Dr. Amrit Hansra, interventional radiologist, gives an overview of imaging modalities as well as key nursing takeaways for common IR procedures such as G-tubes, biliary drains, and nephrostomy tubes.

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Objectives

1. Listeners will be able to describe the differences between the various modes of medical imaging, including their advantages, limitations and indications
2. Listeners will be able to explain the the differences between PEG tubes and G-tubes, including how each are inserted as well as important difference in nursing management
3. Listeners will be able to identify tunneled v. non-tunneled catheters and where to apply pressure after catheter removal.
4. Listeners will be able to describe what biliary drains are, when they are indicated, and how nurses can effectively manage them

Radiology 101

X-ray

• Creates a 2-D image
• Useful for imaging bones, air
• Pros: widely available, can sometimes be performed at bedside
• Cons: not a detailed image, radiation risk

Ultrasound

• Using echoes of ultrasound pulses to delineate objects of different density in the body
• Useful for quickly imaging internal organs and blood vessels
• Pros: No radiation, can be performed quickly at bedside. Because they show images in real-time, the viewer is able to see movement of the internal organs, no radiation
• Cons: not a detailed image

Computed Tomography (CT)

• Creates a 3-D image
• Useful for imaging soft tissue, organs, bones, and blood vessels
• Indicated for an assessment of internal bleeding, fractures, and tumors
• Pros: Creates a detailed image, relatively fast
• Cons: Radiation risk, cannot be performed at bedside

Magnetic Resonance Imaging (MRI)

• Creates very detailed 3-D images of body structures
• Indicated for an assessment of the brain (esp. CVAs), joints, blood vessels
• Pros: Creates a very detailed image, no radiation
• Cons: Requires the patient to lie flat for a long period of time, claustrophobia
• Contraindicated for patients with implanted metal devices

Positron Emission Tomography (PET)

• Indicated for diagnosis and staging of malignancies, some infection/inflammatory processes
• The patient receives a radioactive “tracer” containing glucose that “lights up” highly active (often malignant) cells
• Important nursing note: do not administer insulin prior to a PET scan

G-tubes v. PEG Tubes

Important nursing takeaways

• If a gastrostomy tube is pulled out, immediately insert a foley catheter into the stoma to maintain the tract (no need to inflate the balloon)
• Educate patients and caregivers about which ports to use in a gastrostomy tube (i.e. don’t touch the balloon port!)

Biliary Drains

There are two types of biliary drains: external and internal-external

Important Nursing Takeaway

When flushing an external biliary drain, the NS may not flow back out into the external drain but that’s OK! The NS has drained into the patient’d duodenum, which is a good thing.