Synonym/Acronym
computed axial tomography (CAT), computed transaxial tomography (CTT), helical/spiral CT.
Rationale
To visualize and assess internal organs/structures for abnormal or absent anatomical features, abscess, aneurysm, cancer or other masses, infection, or presence of disease. Used as an evaluation tool for surgical, radiation, and medical therapeutic interventions.
This Core Diagnostic Study is an imaging modality commonly used to provide detailed diagnostic information about almost any area of the body; it is also used to plan or guide various procedures (e.g., biopsy, surgery).
Patient Preparation
There are no activity restrictions unless by medical direction. Instruct the patient to fast and restrict fluids, as ordered, for 2 to 4 hr prior to the procedure; computed tomography (CT) studies performed without contrast usually do not require the patient to fast before the procedure (e.g., computed tomography angiography [CTA]). Fasting may be ordered as a precaution against aspiration related to possible nausea and vomiting. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/.
Note: Protocols regarding the use of iodinated contrast medium in patients with impaired kidney function and who are receiving metformin or drugs containing metformin for type 2 diabetes may vary by facility; the drug may be discontinued on the day of the test and continue to be withheld for 48 hr after the test. Kidney function should be assessed per facility protocol before use of metformin is resumed (e.g., Cr, eGFR, hydration or clinical assessment).
Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.
Normal Findings
General
- Normal structure, function, contour, and patency of organ and related vessels
- Contrast medium normally circulates throughout area of inquiry, symmetrically and without interruption
- No variations in number and size of vessels and organs; no evidence of infection, edema, obstruction, aneurysm, stenosis, malformations, trauma, cysts, polyps, or tumors
Cardiac Scoring
- If the Agatston score is 100 or less, the probability of having significant coronary artery disease (CAD) is minimal or is unlikely to be causing a narrowing at the time of the examination.
General
- Abscess
- Aneurysm
- Tumor with significant mass effect
- Visceral injury; significant solid organ laceration
Abdomen
- Acute gastrointestinal (GI) bleed
- Leaking aortic aneurysm
- Aortic dissection
- Appendicitis
- Bladder cancer
- Bowel perforation
- Bowel obstruction
- Mesenteric torsion
- Prostate cancer
Angiography
- Brain or spinal cord ischemia
- Emboli
- Hemorrhage
- Occlusion
Brain and Head
- Acute hemorrhage
- Aneurysm
- Infarction
- Infection
- Obstruction
- Stroke (ischemic)
Chest
- Pneumothorax
- Pulmonary embolism
Pelvis
- Ectopic pregnancy
- Prostate cancer
Spine
Spleen
Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.
(Study type: X-ray, special/CT with or without contrast.related body system: )
CT is a noninvasive procedure used to enhance certain anatomical views of an organ with its surrounding structures and vessels. The table is moved in and out of a circular opening in a doughnut-like device called a gantry, which houses the x-ray tube and associated electronics. A beam of x-rays irradiates the patient as the table moves in and out of the scanner in a series of phases. The x-rays penetrate liquids and solids of different densities by varying degrees. Multiple detectors rotate around the patient to collect numeric data associated with the density coefficients assigned to each degree of tissue density. The imaging system’s computer converts the numeric data obtained from the scanner into digital images. Air appears black; bone appears white; and body fluids, fat, and soft tissue structures are represented in various shades between black and white.
Cardiac Scoring CT
Cardiac scoring CT is used to enhance certain anatomical views of the heart for quantifying coronary artery calcium content. CAD occurs when the arteries that carry blood and oxygen to the heart muscle become clogged or built up with plaque. Plaque buildup slows the flow of blood to the heart muscle, causing ischemia and increasing the risk of heart failure. The cross-sectional views of the arteries demonstrate the location and degree of plaque accumulation (calcium score). The Agatston score is the most frequently used scale to quantitate the amount of calcium in atherosclerotic plaque. The score is graded in levels from 0 to greater than 400, where a score of 0 is associated with a finding of no evidence of CAD, and a score of greater than 400 is associated with a finding of extensive evidence of CAD. Levels of 1 to 10, 11 to 100, and 101 to 400 respectively define minimal, mild, and moderate evidence of CAD. For additional information regarding screening guidelines for atherosclerotic cardiovascular disease (ASCVD), refer to the study titled “Cholesterol, Total and Fractions.” For information regarding additional cardiac imaging, refer to the study titled “Cardiac Catheterization.”
