Contrast-Induced Nephropathy Case Study

1) Summary of Article: A review of literature shows the length of time a catheter remains in the body is directly associated with CAUTI.

The facility where I work uses two type of IV contrast i.e. omnipaque and visipaque. The use of the contrast depends on the patient's glomerular filtration rate (GFR) and prior allergies to contrast. GFR can be calculated from the blood's creatinine level, age, body size, and gender of the patient. It is to calculate the level of kidney function before administering any contrast. If the GFR of the patient is between 30-60 score, omnipaque can be given and if above 60 only visipaque can be used. However, if the score is below 30, then no contrast can be given in order to avoid any medical emergencies.

The ICUs are associated with over 15 million catheter days while there is indication that only 24.4% of CVC use occurs outside the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013). This implies that millions of patients in the ICUs are at a high likelihood of developing CLABSI

Healthcare maintenance. The patient has not had a physical in years. We will set her up to come back for this at next appointment. She is not had cholesterol done for quite some time. She does continue on TriCor for her hypertriglyceridemia. We will plan on doing blood work to include a vitamin D, CMP, magnesium, lipid panel, hemoglobin A1c, prior to her appointment in three months. She is seeing Christine Wasilewski, MD for her B12 deficiency and anemia. I will not therefore order test for

The decision either to perform or not to perform a cardiac catheterization in a patient who also has acute renal failure can be a difficult decision to reach. Diagnostic blood and urine tests can prove to be beneficial in helping the provider make such a tough decision. The contrast used in the cardiac catheterization can harm the function of the kidneys, and it can push the patient from acute to chronic renal failure, which can influence quality of life as well as morbidity and mortality. When a patient has chest pain, the nurse practitioner should perform a thorough assessment to ensure the angina is cardiac-related and not from another source, such as pleuritic chest pain or muscular chest pain (Grossman & Porth, 2014). Once it is confirmed by one’s assessment that the chest pain is cardiac-related, then one should look at serum diagnostic results, such as the cardiac enzymes.

In reviewing Heparin flushes in Central Venous Catheters (CVCs); one must first understand the importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considered the lifeline of a dialysis patient. Their function and patency is of the utmost importance to the morbidity and mortality rate of a renal patient. “Venous catheters generally develop a fibrin sheath at the tip, which evolve into a clot due to body’s physiological response to the vein injury and the foreign catheter 1 and subsequent catheter obstruction.” (Journal of Evolution of Medical and Dental Sciences, 2014, pg. 46).

Thus, in the current era, It is much more common to perform interventional cardiac catheterization rather than for

We used clinical and biochemical data derived from the DaVita database. The study population (N=420,255) included subjects undergoing hemodialysis in DaVita facilities across the US during the period of 2004 to 2011.

The sample sizes in the studies need to be increased in order to achieve statistical precision and reduce the standard errors (Askari et al. 2012, Edwards et al. 2007). Also, many of these studies are homogeneous, focusing on the middle-aged, Caucasians. This does not take into the consideration that the human genome varies between individuals, and selecting on a criterion of one ethnic does not give a good generalization. Besides the selection of the participants for the study, it also seems that in order for quercetin supplementation has blood pressure lowering effects of a certain range in an individual (Edwards et al. 2007). Another controversy is the relation between quercetin and endothelial function. Askari et al. (2012) found that there is no relationship while Egert et al. (2009) found that age impacted the association. The younger individuals had an improved endothelial function, possibly due to the mechanisms that occur in younger adults versus older adults. Another limitation is that these studies go no longer than 2 months, and 2 studies have confirmed that quercetin does not have any acute effects (Egert and Rimbach 2011, Edwards et al. 2007). Yet, due to a limited length of study the long-term impacts are unknown and if using quercetin for a long time period shows greater improvement. I propose that these limitations found do not

It is reported that even small increase (0.3-0.5 mg/dl) in serum creatinine after cardiac surgery is associated with nearly three-fold increase in 30 day mortality, while a larger increase > 0.5 mg/dl is associated with more that 18-fold increase in 30 - day mortality(13). Patients in need for renal replacement therapy(RRT) have significantly longer in-hospital stay as well as increased

The placement of peripheral intravenous (PIV) catheters is the most common invasive procedure performed in the clinical setting. Up to 80% of all patients admitted to the hospital receive a PIV catheter, even though they may never be used (Do Rego Furtado, 2011). Nearly 330 million PIV catheters are purchased ever year in the United States, and can be used for variety of reasons including parenteral hydration and nutrition, administration of IV fluids, medications, and blood products, monitoring hemodynamic status, and providing hemodialysis.

Incase you suffer from renal failure, diabetes and liver related problems, it is best to exercise caution.

One of the major concerns associated with contrast administration is the risk for renal impairment known as contrast induced nephropathy (CIN). Furthermore, CIN is a serious complication effecting patient outcomes and health care costs. Studies agree, while the true number of CIN occurrences is difficult to attain, pre-existing health factors and conditions, such as, advanced age, kidney disease, congestive heart failure, hypertension, hyperuricemia, hypovolemia, non-steroidal anti-inflammatories, diabetes mellitus, and Glucophage are known to increase the risk potential (Schwab et al., 1989). In addition to CIN, other contrast reactions include contrast induced bronchospasm, and mild systemic contrast reactions. Therefore, identification

In order to understand how this could cause irritation, one must understand the basic mechanisms of isotonic and hypertonic solutions. Isotonic solutions match the osmolality of the blood, which is around 280mOsm/L – 310mOsm/L. This type of solution is used to enhance the fluid volume within the blood vessels. As for hypertonic solutions, they have a higher solute to solvent ratio, which means the solutions’ osmolality is higher than the normal serum levels and the pH is lower than the normal serum pH of 7.35-7.45. The IV administration of hypertonic solutions draws fluids from the blood and endothelial cells, causing them to shrink and become dehydrated. This dehydration poses the highest, most immediate injury risk to the surrounding IV catheter

Biomarkers (also known as biological markers) are a measurement of a biological sample that is used for the prediction of a subject’s disease rate, early detection of disease, and to also enhance the diagnostic classification. (Simon, 2011). In order for biomarkers to be considered useful, they must meet specific criteria, including; accuracy, reliability, meaning that the results are stable when they are repeated numerous times, and therapeutic impact of early intervention (Ge & Wang, 2012). The literature that will be investigated in this paper include, the specific biomarkers in cardiovascular disease, how nutrition can intervene with these biological markers, and also including the pros and cons of using biomarkers to predict disease. However, this review will not explore other diseases in relation to biomarkers.