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Renal Arteriogram

Renal Biopsy
CT Scan/MRI of the
Kidneys/Urinary Bladder

RENAL ARTERIOGRAM
A renal arteriogram is also commonly called
renal angiogram
An arteriogram is a x-ray image of the arteries
or blood vessels of the kidneys (renal).
A fluoroscopic image of the kidneys can also
be done to see the movement of the kidneys.

The catheter is inserted into the femoral artery and is


passed upward through the iliac artery and the aorta
to the renal artery.
This tests permits visualization of the renal vessels
and the parenchyma.
An aortogram is sometimes made with real
angiography to detect any vessel abnormality and to
show the relationship of the renal arteries to the aorta.

Indications/Purposes (RA)

To detect renal artery


stenosis
Renal thrombus or
embolous
Space-occupying lesions
(tumors, cysts)
Aneurysms

To determine the
causative factor of
hypertension
To evaluate renal
circulation

Procedure (RA)
A consent form should be signed by the client or a
designated family member.
The client should be NPO for 8-12 hours before the
test. Antocoagulants (heparin) are usually
discontinued.
Record V/S. have client void before the test.
Dentures and metallic objects should be removed
before the test.
The access site should be shaved.

Premedications (i.e., sedative or narcotic analgesic), if


ordered, are administered an hour before the test. If the
client has a hx of severe allergic reactions to various
substances or drugs, the health care provider may order
steroids or antihistamines before and after the
procedure as a prophylactic measure.
Intravenous fluid may be started before the procedure
so that emergency drugs, if needed, may be
administered.
The client lies in supine position on an x-ray table. A
local anesthetic is administered to the injection
incisional site.
The test takes approximately 1-2 hours.
Laxative or cleansing enema is usually ordered the
evening before the test.

Nursing Implication: Pretest


Obtain history of hypersensitivity to iodine, seafood, or contrast
dye from other x-ray procedures (e.g., IVP). The health care
provider should also know if the client is highly sensitive to
other substances. Skin testing could be done before the test, or
prophylactic medications (i.e., steroids, antihistamines) may be
given prior to and/or following the test.
Record baseline vital signs.
Give laxative or cleansing enema, if ordered. This will cleanse
the lower intestinal tract, allowing better visualization.
Have the client void, wear a gown, and remove dentures.
Administer premedications (sedative and narcotic analgesic) as
ordered. Check that the consent form has been signed before
giving premedications. The client should be in bed with the bed
sides up after premedications are given.

Nursing Implication: Post-test


Apply pressure on the injection site for 5-10 minutes or longer
(venous access) or 30 minutes or longer (arterial access) until
bleeding has stopped. Check the injection site for bleeding when
taking vital signs.
Monitor vital signs as ordered, such as every 15 min for the first
hour, every 30 min fir the next 2hours, and then every hour for
the next 4 hours, or until stable. Temperature should be taken
every 4 hours for 24-48 hours or as ordered.
Enforce bed rest for 5 hours for venous access or 6-8 hours for
arterial access or as ordered. Activities should be restricted for a
day.
Assess injection site for swelling and for hematoma.
Check peripheral pulses in the extremities. Absence or
weakness in pulse volume should be reported immediately

Note the temperature and color of the extremity.


Report changes (e.g., color-pale, pain in the extremity,
especially distal to access site) to the health care
provider immediately. Arterial occlusion to the
extremity may occur.
Apply cold compress or an ice pack to the injection
site for edeme or pain, if ordered.
Monitor ECG tracings, urine output, and IV fluids. IV
fluids and cardiac monitoring may be discontinued
after the angiography.
Observe for a delayed allergic reaction to the contrast
dye (i.e., tachycardia, dyspnea, skin rash, urticarial
[hives], decreasing systolic BP, and decreased urine
output)

Nursing and Patient Care


Consideration
Clear liquids only after midnight before the examination;
adequate hydration is essential
Continue oral medications (especially orders needed for
diabetic patients)
IV access required
May not be done on the same day as other studies
requiring barium or contrast material
Maintain bed rest for 8 hours after the examination, with
the leg kept straight on the side used for groin access
Observe frequently for hematoma or bleeding at access
site. Keep sandbag at bedside for use if bleeding occurs

RENAL BIOPSY
Renal biopsy is the excision of a tissue sample from the
kidney for microscopic analysis to determine cell
morphology and the presence of tissue abnormalities.
The test assists in confirming a diagnosis of cancer
found on x-ray or ultrasound or to diagnose certain
inflammatory or immunologic conditions.
Biopsy specimen is usually obtained either
percutaneously or after surgical incision.