A CT scan may be repeated after administration of contrast medium given orally, by IV injection, or rectally. CT becomes invasive when contrast medium is used. The cross-sectional views, or slices, of the vascular system that supports major organs (brain, heart, liver and biliary tract, lungs, kidneys and adrenal glands, pancreas, spleen, thyroid gland) and anatomical areas such as the abdomen, chest, head, neck, arms, legs, and spine can be reviewed individually or as a three-dimensional image to allow differentiations of solid, cystic, or vascular obstructions as well as identification of suspected hematomas and aneurysms. Contrast is used to differentiate, enhance, or “light up” areas of interest depending on the type of study to be performed, type of contrast medium to be used, and method of administration. The medium works by creating a contrast between areas of interest based on density; penetration of the x-rays is weaker in areas where the contrast medium is detected by the scanner, showing the blood vessels, organs, and tissue as whitish areas that either outline the area of interest or completely fill it.
Oral ingestion of contrast medium can be used for opacification to distinguish the bowel, adjacent abdominal organs, other types of tissue, and blood vessels as the medium moves through the digestive tract. IV injection of contrast medium is used for evaluation of blood flow through vessels and greater enhancement of tissue density and organ visualization. These images are helpful when blood vessels are heavily calcified, and the images give the most precise information regarding the true extent of stenosis. They can also evaluate intracerebral aneurysms. Small ulcerations and plaque irregularity are readily seen with CTA; the degree of stenosis can be closely estimated with CTA because of the increased number of imaging planes. Multislice or multidetector CT scanners continuously collect images in a helical or spiral fashion instead of a series of individual images, as with standard scanners. Helical CT can collect many images over a short period of time (seconds), is sensitive in identifying small abnormalities, and produces high-quality images. Images can be recorded on photographic or x-ray film or stored in digital format as digitized computer data.
CT Colonography (Virtual Colonoscopy)
The procedure is used primarily to detect polyps, which are growths of tissue in the colon or rectum. Some types of polyps increase the risk of colon cancer, especially if they are large or if a patient has several polyps. Compared to conventional colonoscopy, CT colonography is less effective in detecting polyps smaller than 5 mm, more effective when the polyps are between 5 and 9.9 mm, and most effective when the polyps are 10 mm or larger. This test may be valuable for patients who have diseases rendering them unable to undergo conventional colonoscopy (e.g., bleeding disorders, lung or heart disease) and for patients who are unable to undergo the sedation required for traditional colonoscopy. The procedure is less invasive than conventional colonoscopy, with little risk of complications and no recovery time. CT colonography can be done as an outpatient procedure, and the patient may return to work or usual activities the same day.
CT colonography and conventional colonoscopy require the bowel to be cleansed before the examination. The screening procedure requires no contrast medium injections, but if a suspicious area or abnormality is detected, a repeat series of images may be completed after IV contrast medium is given. These density measurements are sent to a computer that produces a digital analysis of the anatomy, enabling HCP to look at slices or thin sections of certain anatomical views of the colon and vascular system. A drawback of CT colonography is that polyp removal and biopsies of tissue in the colon must be done using conventional colonoscopy. Therefore, if polyps are discovered during CT colonography and biopsy becomes necessary, the patient must undergo bowel preparation a second time.
Brain and Head CT
CT of the brain and head can be performed with or without contrast at the discretion of the imaging HCP. In some cases, scans may be repeated after multiple types of contrast are administered. For example, xenon-enhanced CT scanning is an imaging method used to assess cerebral blood flow. Xenon-133 is an odorless, colorless radioactive gas that can be either inhaled or injected. The isotope moves rapidly through the blood into the brain. The diffused gas demonstrates how much blood goes to each area of the brain. Sensitivity of stroke detection in the acute phase is increased by using Xenon. Combinations of diagnostic modalities are also becoming more common. Positron emission tomography (PET) and single-photon emission tomography (SPECT) are types of nuclear medicine studies that offer insights into functionality such as movement of blood flow or uptake and distribution of metabolites into tumors.
