938 Food, Drug, and Cosmetic Act

prevents marketing of drugs not thoroughly tested

1986 Childhood Vaccine Act

regulated safety of biologics

1992 Prescription Drug User Fee Act (PDUFA)

requires non generic drug and biologic manufacturers to pay fees to be used for improvements in drug review

1994 Dietary Supplement Health and Education Act

requires clear labeling of dietary supplements and gives FDA the power to remove supplements that cause a significant public risk

1997 FDA Modernization Act (FDAMA)

reauthorizes the Prescription Drug User Fee Act and reforms the drug review process