Grant of contrast material is usually quite safe. However, injection of any kind will bring little dangerous risk, including injury to the nerves, vessels artery (artery) or veins (vein), inflammation (infection) or an allergic reaction to the injected materials.
Injured blood vessels will cause leakage of contrast material into the surrounding muscle tissue / tissues (Extravasation). This risk was estimated in 0.04% to 1.3%.
Other risks / complications of the injection of contrast material especially allergic reaction, and may include:
â€¢ Occasionally, mild reactions such as the body feels a warm (flushes), sneezing, sneezing, itching of red spots and swelling (hives), vomiting and headache. A little dizzy with the feeling like vomiting that will disappear in a few minutes.
â€¢ For the basic iodine contrast material is injected to iron taste in mouth, bad breath out of sorts and body feels warm in the lower abdomen (pelvic) and on the back of the throat.
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â€¢ Rarely a stronger reaction such as asthma (Asthma), shock (shock) and seizures (convulsions). Emergency supplies are available for events This rare.
â€¢ Death in extremely rare cases, about 1 in. Injection of 250,000 to 400,000 (0.0004%).
â€¢ Although less than 1% injected dose absorbed into the ASI (Air Susu Ibu), breastfeeding is recommended that patients stopped breast feeding (breast milk) for 24 hours after injection and discard breast milk after injection of contrast.
Radiographic contrast material
Contrast materials are compounds used to improve visualization (visibility) on the internal structures of a medical diagnostic imaging. Contrast material used in the X-ray imaging to improve X-ray attenuation (positive contrast material) that will be discussed here or greater reduce the power of X-ray attenuation (negative contrast material with air base or gas). In addition to the contrast material is also used in examining MRI (Magnetic Resonance Imaging), but this method is not based on X-rays, but vary magnetic properties of the hydrogen nucleus absorbs the contrast material. Materials Such contrast MRI with Gadolinium is.
Contrast material, barium sulphate, a white powder that was insoluble. This powder is mixed with water and some additional components to make the mixture contrast. This material is generally only used in the digestive tract, usually ingested or given as an enema. Upon examination, this material will come out of the body along with the faces.
Iodine contrast material
Iodine contrast material can be bound to organic compounds (non-ionic) or a ionic compounds. Ionic materials was first made and is still widely used to depend on the intended inspection. Ionic materials have side effect profile is worse. Organic compounds have side effects because there are fewer molecules dissociates the components. Many of the side effects caused by the hyper osmolar solution which is injected, which these substances lead to more iodine atoms per molecule. The more iodine, then force X-ray attenuation increases. There are many different molecules. Media iodine based contrast to water soluble and not harmful to the body. Contrast materials are widely sold as a solution of clear, colourless liquid. Concentration is usually expressed in mg I / ml. Modern teriodinasi contrast material can be used in almost all parts of the body. Most of them used intravenous, but for different purposes can also be used in intra-arterial, intra-theca (spinal) and intra-abdominally - almost the entire body cavity or a potential space.
Based on the stages of its development, shape and chemical composition of the contrast media:
a. Before 1950
In this period, all ionic contrast media is iodine, which in arrangement. There is a chemical ion. Ions composing the contrast media consist of:
cathode and anode.
b. Mid Year 1950
Starting mid-year 1950 established the molecular basis of the use of benzoic
each molecule binds three atoms of iodine. At this stage the development of shared
1). Ionic Contrast Material
Ions composing contrast media cathode that consist (+ve charge) and anions (-ve charge) ions. Cathode bound to the acid radical (-COO-) chain ring C1 benzene. Cathode also gives the characteristics of contrast media, in which each type give different characteristics to each other. There are several kinds of cathode. The use of contrast media, including:
a). Sodium (Natrium)
The nature of the sodium in contrast medium was reduced viscosity (viscosity), and fewer anaphylactic reactions caused by reducing substances emergence histamine that cause allergic reactions. On the other hand is more sodium corrosive of cells endothelium and parenchyma of certain organs, making it more toxic of other substances.
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b). Meglumine (NMG, N-Methylglucamine)
Meglumine have toxic properties are smaller than sodium, but meglumine diuretic effect (reducing the concentration of iodine in the urine). In the acid type and concentration of meglumine less the same cause increase in blood pressure, bradycardia, and convulsions than sodium.
These substances have properties that are not owned by sodium meglumine maupub, is not have toxic properties and has a low viscosity, but this substance vasodilatation cause strong enough. In addition to the above materials are sometimes also used cathode of calcium (Ca) and magnesium (Mg). To obtain the desired properties of contrast media in radiology examination usually done some combination of several types of cathode in a types of contrast media:
(1). Ionic Contrast Material Monomer
Monomer ionic contrast materials is a form of ionic contrast material that has
one ring in a molecule of benzoic acid.
(2). Ionic Contrast Material dimmer
Ionic contrast media is having two rings of benzoic acid in one molecule. One example of the shape and chemical composition of this type of contrast material
is Oxalate (Hexabrix) which is the first demerit ionic contrast media made.
2). Non-ionic contrast materials.
During the chemical composition of non-ionic contrast media have not found the existence of ionic bonds between the atoms composing the molecule. If the ionic contrast media, there are two compiler molecular particles (cathions and anions) in the non-ionic contrast material. There is only one particle that has a molecular construct its own characteristics.