PET/CT and SPECT/CT are imaging applications that superimpose PET or SPECT and CT findings. The images are collected and produced by a single gantry system. The coregistered or image fusion of PET/CT or SPECT/CT findings can provide a detailed combination of anatomical and functional images. Images can be recorded on photographic or x-ray film or stored in digital format as digitized computer data. The CT scan can be used to guide biopsy needles into areas of suspected tumors to obtain tissue for laboratory analysis and to guide placement of catheters for angioplasty or drainage of cysts or abscesses. Tumor staging and progression, before and after therapy, and effectiveness of medical interventions may be monitored by PET/CT or SPECT/CT scanning. The images can be reevaluated and manipulated for further detailed examination without having to repeat the procedure.
Chest CT
Studies have demonstrated that in high-risk patients, annual screening with low-dose CT scans (LDCT) helps lower the risk of death from lung cancer.
Pregnancy is a general contraindication to procedures involving radiation.
Patients who are claustrophobic.
Patients with conditions associated with adverse reactions to contrast medium (e.g., asthma, food allergies, or allergy to contrast medium). Although patients are asked specifically if they have a known allergy to iodine or shellfish (shellfish contain high levels of iodine), it has been well established that the reaction is not to iodine; an actual iodine allergy would be problematic because iodine is required for the production of thyroid hormones. In the case of shellfish, the reaction is to a muscle protein called tropomyosin; in the case of iodinated contrast medium, the reaction is to the noniodinated part of the contrast molecule. Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids and diphenhydramine; the use of nonionic contrast or an alternative noncontrast imaging study, if available, may be considered for patients who have severe asthma or who have experienced moderate to severe reactions to ionic contrast medium.
Patients with moderate to marked renal impairment (glomerular filtration rate less than 30 mL/min/ 1.73 m2), or with conditions associated with preexisting renal insufficiency (e.g., chronic kidney disease, single kidney transplant, nephrectomy, diabetes, multiple myeloma, treatment with aminoglycosides and NSAIDs), because iodinated contrast is nephrotoxic.
Patients with moderate to marked renal impairment (glomerular filtration rate less than 30 mL/min/ 1.73 m2) and who are also taking metformin, which may put them at risk for development of drug-induced lactic acidosis, a dangerous and sometimes fatal adverse effect of metformin (related to renal impairment that does not support sufficient excretion of metformin).
Patients who are chronically dehydrated before the test, especially older adults and patients whose health is already compromised, because of their risk of contrast-induced acute kidney injury.
Patients with pheochromocytoma, because iodinated contrast may cause a hypertensive crisis.
Patients with bleeding disorders or receiving anticoagulant therapy, because the puncture site may not stop bleeding.
Abnormal Findings Related to
Identification of abnormal findings is assisted by comparison of parameters such as size, shape, symmetry, density, and location. For example, areas of altered density in either an expected or unexpected location may indicate enlargement of an organ or the presence of blood or other fluids, tumors, or cysts. Comparison by type of abnormal findings may also assist in evaluating areas of altered density. For example, well-defined round or oval areas, smaller in size and having lower density than a primary tumor, may indicate a cyst; a crescent-shaped area of abnormal density that alters the proximity of the liver to the Glisson capsule may indicate a hematoma; areas of less than normal density may indicate hepatic lesions; and dilation of the associated ducts may indicate an obstruction.
