Renal Cell Carcinoma and IV Contrast - Report Example

Renal Cell Carcinoma and IV Contrast Name Course Name and Code Date Table of Contents Table of Contents 2 Introduction 3 Outline adverse classifications and typical examples 4 Specific contrast media reaction in Kidney failure 5 Prevention methods 6 Injection of contrast media 8 Risk factor on contrast media 9 After care management 9 Conclusion 10 References 10 Introduction Intravenous contrast media refers to substances used in various diagnostic procedures to improve the quality of images specific to medical diagnosis. The use of IVs in radiology is generally aimed at making blood vessels more visible (Saljoughian 2012, p. 88) . There are basically two types of IV contrast media that are utilized in radiologic studies, namely; the ionic high-osmolality contrast media, as well as, the non-ionic low-osmolality contrast media (Saljoughian 2012, p. 88).The benefits associated with IV contrast include better visualization of vessels and changes within the tissues. Therefore, it is utilized in enhancing the visibility of internal body components. Renal Cell Carcinoma (RCC) is a kidney cancer that is located within the proximal convoluted tubule lining (Radiological Associates of Sacramento (RAS) 2012, p. 51). These tubules are the ones that transport from the glomerulus the glomerular filtrate into the nephron limb (American College of Radiology 2013, p. 88). RCC is the most reported type of kidney cancer across the world whereby it accounts for around three percent of malignant cancer (Bae 2010, p. 12). The kidney is among the components that are found in the blood and with the help of IV contrast media, it is easier to identify the medical condition of the kidneys. Even though the medical technology is important, there are numerous risks and challenges that are associated with IV contrast. Some of the challenges includes reactions to the body and therefore is crucial for doctors to understand these threats with the aim of minimising its impact to a patient (Radiological Associates of Sacramento (RAS) 2012, p. 51). Therefore, the aim of this report is to discuss the adverse reactions on a patient suffering from RCC when they are exposed to IV contrast agent, identification of prevention strategies and after care measures. Outline adverse classifications and typical examples RCC patient when exposed to IV contrast media may result in diverse reactions with different levels of severity (Radiological Associates of Sacramento (RAS) 2012, p. 98). The reactions are usually categorised in terms of severity, which includes mild, moderate and severe reactions (Bae 2010, p. 33). The importance of grouping the severities in categories is to provide an opportunity to a physician to determine the most appropriate strategy and approach to counter the side effects of the medication (Newmark, Mehra & Singla 2012, p. 121). A patient administered with IV contrast can be termed as been affected mildly if the patient exhibits the following symptoms (Romans 2013 p. 62; Saljoughian 2012, p. 53). These symptoms include dizziness, nausea, anxiety, vomiting, shaking, swear and chill. This is the least severe stage and it is important to monitor and provide appropriate medication to prevent the issue from reaching moderate severity (CIBA Foundation Symposium 2009 p. 91). In the case of moderate severity, some symptoms include tachycardia, hypertension coetaneous reaction, dypnea and hypotension (Singh & Daftary 2008 p. 93). This is a critical stage and it is paramount for the doctors to provide the appropriate medication and prevention measures (American College of Radiology 2013, p. 91). The most devastating severity when a patient is administered with IV contrast media is severe reactions. Some symptoms that are associated to severe reactions include cardiopulmonary arrest, chemically arrhythmias, convulsion, unresponsiveness, and profound hypotension (Bae 2010, p. 63; Saljoughian 2012, p. 88). At this stage, a patient is medically unstable and it is paramount to assist the patient with the most appropriate medication (Stucker, Souza and Kenyon 2009 p. 43). Specific contrast media reaction in Kidney failure The common side effects associated to IV contrast administration are mild and moderate reactions. Most studies indicates that these are not life threatening but it is important to observe and support the patient. Even if a patient is suffering from RCC, the patient follows stages in indicating the symptoms that are associated with the side effects of the medication (Bae 2010, p. 41; Radiological Associates of Sacramento (RAS) 2012, p. 23). Therefore, it is easier for a doctor to diagnose and determine the situation of a patient through the symptoms, which are exhibited. This is attributed to categorisation of the symptoms. However, some authors indicate that there are some reactions that are exhibited by patients that include