Indication (RB)
Confirming suspected renal malignancy
Cause of renal disease
Systemic lupus erythematosus or other immunologic
disorders
Monitor progression of nephrotic syndrome
Renal function after transplantation

Contraindication (RB)
Bleeding disorders
Advanced renal disease
Uncontrolled hypertension
Solitary kidney (except transplanted kidney)
Obesity
Severe spinal deformity

Nursing Implication: Pretest


Obtain a history of the patients genitourinary and
immune system including list of known allergens.
Obtain history of bleeding disorders, as well as result
of previously performed tests and procedures,
especially bleeding time, clotting time, CBC, partial
thromboplastin time, platelets and prothombin time.
Obtain a list of medications the patient takes,
including anticoagulant therapy, acetylsalicylic acid,
and herbals known to affect coagulation. These
products should be discontinued 14 days before
dental or surgical procedures.

The requesting health care practitioner and laboratory should


be advised if the patient regularly uses such products so their
effect can be taken into consideration when reviewing results.
There are no medication restrictions unless by medical
direction.
Instruct the patient that nothing should be taken by mouth
beginning the night before the procedure.
Review the procedure with the patient. Sensitivity to cultural
and social issues, as well as concern for modesty is important
in proving psychological support.
Address concerns about pain r/t the procedure. Explain that a
sedative may be administered to promote relaxation during
the procedure.

Assess if the patient has an allergy to local anesthetics and


to inform health care practitioner accordingly.
Confirm nonallergy to anesthesia before open biopsy
procedure performed under general anesthesia.
Obtain written and informed consent before administering
any medications prior to the procedures.
Inform the patient that the procedure is performed by the
surgeon under sterile conditions using local anesthetic
(e.g., lidocaine) and that specimen collection takes
approximately 40-60 min.

Nursing Implication: Intratest


Ensure that the patient has complied with dietary
restrictions before open biopsy.
Direct patient to breathe normally and to avoid
unnecessary movement.
Observe standard precautions
Administer ordered premedication.

Record baseline v/s. after administration of anesthesia, a


surgical incision is made, suspicious areas located, and tissue
sample collected.
Percutaneous needle biopsy:
Assist the patient into a prone position. Cleanse the site
antiseptic. A local anthesthetic is injected and a sterile field is
prepared, a sandbag may be placed under the abdomen to aid
in moving the kidneys to the desired position. Instruct patient
to take deep breath and hold it while the needle is inserted. As
the needle enters the kidney, instruct the patient to exhale. The
needle is rotated to obtain a plug of tissue, and then removed.
Place the specimens in the appropriate containers. Label the
specimen, indicating site location, especially left or right;
promptly transport specimen to the laboratory.
Apply manual pressure for 5-20 min, and apply pressure
dressing.

Nursing Implication: Post-test


Instruct the patient to resume usual diet as directed by the health
care practitioner.
After open biopsy, monitor v/s every 15 min for 1 hr, then every 2 hr
for 4 hr and as ordered. Take temperature every 4 hr for 24 hr.
After local anesthesia, monitor v/s and compare with baseline values.
Inform the patient that blood may be seen in the urine after the first
or second postprocedural voiding.
Monitor fluid I&O for 24 hr.
Instruct the patient to report any changes in urinary pattern or
volume or any unusual appearance of the urine. If the urine volume
is less than 200 mL in the first 8 hr, encourage the patient to
increase fluid intake unless contraindicated by another medical
condition.

Instruct px to immediately report symptoms such as


backache, flank pain, shoulder pain, lightheadedness,
burning on urination, hematoria, chills or fever, which
may indicate presence of infection, haemorrhage, or
inadvertent puncture of other organs.
Observe the needle site or incision for bleeding.
Observe the patient for other signs of distress
including hypotension and tachycardia.
After percutaneous biopsy, instruct patient to stay in
bed lying on the affected side at least 30 min with a
pillow or sandbag under the site to prevent bleeding.
The patient also needs to remain on bed rest for 24 hr.

Instruct patient to avoid strenuous activity, sports, and


heavy lifting for 2 weeks after the procedure.
Recognize anxiety r/t test results and offer support.
Provide teaching and information of the test results, as
appropriate. Educate the patient regarding access to
counselling services.
Evaluate test results in relation to the patients
symptoms and other test performed. Related laboratory
include albumin, aldosterone, antiglomerular basement
membrane antibody, 2-macroglobulin, creatinine
clearance, osmolality, potassium, urine potassium,
protein, urine protein, renin, sodium, urine sodium, urea
nitrogen, urinalysis and urine cytology.

CT SCAN OF THE KIDNEYS


AND BLADDER
Computed tomography (CT or CAT scan) is a noninvasive
diagnostic imaging procedure that uses a combination of Xrays and computer technology to producehorizontal, or
axial,images (often called slices) of the body. A CT scan
shows detailed images of any part of the body, including the
bones, muscles, fat, and organs. CT scans are more detailed
than standard X-rays.
CT scans of the kidneys can provide more detailed
information about the kidneys than standard kidney, ureter,
and bladder (KUB) X-rays, thus providing more information
related to injuries and/or diseases of the kidneys.

