Preparation of the patient for the procedure.
The introduction of contrast media is carried out on an empty stomach, however, the intake of water is not limited. Preliminary violations of water electrolyte exchange should be eliminated, if any. This is especially important for patients with uncompensated diabetes mellitus, polyuria, oliguria or gout, generalized myeloma, as well as in young children and elderly patients, who can not limit fluid intake before applying hypertonic radiopaque means.
When angiography of the vessels of the abdominal cavity and urography for better diagnosis it is recommended to thoroughly clean the intestines of the patient. Therefore, two days before the examination, patients should avoid eating foods that cause flatulence (especially legumes, salads, fruits, black and fresh bread, as well as any vegetables in their raw form). The last meal should be no later than 18 hours before the start of the examination. In addition, it is advisable to take an overnight laxative. Thoracic and small children large intervals in the intake of food, as well as the appointment of laxatives are contraindicated.
Patients who are afraid of the procedure, it is necessary to appoint sedatives.
For patients with pheochromocytoma, preliminary preparation with alpha-adrenergic receptor blockers is recommended in order to avoid the risk of developing a hypertensive crisis.
General rules of the procedure
To dial into the syringe, the contrast agent should be immediately before the start of the study.
The remnants of contrast medium not used in the study are no longer used. Angiography requires frequent rinsing of used catheters with saline solution to minimize the possible risk of thromboembolism. It should be borne in mind that the contrast agent is better tolerated and injected easier if it is heated to body temperature immediately before use. When using a thermostat, only the amount of ampoules of contrast medium that is to be used should be heated to 37 ° C.
It is not recommended to perform preliminary testing of individual sensitivity with the use of small doses of the drug, in view of the risk of developing severe hypersensitivity reactions.
Intravascular injection of radiopaque means, if possible, is best done when the patient is lying down.After the injection, careful monitoring of the patient for at least 30 minutes is necessary, since most complications occur precisely in the first half hour after the administration of the drug.
If several high single doses are required to clarify the diagnosis, the interval between injections should be 10-15 minutes (to compensate for increased serum osmolarity due to the inflow of interstitial fluid). If once more than 300 ml of contrast medium is administered, intravenous infusion of solutions of electrolytes is prescribed.
I. Study of the kidneys and urinary tract.
Trazograf solution is used for excretory urography, retrograde pyelography and cystography by intravenous or intracavitary (in the bladder, renal pelvis) administration.
1.1. Excretory urography
Adults inject intravenously with 20-50 ml of 60% solution or 20 ml of 76% Traizograf solution at a rate of 0.3 ml / s. In patients with increased body weight, 76% Traizograf solution is more appropriate.
Children due to the physiologically reduced concentration ability of an immature kidney nephron require relatively high doses of Trazograf® 76%:
- up to 1 year:
6 ml - from 1 year to 2 years: 8 ml
- from 2 to 6 years: 10 ml
- from 6 to 12 years: 12-14 ml
- from 12 to 15 years: 16 ml
1.1. Infusion urography
A mixture of 80 ml of 60% or 76% Trazograf® solution and 80 ml of a 5% dextrose solution at a rate of 20-30 drops per minute is injected intravenously into adults.
1.2. Retrograde pyelography
For intracavitary administration, Trazograf® should be diluted with an isotonic sodium chloride solution or 5% dextrose solution until a 30% solution is obtained. A 30% solution of Trazograf® is introduced retrograde through a catheter into the urinary tract at low pressure under visual radiographic control (not allowing pain in the lumbar region), usually at a dose of 3-8 ml; in the case of ectasia of the cavities of the system - up to 20 ml and more, depending on the degree of expansion of the cavities of the kidneys.
1.3. Cystography
A 30% solution of Trazograf® is injected into the bladder retrograde or through epicystostom under visual radiology in a volume slightly smaller than the capacity of the bladder (100-200 ml).
2. Angiografiya.
Trazograf® is used for angiocardiography, aortography, arteriography, selective angiography, phlebography by intravascular injection, and also with splenoportography.
2.1. With aortography in the aorta, 30-60 ml of 76% solution of the drug is administered at a rate of 25-35 ml / sec .;
2.2. With angiocardiography, apply up to 60 ml of 76% Traizograf solution at a rate of 10-30 ml / sec .;
2.3. With peripheral arteriography - 20-40 ml is administered intraarterially on the lower extremity, 10-20 ml of 60% Trazograf solution at the rate of 8-12 ml / sec on the upper limb;
2.4. In selective angiography, a 60% and 76% Traizograf solution is used in an amount corresponding to the volume of the bed of the test vessel at a rate of 3-12 ml / sec .;
2.5. With phlebography, 20-40 ml is injected intravenously on the lower extremity, 10-20 ml of 60% solution of the drug on the upper limb at a rate of 3-5 ml / sec .;
2.6. With splenoportografii injected into the spleen 30-50 ml of 76% Traizograf solution at a rate of 8 ml / sec.