nonanaphyctoid, anaphylactoid, idiopathic, nasovagal, chemotoxic and combination of these numerous reactions (Singh & Daftary 2008 p. 106). The anaphylactic reactions are also referred as idiosyncratic reactions and the causes of these reactions are uncertain (Newmark, Mehra & Singla 2012, p. 78). Conversely, the reactions associated to direct organic toxicity, chemotoxic and osmotic are easily identifiable and predictable and the prevention measures are easier to employ (American College of Radiology 2013, p. 55). Nevertheless, those reactions that have different features from anaphylactoid can be referred to as nonanaphylactoid (Radiological Associates of Sacramento (RAS) 2012, p. 51). In the case of vasovagal reactions, the main outcomes include decreased blood pressure that may be associated with other factors such as confusion, apprehension, loss of bowel and unresponsiveness (Bae 2010, p. 62; Saljoughian 2012, p. 97). The physician should be carefully when addressing vasovagal reactions because they are not definite in their origin because some are associated to other procedures beyond IV contrast administration (Radiological Associates of Sacramento (RAS) 2012, p. 66). In certain specific circumstances, a patient can show both types of reactions: anaphylactoid and nonanaphylactoid (Lindor and Talwalker 2010 p. 112). The results of such reactions are complex and life threatening and when a patient shows these symptoms, it is paramount to identify the origin of the problem and the causative agents. One of the strategies to identify the problem is through analysing the medication history of the patient. Prevention methods Prevention comes in different forms depending on the nature of the condition and severity of the condition (Radiological Associates of Sacramento (RAS) 2012, p. 51). Prevention may start from dose concentration to other measures such as patient communication. Some of the prevention methods include: Dose concentration IV contrast should not be administered to RCC patients especially if the patient has side effects to the contrast media. Some of the side problems that may deem dangerous include severe bronchospasm, cardiac arrhythmias, hypertension and laryngeal edema (Newmark, Mehra & Singla 2012, p. 133; Saljoughian 2012, p. 67). In those circumstances that IV contrasts is inevitable, prior administration of Prednisone 50mg PO, Methylprednisolone 125mg IV, Benadryl 150mg PO and Zantac 50mg IV should be administered before the patient is injected with IV contrast. It is important for the physician to note the time interval in which the medication should be administered to ensure the drugs operates optimally. Pre-operative testing/questioning It is important to prepare a patient before administrating IV contrast to prevent RCC patient from been affected by the medication (Radiological Associates of Sacramento (RAS) 2012, p. 71). The importance of this strategy is to prevent contrast reaction and to determine the most appropriate mitigation strategy if any problem may occur. One of the most appropriate steps is reviewing the medical history of the patient (American College of Radiology 2013, p. 60). The person performing this task should concentrate on determining whether there are information on reactions on IV contrast and the chances of occurrence of problems if the medication is administered. In addition, some important information to be analysed include nutrition status of the RCC patient, neurologic and hemodynamic components relative to threats posed. Major concentration should be placed on those patients with know allergies (Bae 2010, p. 71; Saljoughian 2012, p. 19). Management of reactions Although preventive measures are necessary before administering an IV contrast media, sometimes reactions will occur, requiring attention to be carefully managed. If extravasations occur to a patient, it is important to assess its severity as well as the category of the reaction, and then calling for assistance when necessary (Singh & Daftary 2008, p. 72). Securing intravenous lines and improving flow of oxygen are important in such cases. Drugs can be given immediately in presence of monitoring and assessing the patient’s case. Patient communication Another important factor to be considered is the importance of communication in the entire process. The patient should be informed and the close relatives update in enabling the physician and patient understanding the relative positions (American College of Radiology 2013, p. 103; Saljoughian 2012, p. 5). Such approach reduces the chances of mistakes occurring and the patient becoming satisfied by the entire process. Patient communication allows the patient chance of stating how they feel and what should be done to improve on their comfort while the physician can inform the patient on medication progress (Newmark, Mehra & Singla 2012, p. 63; Fox 2011 p. 92). In addition, a patient should continuously update the physicians on their