Pretest Patient Care
Explain the purpose, procedure, benefits, and risks of the test. Explain that some discomfort may be felt during the procedure. Tell the patient that the disadvantages of water-soluble and air contrast include poor visualization and painful headache (with air contrast) because of the difficulty in controlling the gas introduced into the area. Refer to iodine contrast test precautions if iodine is used.
Ensure that a legal consent form is properly signed and witnessed before the test.
Assess pregnancy status of female patients. Alert the radiology department if positive.
Explain that the examination table may be tilted during the test but that the patient will be securely fastened and will not fall off the table.
Explain any dietary restrictions. Most diagnostic departments require the patient to refrain from eating for approximately 4 hours before testing. Clear liquids may be permitted and even encouraged to lower the incidence of headaches after the test. Check with the radiology department and healthcare provider for specific orders.
Inform the patient that a myelogram usually produces some discomfort. Administer a pain reliever if necessary to allow easier positioning and movement during the test.
Follow guidelines in Chapter 1 for safe, effective, informed pretest care.
Clinical Alert
This test is to be avoided unless there is a reason to suspect a lesion. Multiple sclerosis, for example, may be worsened by this procedure.
Assess whether the patient is allergic to latex or iodine and inform the radiology department of any known or suspected sensitivities before study.
If the patient has diabetes, assess whether they are taking metformin. Because of an increased risk for AKI and lactic acidosis, this medication regimen may need to be discontinued the day of and several days after administration of contrast media. Consult the radiology department for specific instructions.
Many radiology departments require the discontinuation of warfarin sodium therapy for several days before performance of a myelogram. Often, a prothrombin time (PT) is required before beginning the examination.
Posttest Patient Care
Review test results; report and record findings. Modify the nursing care plan as needed.
Explain that bed rest is necessary for 4–24 hours after testing. If a water-soluble contrast is used, elevate the head of the bed to 45° for 8–24 hours after the procedure. Advise the patient to lie still and quietly because this position reduces upward dispersion of the contrast medium and keeps it out of the head, where it may cause headache. If oil contrast dye is used, have the patient lie prone for 2–4 hours and then remain on their back for another 2–4 hours. If the entire amount of oil contrast is not withdrawn at the end of the procedure, elevate the head to prevent the oil from flowing into the brain.
Encourage fluid intake to hasten absorption of residual contrast material, to replace cerebrospinal fluid (CSF), and to reduce risk for headache and unusual or metallic taste.
Check for bladder distention and adequate voiding, especially if metrizamide has been used.
Check vital signs frequently (at least every 4 hours) for the first 24 hours after the examination.
Follow guidelines in Chapter 1 for safe, effective, informed posttest care.
Clinical Alert
Observe the patient for possible complications such as nausea and vomiting, headache, fever, seizure, paralysis of one side of the body or both arms or legs (rare), arachnoiditis (inflammation of the spinal cord coverings), change in level of consciousness, hallucinations, drowsiness, stupor, neck stiffness, and sterile meningitis reaction (severe headache, symptoms of arachnoiditis, slow wave patterns on electroencephalogram).
Alteration of CSF pressure may cause an acute exacerbation of symptoms that may require immediate surgical intervention. Lumbar punctures should not be done unless absolutely necessary.
Determine whether water-soluble, oil, or air contrast was used for the procedure because posttest interventions differ.
If nausea or vomiting occur after the procedure and a water-soluble contrast has been used, do not administer phenothiazine antiemetic drugs such as prochlorperazine.