Abdomen
- Abdominal abscess
- Abdominal aortic aneurysm
- Abnormal accumulations of blood, fat, or body fluid
- Adrenal tumor or hyperplasia
- Appendicitis
- Bowel obstruction
- Bowel perforation
- Cirrhosis
- Dilation of the common hepatic duct, common bile duct, or gallbladder
- Diverticulitis
- Gallstones related to cholecystitis
- GI bleeding
- Hematomas
- Hemoperitoneum
- Hepatic cysts or abscesses
- Infarction (e.g., intestinal, omental)
- Infection
- Pancreatic pseudocyst
- Primary and metastatic tumors in bone, organs, glands, ducts, or ligaments
- Prostate cancer
- Renal calculi
- Splenic laceration
- Thyroid cancer related to metastases
- Trauma
Angiography
- Aortic aneurysm
- Cysts or abscesses
- Dissected aorta
- Emboli
- Hemorrhage
- Occlusion
- PAD
- Pericarditis
- Shunting
- Stenosis
- Stroke (ischemic)
- Tumor
Biliary Tract and Liver
- Dilation of the common hepatic duct, common bile duct, or gallbladder
- Gallstones related to cholecystitis
- Hematomas
- Hepatic cysts or abscesses
- Jaundice (obstructive or nonobstructive)
- Primary and metastatic tumors
- Dilation of the common hepatic duct, common bile duct, or gallbladder
- Gallstones
- Hematomas
- Hepatic cysts or abscesses
- Jaundice (obstructive or nonobstructive)
- Primary and metastatic tumors
Brain and Head
- Abscess
- Alzheimer disease
- Aneurysm
- AVMs
- Cerebral atrophy
- Cerebral edema
- Cerebral infarction
- Congenital abnormalities
- Craniopharyngioma
- Cysts
- Foreign body
- Hematomas (e.g., epidural, subdural, intracerebral)
- Hemorrhage
- Hydrocephaly
- Increased intracranial pressure or trauma
- Infarction
- Infection
- Pheochromocytoma
- Sclerotic plaques suggesting multiple sclerosis
- Sinusitis
- Stroke (hemorrhagic, ischemic)
- Trauma
- Tumor
- Ventricular or tissue displacement or enlargement
Cardiac Scoring
Calcified plaque in the coronary arteries is similar in composition to bone and if present will appear as areas of whiteness depending on the amount of accumulated calcification.
- If the Agatston score is between 100 and 400, a significant amount of calcified plaque was found in the coronary arteries. There is an increased risk of a future MI, and a medical assessment of cardiac risk factors needs to be done. Additional testing may be needed.
- If the Agatston score is greater than 400, the procedure has detected extensive calcified plaque in the coronary arteries, which may have caused a critical narrowing of the vessels. A full medical assessment is needed as soon as possible. Further testing may be needed, and treatment may be needed to reduce the risk of MI.
Chest
- Aortic aneurysm
- Chest, mediastinal, spine, or rib lesions
- Cysts or abscesses
- Enlarged lymph nodes
- Esophageal pathology, including tumors
- Hodgkin disease
- Pleural effusion
- Pneumonitis
- Pneumothorax
- Pulmonary embolism
- Tumors
Colon
- Abnormal endoluminal wall of the colon
- Extraluminal extension of primary cancer
- Mesenteric and retroperitoneal lymphadenopathy
- Metachronous lesions
- Metastases of cancer
- Polyps or growths in colon or rectum
- Tumor recurrence after surgery
Kidneys
- Adrenal tumor or hyperplasia
- Congenital anomalies, such as polycystic kidney disease, horseshoe kidney, absence of one kidney, or kidney displacement
- Dilation of the common hepatic duct, common bile duct, or gallbladder
- Renal artery aneurysm
- Renal calculi and ureteral obstruction
- Renal cell cancer
- Renal cysts or abscesses
- Renal laceration, fracture, tumor, and trauma
- Perirenal abscesses and hematomas
- Primary and metastatic tumors
Pancreas
- Acute or chronic pancreatitis
- Obstruction of the pancreatic ducts
- Pancreatic abscesses
- Pancreatic cancer
- Pancreatic pseudocyst
- Pancreatic tumor
Pelvis
- Bladder calculi
- Ectopic pregnancy
- Fibroid tumors
- Hydrosalpinx
- Ovarian cyst or abscess
- Primary and metastatic tumors
- Prostate cancer
Pituitary
- Abscess
- Adenoma
- Aneurysm
- Chordoma
- Craniopharyngioma
- Cyst
- Meningioma
- Metastasis
- Pituitary hemorrhage
Spine
- Congenital spinal malformations, such as meningocele, myelocele, or spina bifida
- Herniated intervertebral disks
- Paraspinal cysts
- Spinal tumors
- Spondylosis (cervical or lumbar)