recuperation with the aim of provision of updated and appropriate medication. Injection of contrast media In injecting the patients, there are numerous issues that should be addressed which includes clinical problems, vascular access and numerous types of examination (Radiological Associates of Sacramento (RAS) 2012, p. 51). In administering IV contrast, the physician should inform the patient with the aim of understanding their positions and solicitation of their views. This can be achieved through effective communication among the involved stakeholders (Radiological Associates of Sacramento (RAS) 2012, p. 51). The physician should monitor the entire process to prevent chances of palpation in determining administration of the contrast media injection. Risk factor on contrast media Some of the risk factors associated to contrast media include allergies, asthma, renal diseases and also diabetes mellitus (Radiological Associates of Sacramento (RAS) 2012, p. 51). Other risks that are associated with renal carcinoma and contrast media include baseline blood urea nitrogen, renal dysfunction and creatinine. In the case of RCC patients associated with impaired renal dysfunction, the amount of IV contrast media that is utilised is limited and also based on the specifications and requirements of the patients. It is also important to consider cardiac status of the patients since higher rates of cardiac status may play a major impact in affecting a patient position. In addition, it is important for the patients and other stakeholders to understand the mental status of the patient (Radiological Associates of Sacramento (RAS) 2012, p. 51). Other risk factors that are associated with IV contrast media includes predisposition of irreversible renal failure and precipitation in the renal tubules. In addition, the ongoing quality assurance and quality programs should factor into consideration the numerous scenarios in ensuring the entire process is effective (Radiological Associates of Sacramento (RAS) 2012, p. 51). After care management After care management is a requirement for any disease to determine whether the process has been successful or preventive measures should be instituted to address the issue (Newmark, Mehra & Singla 2012, p. 55). Communication is important and the patient should be requested to report what they feel while the physicians should utilise their skills in reviewing and updating the progress of the patient (Saljoughian 2012, p. 3). The physician should base the after care management on the types of reactions e.g. mild, moderate and severe in determining the most appropriate intervention strategy (Radiological Associates of Sacramento (RAS) 2012, p. 51). Conclusion Renal Cell Carcinoma (RCC) is a cancer that affects the kidney and is the most common form of kidney cancer that affects many people. The report has analysed the benefits of IV contrast that includes revealing of the medical condition but the IV contrast can become a challenge to the treatment process because of reactions to the body. The reactions are grouped into mild, moderate and severe reactions. It is easier to monitor these reactions and the prevention strategies can be employed to address the issue. Some of the prevention strategies include appropriate medication and reviewing the medical history of the patient. The risk of IV contrast media is associated with previous reaction to asthma, renal diseases, allergies, diabetes mellitus and renal dysfunction. References American College of Radiology. 2013. ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. Version 9, 2013. Bae, Kyongtae.T. 2010. Intravenous Contrast Medium Adminstration and Scan Timing at CT: Considerations and Approaches. July 2010 Radiology. 256, 32-61. Newmark, Jordan L, Mehra Ami., & Singla, A.K. 2012. Radiocontrast Media Allergic Reactions and Interventional Pain Practice – A Review. Pain Physician Journal, 15, 665-675. Radiological Associates of Sacramento (RAS). 2012. CT Oral &IV Contrast Information. Accessed on August 14, http://www.radiological.com/services.aspx?page=id%7C6027 Romans, Lois E. 2013. The Use of Contrast Media in the CT Department. CEwebsource.com. May 15, 2013. Saljoughian, Manouchehr. 2012. Intravenous Radiocontrast Media: A Review of Allergic Reactions. U.S. Pharmacist. Accessed on August 14, http://www.uspharmacist.com/content/d/in-service/c/34558/ Singh, Jagdish & Daftary Aditya. 2008. Iodinated Contrast Media and Their Adverse Reactions. Journal of Nuclear Medicine Technology, 36(2) 69-74. CIBA Foundation Symposium. 2009. Haemopoiesis: Cell Production and its Regulation. New York: John Wiley & sons Fox, Christian. 2011. Atlas of Emergency Ultrasound. Cambridge: Cambridge University Press Lindor, Keith, and Talwalker Jayant. 2010. Cholestatic Liver Disease. New York: Springer Stucker, Fredrick, Souza Chris, and Kenyon Guy. 2009. Rhinology and Facial Plastic Surgery. New York: Springer Publishers. Read More