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;

1. 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?
2. The patient has the following lab values BUN 40, Creatinine 1.6 mg/dl.
3. 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

Contrast can be injected in to the Medicaid port but since the patient have 24 gauge iv access, we can prefer that

Any medical health providers especially nurse who is trained in sterile technique and proper care can access the needle in to the port

the method to identify if port is power injectable:

• The patient will be given 3 identify cards 2 will be with patient and 1 will be in the form of ring, the nurse should check the power injectable specifications.
• Ports are usually assessed by using a special noncoring needle called Huber needle under sterile technique
• This needle goes the skin and silicone septum of port, this procedure may not be much painful
• To ensure the port is power injectable attach 10ml syrenge with NS and check for blood return. After verifying, the NS will be injected to check the patency and then the the catheter will be flushed

Precautions while injecting contrast media

• Check for the allergies
• Instruct the patient to tell if there is feeling of pain or discomfort during injection
• Inject warmed contrast
• Do not exceed the flow rate limits
• If swelling, excavation is noted then stop the the infusion immediately.

If the patient have history of mild hypersensitivity to iodinated contrast media then details of previous reactions should be collected and some alternatives should be provided

As a prophylactic measure antihistamines can be administered to reduce hypersensitivity reactions