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Introduction ⬇

A GI bleeding scan is a test that is very sensitive in the detection and location of acute GI bleeding that occurs distal to the ligament of Treitz (suspensory ligament of the duodenum). (Gastroscopy is the procedure of choice for diagnosis of upper GI bleeding.) Before this diagnostic technique was refined, barium enemas were used to identify lesions reflecting sites of bleeding, but that test was not specific and frequently missed small sites of bleeding. This scan is also indicated for detection and localization of recent hemorrhage, both peritoneal and retroperitoneal. The radiopharmaceutical of choice for suspected active bleeding is 99mTc-labeled RBCs.

Procedure ⬆ ⬇

  1. Inject 99mTc-labeled RBCs intravenously.

  2. Begin imaging immediately after injection and continue every few minutes. Obtain anterior images over the abdomen at 5-minute intervals for 60 minutes or until a bleeding site is located. If the study is negative after 1 hour, obtain delayed images at 4, and sometimes 24 hours later, when necessary, to identify the location of difficult-to-determine bleeding sites.

  3. Total examining time varies.

  4. See Chapter 1 guidelines for safe, effective, informed intratest care.

Clinical Alert

  1. This test is contraindicated in patients who are hemodynamically unstable. In these instances, angiography or surgery should be the procedure of choice.

  2. Assess the patient for signs of active bleeding during the examining period.

  3. Recent blood transfusion may be a contraindication for this study.

Clinical Implications ⬆ ⬇

Abnormal concentrations of RBCs (hot spots) are associated with active GI bleeding sites, both peritoneal and retroperitoneal.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, procedure, benefits, and risks of the GI imaging.

  2. Determine whether the patient has received barium as a diagnostic agent within the past 24 hours. If the presence of barium in the GI tract is questionable, an abdominal x-ray may be ordered.

  3. Advise the patient that delayed images may be necessary. Also, if active bleeding is not seen on initial imaging, additional images must be obtained for up to 24 hours after injection in a patient with clinical signs of active bleeding.

  4. Refer to standard NMI pretest precautions.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Refer to standard NMI posttest precautions.

  2. Review test results; report and record findings. Modify the nursing care plan as needed.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

Presence of barium in the GI tract may obscure the site of bleeding because of the high density of barium and the inability of the technetium to penetrate the barium.

Reference Values ⬆

Normal

No sites of active bleeding