- Vascular malformations
Spleen
- Abdominal aortic aneurysm
- Hematomas
- Hemoperitoneum
- Primary and metastatic tumors
- Splenic cysts or abscesses
- Splenic laceration, tumor, infiltration, and trauma
Potential Problems: Assessment & Nursing Diagnosis/Analysis
| Problems | Signs and Symptoms |
|---|
| Abdomen and CT Angiography: Cardiac output (decreased—related to dissection, rupture) | Altered level of consciousness, hypotension, increased pulse that may be thready, delayed capillary refill, diminished peripheral pulses, cool skin, restlessness, anxiety |
| Biliary Tract and Liver: Fluid volume (deficit—related to vomiting, nausea) | Dry mucous membranes, low blood pressure, increased heart rate, slow capillary refill, diminished skin turgor, diminished urine output |
| Brain and Head: Cerebral tissue perfusion (inadequate—related to infarct, hemorrhage, mass, edema, infection, plaque, atrophy) | Diminished or altered level of consciousness, aphasia that can be expressive or receptive, loss of sensory functionality, slurred speech, dysphagia, difficulty in completing a learned activity or in recognizing familiar objects (apraxia, agnosia), motor function deficits, spatial neglect, facial droop and/or varying degrees of flaccid extremities |
| Cardiac Scoring and Chest: Fluid volume (excess—related to diminished renal perfusion with release of antidiuretic hormone, inadequate cardiac pumping) | Weight gain, edema, decreased urinary output, tachycardia, dyspnea, elevated blood pressure, jugular venous distention, restlessness |
| Colonography: Bowel elimination (altered related to operative bowel elimination) | Silent bowel sounds with auscultation, does not pass stool or flatus, bloating; nausea, abdominal distention |
| Kidneys: Infection (related to obstruction, aneurysm, infection, cyst, abscess, inflammation, tumor, trauma, injury) | Positive culture, fever, chills, elevated temperature, elevated white blood cell (WBC) count, flank pain, hematuria, urinary frequency |
| Pancreas: Nutrition (insufficient—related to decreased oral intake associated with pain, NPO status) | Self-report of pain with eating, presence of nausea and vomiting, NPO order, inflammation |
| Pelvis: Pain (related to tumor, inflammation, abdominal pressure) | Self-report of pain, facial grimace, crying, restlessness, anxiety, elevated blood pressure and heart rate |
| Pituitary: Infection risk (related to a combination of surgical procedure and immunosuppression secondary to chemotherapy) | Redness, warmth, or drainage at the incision site, elevated temperature, elevated WBC count and CRP |
| Spine: Mobility (related to pain, muscular spasms, nerve compression) | Slow, guarded movement; pain; difficulty standing upright |
| Spleen: Bleeding (related to trauma, injury) | Decreasing Hgb and Hct, hypotension, tachycardia, shortness of breath, weakness, fatigue, pallor |
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Review the procedure with the patient.
- Discuss how this procedure can assist in assessing internal organs and other anatomical areas of interest.
- Explain that the procedure takes about 15 to 30 min depending on factors such as the type of study ordered, whether contrast is used, and the type of contrast used; cardiac scoring takes about 10 to 15 min and is usually performed in the radiology department.
- Explain that prior to the procedure, laboratory testing may be required to determine the possibility of bleeding risk (coagulation testing) or to assess for impaired kidney function (serum Cr or eGFR) if use of iodinated contrast medium is anticipated. Pregnancy testing may be required.
- Discuss how there may be moments of discomfort or pain when the IV line or catheter is inserted allowing for infusion of fluids such as saline, anesthetics, sedatives, medications used in the procedure, or emergency medications.
- Explain that contrast medium will be injected, by catheter, at a separate site from the IV line. A burning and flushing sensation may be felt throughout the body during injection of the contrast medium, and an urge to cough, flushing, nausea, or a salty or metallic taste may be experienced.
