Osmolar Contrast Media

The medical director ordered a postvoid catheterization, which yielded 100 mL of cloudy urine that had

Because of very high glomerular filtration rates, nearly the entire volume of the blood enters the renal tubules every 30 minutes. Obviously, most of it must be reabsorbed to avoid

Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be

1. What specific part of the kidney does the dialysis tubing represent? What is the function of this part?

Reactions from contrast dyes can be sensed as soon as one minute of injecting the dye and can go as long as several days before ever becoming known to the patient or the doctor 1. Hypersensitivity can also be mistaken as an allergic reaction in some patients. When a patient is hypersensitive they can show signs of allergic reactions that are not as severe as a normal allergic reaction. Contrast dyes are broken down into two categories, high-osmolar and low-osmolar. High-osmolar dye is an ionic dye with particles that dissociate in solution while the low-osmolar dyes are nonionic and do not dissociate in the solution2. In some cases the physician or radiologist may see that a contrast media is not necessary and can determine to go without it. If a contrast dye is needed to see the specified image clearly then a low-osmolar dose maybe given to the patient and it is recommended that all patients stay in the department 20-30 minutes after an injection to watch for acute or severe reactions 2. In some cases a medication can be given before the contrast media to help combat the reactions a patient may have experienced

of the water. The osmolality of the water leaving the tube of Henle is lower than the

It can also occur during blood transfusion or during dressing change. The insertion of central catheters can occur in the Interventional Radiology or sometimes at the bedside. Regardless of the where the insertion process occur, a sterile field must always be maintained and sterile techniques must always be employed to prevent any organisms from being introduced to the central line into the patient. According to The Joint Commission (2013), many organizations such as Michigan Keystone Intensive Care Unit Project and Institute for Healthcare Improvement are actually adhering to insertion bundles to reduce the CLABSI rates. The bundles include hand hygiene, maximal barrier precautions, chlorhexidine skin preparation, avoidance of femoral vein, and prompt removal of central catheter. Furuya et al. (2011) studied the effectiveness of the insertion bundle and how it impacts the bloodstream infections for patients in the Intensive Care Unit. As a result, lesser infection have occurred when the compliance is high. As mentioned, the site of the catheter also needs to be considered in the insertion process. Avoiding areas such as the groin to access the femoral artery is recommended because this area can be easily contaminated with urine or feces. In addition, after the insertion of a new central line, all the used IV tubing

In Kidney failure cases urea, creatine, uric acids and electrolytes move from the blood to the dialysate with the net effect of lowering their concentration in the blood. RBC s WBC s and plasma proteins are too large to diffuse through the pores of the membrane. Hemodialysis patient are exposed to 120 to 130 L of water during each dialysis treatment. Small molecular weight substances can pass from the dialysate in to patient’s blood. So the purity of water used for dialysis is monitored and controlled.

The patient is a 45 year old man who had GI surgery 4 days ago.  He is NPO, has a nasogastric tube, and IV fluids of D51/2saline at 100 mL/hr.  The nursing physical assessment includes the following:  alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities, complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has drained from NG tube in last 3 hours.  Voiding dark amber urine without difficulty.  Intake for last 24 hours is 2500mL.  Output is 2000mL including urine and NG drainage.  Febrile and diaphoretic; BP 130/80; pulse 88; urine specific gravity 1.035; serum

The emergency department physician inserts a central venous catheter via the subclavian vein and prescribes Lactated Ringer's solution at 1,000 ml/hr via infusion pump.

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

The barium is then released from the bag and begins to flow slowly into your colon. As the barium begins to fill your bowel you will feel some pain and pressure, and an urgency to have a bowel movement. The doctor will watch the barium as it moves through your intestine on a TV screen, using a special “live x-ray” called fluoroscopy. You will be asked to turn to different positions, and the table may be tilted slightly to help the barium flow through your colon and to take x-rays from different directions. Sometimes a slightly different version of the test may be done. It is called a double contrast barium enema. If a double contrast study is being done, the barium will be drained out, and then air will be injected into your colon. As you can imagine with the air contrast study, the amount of cramping and pain increases, due to the expansion of the bowel with air. After all of the films are taken the enema tube is removed, and you are taken to the restroom to expel the remaining barium and air. One or two films may be taken afterwards, to check how much barium is remaining in your bowel. The entire test takes anywhere from thirty minutes to one hour. After the exam you may resume a regular diet, and be sure to drink plenty of liquids to replace those you have lost and to help flush the remaining barium out of your system.

Besides echocardiography, cardiac magnetic resonance (CMR) and Multi-slice computed tomography angiocardiography (MSCT) have gained particular importance. (8) The presence of image degrading artifacts from implanted metal, such as intravascular stents and embolization coils; higher cost; limited availability; contraindication in imaging of

Brusch says, “Once a indwelling catheter is placed, the daily incidence of bacteriuria can be between 3-10%.” Another large problem that results CAUTI’s is that at times, catheters are left in a patient longer than necessary. Prolonged use of

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