Indication (CT Scan)


Tumors or other lesions
Kidney stones
Congenital anomalies
Polycystic kidney disease
Accumulation of fluid around the kidneys
Location of abscesses

Contraindication (CT Scan)


Allergies to shellfish or iodinated dye
Px w/ known hypersensitivity to the medium may benefit
from premedication w/ corticosteriods
Claustrophobic
Pregnant
Elderly & Chronically dehydrated
Renal failure
Outweigh the risk of exposure to high levels of radiation

Nursing Implication
Obtain history of the pxs complaints or clinical sx, including
allergens, especially allergies or sensitivities to iodine, seafood,
or other contrast mediums
Obtain a history of results of previously performed diagnostic
procedures, & laboratory tests
Note any recent barium or other radiologic contrast procedures.
Record the date of the last menstrual period & determine the
posibility of pregnancy in permenopausal women
Obtain a list of the medications the px is taking

Nursing Implication: Pretest


In case contrast is used, px receiving metformin

(glucophage) for non-insulin-dependent (type 2) diabetes


should the drug on the day of the test & continue to
withhold it for 48 hrs after the test
Review the pocedure w/ the px
Provide psychological support before, during, & after the

procedure
Explain that an IV line may be inserted to allow infusion of IV

fluids, contrast medium, dye, or sedatives.

Inform the px that he/she may experience nausea, a


feeling of warmth, a salty or metallic taste, or a
transient headache after injection of contrast medium,
if given
The px should fast & restrict fluids for 6-8 hrs prior to
the procedure. Instruct the px to avoid taking
anticoagulant medication or to reduce dosage as
ordered prior to procedure

Instruct the px to remove jewelry, credit cards, keys,


coins, pagers, cellphone & other metallic objects
Make sure a written & informed consent has been
signed prior to the procedure & before administering
any medications

Nursing Implication: Intratest


Ensure that the px has complied w/ dietary, fluids, &
medication restrictions & pretesting preperations,
assure that food has been restricted for atleast 6hrs
prior to the procedure. Ensure that the px has removed
all external metalic objects prior to the procedure
Have emergency equipment readily available
If the px has a history of severe allergic reactions to any
substance or drug. Administer ordered prophylactic
steroids or antihistamines before the procedure.

Px are given a gown, robe, & foot coverings to wear &


instructed to void prior to the procedure
Observe standard precautions
Instruct the px to cooperate fully & to follow directions
Establish an IV line for the injection of contrast, emergency
drugs, & sedatives
Administer an antianxiety agent, as ordered, if the px has
claustrophobia. Administer a sedative to a child or to an
uncooperative adult, as ordered
Place the px in the supine position on an exam table

If contrast is used, the contrast medium is injected, & a


rapid series of images is taken during & after the filling of
the vessels to be examined. Delayed images may be taken
to examine the vessels after a time to monitor the venous
phase of the procedure
Ask the px to inhale deeply & hold his/her breath while the
x-ray images are taken, & then to exhale after the images
are taken
Instruct the px to take slow, deep breaths if nausea occurs
during the procedure. Monitor & administer an antiemetic
agent if ordered. Ready an emesis basin for use

Monitor the px for complications related to the procedure (eg.


Allergic reaction, anaphylaxis, bronchospasm) if contrast is
used
The needle or vascular catheter is removed, & a pressure
dressing is applied over the puncture site
The results are recorded on film, or by automated equipment
in a computerized system for recall & post procedure
interpretation by the appropriate health care practitioner

Nursing Implication: Post-test


Instruct the px to resume usual diet, fluids,
medications, or activity, as directed by the health care
practitioner. Renal function should be assessed before
metformin is resumed, if contrast was used
Monitor vital signs & neurologic status every 15 mins
for 30 mins.

If contrast was used delayed allergic reactions


If contrast was used, advise the px to immediately report
sx such as heart rate, difficulty breathing , skin rash,
itching, or decreased urinary output
Observe the needle/ catheter insertion site for bleeding,
inflammation, or hematoma formation
Instruct the client to apply cold compress to the puncture
site, as needed, to reduce discomfort or edema

Instruct the px to increase fluid intake to help


eliminate the contrast medium, if used
Inform the px that diarrhea may occur after ingestion
of oral contrast medium
A written report of the examination will be completed
by health care practitioner

MRI OF THE KIDNEYS


AND BLADDER
MRI uses a magnetic radio waves to produce
an energy field that can be displayed as
imaged

Indication (MRI)
At risk of contrast nephropathy.
Allergy to contrast agents.
Renal cell carcinoma.
Women with chronic urinary tract infections

Contraindication (MRI)
Px w/ certain ferrous metal prostheses, valves, aneurysm
clips, inner ear prostheses, or other metallic objects
Px w/ metal in their body, such as ferrous metal in the eye
Px w/ intrauterine devices
Px w/ iron pigments tattoos
Px who is claustrophobic
Px who is pregnant