Intravenus Urography (IVU)

8/6/2019 Intravenus Urography (IVU)

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HAMZEH ALMASRI

Intravenus Urography/Pyelography

(IVU/IVP)


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This exam is used to visualize urinary

system anatomy and excretory function.


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1- are you allergic to anything?

2- are you allergic to fish, iodine, eggs or any type of

medication?3- do you have asthma, allergic rhinitis?

4- have you done a previous intravenous CM injectionand had a reaction?

Take patient history before giving the

contrast media injection:


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5- are you a diabetic patient taking Glucophage (metformin)?

6- check patient chart (kidney function test);

Createnine level 0.5-1.5 mg/dl

BUN(Blood-Urine-Nitrogen) 5-25 mg/100ml

Take patient history before giving the

contrast media injection:


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1-Suspected urinary tract pathology.

2-Repeated infections.

3-Heamaturia.4-Investigation of hypertension.

5-Renal colic (stone).

6-Trauma.

Indications for imaging:


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1- Allergy to iodine.

2- Kidney failure.

3- High createnine and urea level in blood.4- DM patient that is taking Glucophage(must be withheld 48 hours prior to the

contrast media study).5- Anuria, or absence of urine excretion.

Contraindication of this exam:


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We give the patient prophylactic (hydrocortisone)

Prednizelone (1 tablet 5 mg)

Day 4 4*2=40 mg

Day3 3*2=30 mg

Day2 2*2=20 mg

Day1

1

*2=1

0 mg

What to do in case of an allergic patient?


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1-Light evening meal.

2-Drink laxative (castor) oil on the day prior to theexam.

3-Fasting for 6-8 hours

4-Don't smoke on the day of the exam.

5-Void prior to the exam to avoid diluting of the CM in

the bladder.

Patient preparation before the day of the

exam and on the day of the exam:


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General IVU procedure


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is taken to:

1-verify patient preparation (bowel clear fromgases and feces)

2-Determine whether exposure factors are

acceptable.

3-Verify positioning.

4-Detect any abnormal calcification.

(CR is at the level of iliac crest, Exposure is madeon suspended expiration).

Scout Image (control or Preliminary),KUB


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The median cubital vein is punctured and the warmed

contrast agent is injected rapidly.

Contrast Media Injection:


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Basic imaging routine:


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AP of renal area is taken immediately after complete

of injection to see the renal parenchyma.

(CR is centered at level of lower costal margin ,

Exposure is made on suspended expiration).

1) Immediate film (nephrogram):


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Full KUB to see if the excretion is symmetrical, or if

uptake is poor and a further dose of contrast agent is

required.

(CR is centered at level of iliac crest ,Exposure is made

on suspended expiration).

Compression may be applied in some centers at this point

to distend the pelvicalyceal systems to demonstrate any

filling defects and a film taken at 10 minutes of the renalareas.

2) 5-minute (Excretory film):


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1- Possible ureteric stones (difficult to distinguish between the

effects of compression versus the appearance due to a stone).

2- Large abdominal mass (acts as compression).

3- Abdominal aortic aneurysm.

4- Recent abdominal surgery.

5- Severe abdominal pain.

6- R

enal trauma.

Compression is contraindicated in:


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to demonstrate the distended bladder(size and

any

filling defects).

(CR :15 caudal angulation centered 5 cmabove the upper border of the symphysispubis).

3) Full bladder:


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to demonstrate the bladder emptying success(if

there is any residual urine).

(CR :15 caudal angulation centered 5 cm abovethe upper border of the symphysis pubis).

4) Post Micturition (void) film:


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Mild reactions ( reassurance, no treatment ):

Nausea, hives, urticaria, itching.

Moderate: ( hydrocortisone, antihistamine,iv fluid )

Tachycardia, vomiting, excessive urticaria,

Severe( emergency treatment -epinephrine )

Low blood pressure, respiratory arrest, loss of

consciousness, cyanosis,convusions.

Possible reactions toCM:


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NOTE: Common side effects occurr after CM injectionare temporary hot flash and metallic taste in themouth.

The patient should NEVER be left alone.

Intravenus Urography (IVU)

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