- Discuss how reducing health-care-associated infections is an important patient safety goal, and a number of different safety practices will be implemented during the procedure. Hair in the area near the catheter insertion site may be clipped and the area cleaned with an antiseptic solution to cleanse bacteria from the skin in order to reduce the risk for infection.
Procedural Information
- Policies regarding breastfeeding before and after an imaging procedure may vary among facilities. For additional information, see Appendix A: Patient Preparation Specimen Collection, subsection: Potential Contraindications and Complications Associated With Diagnostic Procedures.
- Note: The World Health Organization, Centers for Disease Control and Prevention, and Association of periOperative Registered Nurses recommend that hair not be removed at all unless it interferes with the incision site or other aspects of the procedure because hair removal by any means is associated with increased infection rates.
- Hair removal requires facilities to use a protocol that is based on scientific literature or the endorsement of a professional organization. Clipping immediately before the procedure and in a location outside the procedure area is preferred to shaving with a razor. Shaving creates a break in skin integrity and provides a way for bacteria on the skin to enter the incision site.
- Baseline vital signs are recorded and monitored throughout the procedure.
- Cardiac Scoring: ECG electrodes are placed at the appropriate locations on the patient’s chest. The CT scanner is synchronized with the patient’s heart rate in order to record images when the heart is at rest. For cardiac scoring, a rapid series of images is taken during and after the filling of the vessels to be examined.
- Abdomen, Angiography, Biliary, Colonography, Kidney, Pancreas, Pelvis, Spleen: The patient is advised that a request may be made to drink approximately 450 mL of a dilute barium solution (approximately 1% barium) or a water-soluble oral contrast; the oral contrast is given within a specified time period prior to the study.
- Patient placement is in the supine position on an examination table.
- Oral contrast is administered to distinguish GI organs from the other abdominal organs and to enhance other areas of interest. Oral contrast is also sometimes administered when the patient cannot receive IV iodinated contrast (e.g., CT colonography).
- If IV contrast media is used, a rapid series of images is taken during and after the filling of the vessels to be examined. Delayed images may be taken to examine the vessels after a time and to monitor the venous phase of the procedure. The patient is asked to inhale deeply, hold the breath while the images are taken, and then exhale after the images are taken.
- The patient is advised to take slow, deep breaths if nausea occurs during the procedure. An ordered antiemetic drug is administered as needed. An emesis basin is available for use as needed.
- Once the study is completed, the needle or catheter is removed, and a pressure dressing is applied over the puncture site.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
- Angiography and Cardiac Scoring: Investigate the presence of other risk factors, such as family history of heart disease, smoking, obesity, diet, lack of physical activity, hypertension, diabetes, previous MI, and previous vascular disease. Knowledge of genetics assists in identifying those who may benefit from additional education, risk assessment, and counseling.
- Genetics is the study and identification of genes, genetic sequence variations, and inheritance. For example, genetics provides some insight into the likelihood of inheriting a medical condition such as CAD.
- Genomic studies evaluate the interaction of groups of genes. The combined activity or combined expression of groups of genes allows assumptions or predictions to be made. As an example, genomic studies measure the levels of activity in multiple genes to predict how they, along with environmental and lifestyle decisions, influence the development of type 2 diabetes, CAD, MI, or ischemic stroke. Further information regarding inheritance of genes can be found in the study titled “Genetic Testing.”
- Glucagon or an anticholinergic drug may be given to stabilize movement of the stomach muscles; peristaltic contractions (motion) may alter study findings.
Safety Considerations
- Anticoagulants, aspirin, and other salicylates should be discontinued by medical direction for the appropriate number of days prior to a procedure where bleeding is a potential complication.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Monitor for complications related to the procedure.
- Note that establishing an IV site and injection of contrast medium are invasive procedures that can cause rare complications. For additional information see Appendix A: Patient Preparation Specimen Collection, subsection: Potential Contraindications and Complications Associated With Diagnostic Procedures. Immediately report symptoms such as difficulty breathing, chest pain, fever, hyperpnea, hypertension, nausea, palpitations, pruritus, rash, tachycardia, urticaria, or vomiting to the appropriate HCP.
