INTRAVENOUS PYELOGRAM (IVP)

INTRODUCTION
This radiologic examination is done to visualize the entire urinary tract to identify
abnormal size, shape, and function of the kidneys or to detect renal calculi (stones), tumors, or
cysts. A radiopaque substance is injected IV and a series of x-rays taken.
An intravenous pyelogram (IVP) is an X-ray test that provides pictures of the kidneys,
the bladder, the ureters, and the urethra (urinary tract). An IVP can show the size, shape, and
position of the urinary tract, and it can evaluate the collecting system inside the kidneys.An
ultrasound or a computed tomography (CT) scan may be combined with an IVP if more details
about the urinary tract are needed. A computed tomography intravenous pyelogram (CT/IVP) is
usually done to look for the cause of blood in the urine.
PROCEDURE
During IVP, a dye called contrast material is injected into a vein in your arm. A series of
X-ray pictures is then taken at timed intervals. An injection of X-ray contrast medium is given to
a patient via a needle or cannula into thte vein, typically in the arm. The contrast is excreted or
removed from the bloodstream via the kidneys, and the contrastr media becomes visible on X-
rays almost immediately after injection. X-rays are taken at specific time intervals to capture the
contrast as it travels through the different parts of the urinary system. This gives a
comprehensive view of the patient`s anatomy and some information on the functioning of the
renal system.
INDICATIONS
IVP is commonly done to identify diseases of the urinary tract, such as kidney stones ,
tumors, or infection. It is also used to look for problems with the structure of the urinary tract
that were present from birth (congenital). An intravenous pyelogram (IVP) is done to: Look for
problems with the structure of the urinary tract. Find the cause of blood in the urine. Find the
cause of ongoing back or flank pain. Locate and measure a tumor of the urinary tract. Locate and
measure a kidney stone. Find the cause of recurring urinary tract infections. Look for damage to
the urinary tract after an injury. If you have had kidney problems in the past, blood tests
(creatinine, blood urea nitrogen) may be done before the test to make sure that your kidneys are
working properly.
CONTRAINDICATIONS
Historically, the drug metformin has been required to stop 48 hours pre and post procedure, as it
known to cause a reaction with the contrast agent. However the newest guidelines published by
the Royal College of Radiologists suggests this is not as important for patients having <100mls
of contrast, who have a normal renal function. If renal impairment is found before administration
of the contrast, metformin should be stopped 48 hours before and after the procedure.


SIGNIFICANT FINDINGS AND INTERPRETATION
Immediately after the contrast is administered, it appears on an X-ray as a renal blush. This is
the contrast being filtered through the cortex. At an interval of 3 minutes, the renal blush is still
evident (to a lesser extent) but the calyces and renal pelvis are now visible. At 9 t 13 minutes the
contrast begins to empty into the ureters and travel to the bladder which now begun to fill. To
visualize the bladder correctly, a post micturition X-ray is taken, so that the bulk of the contrast
(which can mask a pathology) is emptied.
The kidneys are assessed and compared for: Regular appearance, smooth outlines, size, position,
equal filtration and flow. The ureters are assessed and compared for: size, smooth regular and
symmetrical appearance. A `standing column` is suggestive of a partial obstruction. The bladder
is assessed for: regular smooth appearance and complete voiding.
CLIENT PREPARATION

1. Assess knowledge and understanding of procedure, clarifying information as needed.
2. Schedule IVP prior to any ordered barium test or gallbladder studies using contrast
material.
3. Ask about allergy to seafood, iodine, or radiologic contrast dye. Notify physician or
radiologist if allergies are known.
4. Verify the presence of a signed consent for the procedure.
5. Assess renal and fluid status, including serum osmolality, creatinine, and blood urea
nitrogen (BUN) levels. Notify the physician for any abnormal values.
6. Instruct the client to complete ordered pretest bowel preparation, including prescribed
laxative or cathartic the evening before the test, and an enema or suppository the morning
of the test. Withhold food for 8 hours prior to the test; clear liquids are allowed.
7. Obtain baseline vital signs and record.

DURING THE PROCEDURE

Dye will be injected into the IV. A band maybe put around the patient`s stomach. This band can
be tightened to help keep the dye in the kidneys for a short time. Several x-rays will be taken.
The caregiver may push on the stomach and ask to change positions. Patient will be asked to go
to the bathroom and empty the bladder. More x-rays will be taken after goint to the bathroom.

AFTER THE TEST

1. Monitor vital signs and urine output.
2. Report manifestations of delayed reaction to the contrast media such as dyspnea,
tachycardia, itching hives, or flushing.



HEALTH EDUCATION FOR THE CLIENT AND FAMILY

1. X-rays and dye that is rapidly excreted in the urine are used to show the structures of the
kidney, ureters, and bladder. The test takes about 30 minutes.
2. A laxative and possibly an enema or suppository are used before the test to clear the
bowel of feces and gas. Do not eat after the ordered time the evening before the test. You
may drink clear fluids such as water, coffee, or tea (without creamer).
3. As the dye is injected, you may feel a transient flushing or burning sensation, along with
possible nausea and a metallic taste.
4. Notify your doctor immediately if you develop a rash, difficulty breathing, rapid heart
rate, or hives during or after the test.
5. Increase fluid intake after the test is completed.

COMPLICATIONS & MANAGEMENT
The dyes are of 2 types: ionic and non-ionic. Both types of dye contain iodine but differ
in 2 key ways: the rate of adverse reactions and the cost. Although the overall rate of adverse
reactions is relatively low with both, there is a greater incidence of adverse reactions with the
less expensive ionic dye with the non-ionic. Minor reactions, which are infrequent and do not
last long, include flushing, nausea, vomiting, and itching. A small percentage of people
experience a severe reaction to the dye, such as difficulty breathing, speaking, or swallowing;
swelling of the lips and tongue low blood pressure or loss of consciousness.
People who have had a severe reaction after receiving the dye once should not be exposed again.
Pregnant women should not have an IVP because of the high radiation exposure. People with
known kidney diseases or failure should not have an IVP because the dye can worsen kidney
function. Elderly people and those with diabetes, high blood pressure, high disease, or evidence
of dehydration are at risk of developing kidney failure following administration of the dye.
To avoid this complication, the kidney function should be tested with a blood test for creatinine,
and the results should be known before the IVP is performed.
Those with diabetes who are taking metformin (Glucophage) will have to discontinue this
medication prior to and for 2 days after the IVP. They should inform their doctor of the test, and
the doctor will coordinate their management during that time.