(1). Non-ionic contrast material Monomer
Contrast material was derived from an ionic monomer contrast media, which is the
replacing the carboxyl group by a radical group that is non-ionic amide (-CONH2).
(2). Ingredients Non-ionic dimeric contrast
Formation of the chemical structure of contrast material through the process of replacing the group carboxyl dimmer ionic contrast media as well as by groups of non-ionic radicals, which in end of a sisntesa produce iodine to particle ratio contrast media 6 : 1.
The concentration of active molecules that provide the solution osmotic pressure, so
provide the capability of a solvent (water) through a membrane. To set with milliosmol per litre (osmolarity) or milliosmol per kilogram water (H2O) in the 37oC (osmolality).
Osmolality was not influenced by particle size, but its value depends;
The total particle concentration and iodine. Ionic contrast material has a number of particles greater than non-ionic contrast material because of the ionic contrast media are two particles (cations and anions) to two times higher osmolality.
OSMOLALITY (m 0sm/Kg) = mgI/ml . K.G
Iodine contrast materials that modern medicines are safe; reactions dangerous could happen, but not common. The main side effects are anaphylactic reactions and nephropathy.
1. Reaction-Reaction Anaphylactic
Anaphylactic reactions are rare, but can occur as a response to the contrast material is injected or given via oral and rectal pyelografi and even worsen. Symptoms are similar to anaphylactic reactions, but not caused by IgE mediated immune response. Patients who have a history of reaction to contrast, at high risk for experiencing reactions anaphylactic. Anaphylactic reactions ranging from urticaria and can itch, until bronchospasma and facial and laryngeal enema. For cases of moderate and urticaria itching. Benadryl (Diphenhydramine) through the mouth or IV (intravenous) can be given. For reactions are more severe, such bronchospasma and neck or facial enema can be given subcutaneous or epinephrine IV or albuterol inhaler, add Diphenhydramine may required. If respiration is affected, the airway should be released.
2. Nephropathy caused by Contrast Medium
Contrast media nephropathy could be caused by both the increase in blood keratinize level greater than 25%. There are three factors associated with increased risk of nephropathy is influenced by the contrast medium, renal disorders are diabetes, and intravascular volume is reduced. Osmolality contrast material is believed to play an important role in nephropathy. Ideally, contrast material should iso-osmolar of blood. Iodized contrast material that modern typically non ionic, ionic types of old-type common cause harmful effects over and not used again. To minimize the risk of contrast medium nephropathy as a result, the various actions could be done, all of which have been analyzed in a meta-analysis are:
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1. The dose of contrast media should be tried as low as possible, although
still able to conduct inspections added.
2. Non ionic contrast material
3. And non-ionic contrast media iso-osmolar. One of controlled trials
Random discovered that a substance iso-osmolar non-ionic contrast is better compared to non-ionic contrast media of low-osmolar.
4. Hydration intravenous fluids with a salt solution.
5. Intravenous fluid hydration with saline solution plus sodium bicarbonate.
Effect of bicarbonate renoprotektif alkalinises be caused by urine, which creates an environment that is more susceptible to the formation of harmful free radicals. 6. N-asetilcystein (NAC).NAC, 600 mg use twice a day by orally, the day before during the procedure if the discharge is less than the estimated keratinize clearance 60 mL / min (1.00 mL / sec). A randomized controlled trial found that the higher doses of NAC to assist the (74% of reduction risk) coronary angioplasty received by patient with a higher volume of contrast. Some recent research shows that the N-asetilcystein protecting kidneys from the toxic effect of contrast materials .This effect is not evenly distributed, some researchers (eg Hoffman et al., 2004) have claimed that this effect caused by interference with creatinine laboratory test itself. This is supported by the lack of correlation between rates of creatinine and cystatin C content .Other pharmacologic agents, like dopamine, mannitol, furosemide, , aminophylline, theophylline and atrial natriuretic peptide already tried, but no beneficial effect or even have a harmful. Kemotoksik reactions in patients who have thyroid disorders often experience a reaction after an inspection kemotoksik with contrast material. Actually, the bound iodine atom into the compound of contrast material did not give a big influence. It is only sensitive to the small independent iodide ions were found in the contrast material. Increase intake of iodide is why tirotoksikosis. The contribution of sea-food and other allergies should be emphasized here that the allegations about the "allergy" of seafood, which is often based more on myth compared to the fact, that is not a contraindication to the use of contrast material beriodum. A correlation between the rate of iodine in seafood and seafood allergy as a result are part of the medical field. Although the rate of iodine in seafood is higher than in non-marine foods, but consume the last of these exceed the first and there is no evidence to suggest that the iodine content of seafood related to the reactions of sea-food. Data suggest seafood allergies due to increased risk of a reaction that is mediated by the amount of contrast material about the same as allergic to the fruit or the same as the causes of asthma. In other words, more than 85% of patients who suffer food allergies, the sea will not have dangerous reactions to iodized contrast. Lastly, there is no evidence to suggest that the skin reactions that are harmful to the antiseptic-containing topical iodine antiseptic (such as betadin, povidin) a lot to do with giving IV contrast material.