What are the contraindications for CT IV contrast? To order rectal contrast, order a CT scan as you would otherwise, specify your desire for rectal contrast in the order, and specifically request it when communicating verbally with the ER Radiologist. Otherwise, it can be useful to evaluate for surgical complications or colonic fistulas, but extreme caution must be exercised in deciding whether to insert a rectal tube in a potentially friable or traumatized/post-surgical rectum. In the setting of penetrating trauma to the pelvis, rectal contrast may be necessary. There are very few indications for rectal contrast in the ER.When would I need rectal contrast? How do I order it? Generally, there is a 45-60 minute delay after finishing PO contrast before performing the CT study.How long does my patient have to wait after drinking PO contrast before having the study? Full policy details on when oral contrast is used for CT in the ED.What is the Oral Contrast Policy for Abdominal CT in ED Patients? If a patient has a contraindication to IV contrast, the study can be performed without it. IV contrast improves tissue contrast, the parameter that distinguishes one organ from the next) and greatly aids in identifying masses or inflammatory/infectious processes. For all other purposes IV contrast is strongly desirable (including evaluating for infection associated with kidney stones). These are when evaluating for ureteral calculi or retroperitoneal hematoma. There are several times when IV contrast is not necessary.When is IV contrast used for abdomen and pelvis CT? In general, workups start with a non-contrast brain CT study and then may progress to MRI or contrast enhanced CT when necessary. IV contrast is used in brain CT when performing a CT angiogram (or venogram) or for evaluating an abscess or malignancy.However, trauma studies are timed for the late arterial/early portal venous phase.ĬT scans of the brain: when is IV contrast used? Most CT scans of the abdomen and pelvis are timed so that the contrast is in the portal veins. For the abdomen and pelvis, contrast timing is more complicated, because there are both systemic and portal venous capillary beds. Meanwhile, a general CT of the chest with IV contrast will have the contrast timed so that it is present within the capillary bed of the soft tissues. A CT angiogram of the chest to evaluate for aortic dissection will have the timing set so the contrast is present in the aorta. For instance, a CT angiogram of the chest to evaluate for PE will have the timing set so the contrast is present in the pulmonary arteries. In a CT angiogram the contrast is timed so that it will highlight either the arteries or veins (venogram) of interest. An angiogram is a specific type of CT scan with contrast.What is the difference between a CT angiogram and a CT scan with IV contrast? Rectal contrast like oral contrast is dilute iodinated contrast, but administered through a rectal tube. Barium is available as an alternative for ER patients with allergic reactions to iodinated contrast agents currently the Department of Radiology recommends premedication for PO iodinated contrast in patients with a history of moderate or severe allergy (see departmental policy). PO contrast for all ER and inpatient CT scans is dilute iodinated contrast (same agent used for IV contrast in CT). IV contrast is either gadolinium for MRI or iodinated contrast for CT.
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