Diagnostic Imaging

Patient group Directive for the Supply/administration of….

Gastrografin For CT examinations of the Abdomen and Pelvis

Define situation/condition / Gastrografin is used in x-ray and Computer Tomography examinations for investigations of the gastrointestinal tract. It can be used either orally or as an enema. It can make it easier to find and see diseases and improves the diagnostic information needed by the doctor.
X-ray contrast for use in adults and children for CT as justified by Practitioner/Radiologist
Examination justified against referral criteria.
Criteria for inclusion / All patients referred for and justified by a practitioner/Radiologist for an oral contrast enhanced Computer Tomography Scan.

Criteria for exclusion

/ ·  Manifest hyperthyroidism.
·  Hypersensensitivity to iodine-containing contrast media.
Action if excluded /

Further advice should be sought with an over-seeing Consultant Radiologist.

Possible contraindications / Special precautions:
·  Thyroid disease.
·  Oesophagotracheal fistulae to avoid passage of the medium into the lungs.
During pregnancy the use of Gastrografin should be only considered if the examination is absolutely necessary.
Action if contraindications /

In all the above ‘special precautions’ criteria, further advice should be sought with an over-seeing Consultant Radiologist.

Action if patient declines / Refer to radiologist and contrast media reaction protocol
2. Characteristics of staff
Qualifications required / State Registered Radiographers and nursing staff with:
Verification to proceed by Radiologist of administration of contrast.
Treatment of anaphylaxis course.
Assessed and signed as competent by a Radiologist.
Additional requirements / Audit to demonstrate regular practice.
Applies to the Diagnostic imaging staff indicated in ‘Staff Group’ that may administer, without medical prescription, Gastrografin.
Continued education & training requirements / Support and development as required from Radiologists and self directed learning using reflective practice.
3. Description of Treatment
Name of Medicine / Gastrografin
Legal status of medicine / POM
Dose / For CT examinations of the Abdomen and pelvis 20ml of Gastrografin should be diluted in 1000ml of water. Patients should drink as much of this slowly over an hour before their Computer Tomography examination.
Route / Oral
Frequency / Once during the procedure.
Total dose/number of doses / One dose.
Drug / Contraindications/
Cautions / Common Adverse Effects / Interactions / Notes
Gastrografin / Hypersensitivity to iodine-containing contrast media. Manifest hyperthyroidism.
Gastrografin must not be administered undiluted in patients with low plasma volume, as for example in newborns, infants, children and in dehydrated patients, since hypovolaemic complications can be particularly serious in these patients.
broncho-oesophageal fistula, since hyperosmolarity may cause acute pulmonary oedema, chemical pneumonia, respiratory Gastrografin must not be administered undiluted in patients with suspected possibility of aspiration or collapse and death. / Prior to administration all examinations to be supervised by over-seeing Practitioner/ Radiologist.
Post administration of contrast any signs or symptoms of allergy contrast related side effects.
Nausea, vomiting
Urticaria, laryngeal oedema, hypotension, generalized anaphylactoid reaction, contrast media extravasations, delayed skin reactions, bronchospasm / Delayed reactions may occur (hours later or up to several days) (see section 4.8).
Medication for the treatment of hypersensitivity reactions as well as readiness for institution of emergency measures are necessary.
The risk of anaphylactoid/hypersensitivity reactions is higher in case of:
- any history of allergic disorders,
- history of bronchial asthma,
- a previous anaphylactoid/hypersensitivity reaction to iodinated contrast media.
Patients with cardiovascular disorders are more susceptible to serious or even fatal outcomes of severe anaphylactoid/hypersensitivity reactions. / 1ml of Gastrografin solution contains: 100mg sodium amidotrizoate (sodium diatrioate) and 660 mg meglumine amidotrizoate (meglumine diatrizoate)
Barium sulphate
If Gastrografin is used together with barium sulfate preparations, attention must be drawn to the contraindications, warnings and possible side effects relevant to the preparation.
Gastrointestinal
In case of prolonged retention of Gastrografin in the gastrointestinal tract (e.g. obstruction, stasis), tissue damage, bleeding, bowel necrosis and intestinal perforation may occur.
Hydration
Adequate hydration and electrolyte balance should be established and maintained in the patients, since the hyperosmolarity of Gastrografin may cause dehydration and electrolyte imbalance.
Because of the additives (flavourings and a wetting agent), Gastrografin must not be used intravascularly.
Follow up treatment
Written/verbal advice for patient / ·  Staff must be aware if the patient has been scheduled for an iodine isotope examination or therapy. Following administration of Gastrografin the capacity of thyroid tissue to take up iodine will be reduced for 2-6 weeks after.
·  The possible side affects are as follows:
·  Nausea and vomiting.
·  Urticarial skin reaction.
·  Anaphylactoid reactions and shock are possible.
·  Gastrografin may occasionally cause diarrhoea.
·  The patient is advised to contact her GP/AE should symptoms of allergy occur within six hours post procedure i.e. rash, swelling or breathlessness.
·  Owing to the high osmolarity of Gastrografin patients are recommended to keep well hydrated for 12 hours following the examination.
Specify method of recording supply and /or administration / Administration as per inpatient instruction leaflet. Batch number and expiry details to be recorded on CRIS when administered in the department. Wards are responsible for recording administration to inpatients.
Procedure for reporting ADRs to Medical Practitioner / Identify mild ADR in the comment field in contrast page in Radiology system. - No other action to be taken.
Identify moderate & severe ADR in the front page ALERT FIELD.
Complete clinical alert sticker for patient’s notes and send a yellow form to the GP.
Management of Group Directions:
Group direction developed by: / Graeham Mann- Superintendent CT scanner..
Dr. Anthony Cave– Consultant Radiologist.
Gillian Honeywell – Chief Pharmacist.
Authorizing Doctor/s: / Dr. Anthony Cave
Signature:
Date applicable:
Reviewed: / 01/12/2008
April 2011
Review date: /
01/12/2012
Senior Nurse (or senior member of the profession undertaking the PGD) / Graeham Mann Superintendent CT scanner.
Signature
Clinical Directorate Pharmacist / Gillian Honeywell
Signature:
Approved by Nursing Policy Group
(or other appropriate professional body) / Signature
Signed by chair of committee
Approved by Clinical Standards Group / Signature

The group direction is to be read, agreed to, and signed by all staff it applies to. One copy is to be given to the health professional, another kept in the department.

______

I have read the group direction and agreed to use it in accordance with the criteria described.

All professionals who will be using the PGD need to read it and sign. Their review date should ideally be linked to appraisals or other personal review processes to ensure that they are still competent to be approved practitioners under the PGD

Name:

Signature:

Date:

Review date:

Name:

Signature:

Date:

Review date:

Name:

Signature:

Date:

Review date:

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