Equipment Aids in Intravenous Pyelography

Abstract

In recent articles by Hildreth, Pendergrass, Tondreau, and Ritchie (1, 2), a comprehensive evaluation of the reactions associated with intravenous urography has been given, along with methods of prevention and therapy. We feel that a simple and practical technic for intravenous administration of urographie media may be of general interest. Equipment includes; 1. Anesthesia arm stand 2. Opaque material: diatrizoate sodium (Hypaque) 3. Sterile normal saline, 150 c.c. ($0.66) 4. Disposable plastic infusion tubing, Baxter-41 ($0.40) 5. Disposable needles ($0.10) 6. Venotube 20 ($0.28) 7. Syringe, 20 c.c. 8. Medication and equipment in stand drawer: a. Epinephrine HCl, 1∶1000, or Neophed b. Antihistamine (diphenhydramine HCl, chlorprophenpyridamine maleate) in sterile solution for injection c. Phenylephrine HCl (0.5 mg.) d. Levarterenol bitartrate (Levophed) e. Hydrocortisone 100 mg./c.c. f. Oral airway g. Syringe (2 c.c.) and disposable needles h. Spare tourniquet 9. Oxygen and blood-pressure apparatus in room Technic Upon arrival in the Radiology Department the patient is questioned regarding any history of allergy, including hay fever, asthma, urticaria, and any known reaction to medication. If the history is negative, an abdominal scout film is obtained and this is viewed wet by the radiologist. If there is no indication of poor preparation or other factors which would preclude adequate studies, the examination is continued. The patient is made as comfortable as possible on the examining table. A radiolucent mattress is used, and a pillow is placed beneath the knees. The patient's arm is anchored to the anesthesia stand in a comfortable, supine position (Fig. 2). A needle, connected to a 150-c.c. vial of sterile normal saline by a standard intravenous solution administration set is introduced into an accessible vein, preferably antecubital, and a slow infusion is begun. A test dose of 1.0 c.c. of the opaque material is injected into the rubber coupling of the intravenous set. If there is no evidence of reaction after an interval of ten minutes, the radiologist is called to administer the full dose of the medium. He again questions the patient concerning any possible allergic history. If the reply is satisfactory, 20 c.c. of the opaque medium is injected into the rubber coupling by connecting the 20-c.c. syringe to a sterile disposable needle with a 20-inch length of disposable plastic tubing (Venotube 20). The syringe is supported by the clamp on the anesthesia stand (Fig. 3). Summary A simple, practical, and inexpensive method of administering opaque media for pyelography is presented, and the advantages of this technic are described. They are as follows: 1. Venospasm is decreased as a result of slight dilution of opaque material by normal saline. 2. Only one venipuncture is necessary for both the test dose and diagnostic dose of opaque solution.