- Observe/assess the needle/catheter insertion site for bleeding, inflammation, or hematoma formation.
- Administer ordered antihistamines or prophylactic steroids as needed for an allergic reaction.
- Monitor peripheral pulses as well as changes in the color or temperature of the skin around the insertion site that may be indicative of bleeding. Assess extremities for signs of ischemia or absence of distal pulse caused by a catheter-induced thrombus.
Treatment Considerations
General
- Follow postprocedure vital sign and assessment protocol. Protocols may vary among facilities.
- Instruct the patient to resume pretesting diet, as directed by the HCP. Assess the patient’s ability to swallow before allowing the patient to attempt liquids or solid foods.
- Maintain bedrest in the supine position for 2 to 6 hr, depending on the location of the insertion site, to prevent stress on the puncture site.
- Explain that ingestion of oral contrast media may cause postprocedural diarrhea.
- Provide IV fluid to support blood pressure (rapid rate as appropriate) or blood transfusion as ordered.
Pain
- Facilitate management of pain using an easily understood culturally and age-appropriate pain rating scale.
- Interventions/actions related to pain management include the following: Assess pain character, location, duration, and intensity. Place in a position of comfort and administer ordered medications. Consider alternative measures for pain management (imagery, relaxation, music, etc.). Assess and trend vital signs; facilitate a calm, quiet environment.
CT Abdomen and CT Angiography
Cardiac Output
- Facilitate management of decreased cardiac output.
- Interventions/actions related to decreased cardiac output include the following: Administer IV fluid to support blood pressure (rapid rate as appropriate). Administer ordered blood and blood products. Monitor and trend vital signs, ECG. Assess for changes in sensorium. Monitor intake and output and renal status.
CT Biliary Tract and Liver
Fluid Volume
- Facilitate management of fluid volume deficit.
- Interventions/actions related to fluid volume deficit include the following: Administer ordered parenteral fluids. Encourage oral fluids as appropriate. Monitor and trend vital signs. Implement strict intake and output. Monitor urine color. Administer ordered antiemetics.
CT Brain and Head
Cerebral Tissue Perfusion
- Facilitate management of inadequate cerebral tissue perfusion.
- Interventions/actions related to inadequate cerebral tissue perfusion include the following: Complete baseline neurological assessment for ongoing comparison to evaluate improvement or deterioration. Monitor and trend vital signs. Elevate the head of the bed. Maintain a quiet, restful environment. Administer ordered antihypertensive medication, steroids, diuretics, calcium channel blockers, and antiseizure, antiplatelet, anticoagulant, or thrombolytic medications. Prepare the patient for and facilitate complementary diagnostic studies; magnetic resonance imaging (MRI), PET, ultrasound, or subtraction angiography.
Cardiac Scoring and CT Chest
Fluid Volume
- Facilitate management of fluid volume excess.
- Interventions/actions related to fluid volume excess include the following: Administer prescribed antihypertensive medication and diuretics. Monitor and trend fluid and electrolytes. Monitor and trend heart rate, blood pressure, daily weight. Facilitate a low-sodium diet.
CT Colonography
Bowel Elimination
- Facilitate management of altered bowel function.
- Interventions/actions related to altered bowel function include the following: Assess bowel sounds according to organizational postprocedure guidelines. Consider whether patient needs to remain NPO until bowel function returns. Ensure patency of nasogastric tube (NGT) if one is in use. Monitor strict intake and output. Provide good oral care.
CT Kidneys
Infection
- Facilitate management of infection.
- Interventions/actions related to infection include the following: Monitor for results of complementary diagnostic studies: KUB, CT, MRI, IVP. Monitor and trend laboratory studies: BUN, Cr, WBC count, Hgb, Hct, electrolytes, urine cultures. Administer ordered antibiotics. Increase oral fluid intake appropriately. Administer ordered parenteral fluids. Monitor and trend temperature.
CT Pancreas
Nutrition
- Facilitate management of insufficient nutrition.
- Interventions/actions related to nutrition include the following: Complete a culturally appropriate nutritional assessment. Monitor and trend daily weight, intake and output. Administer ordered IV fluids with supplements such as electrolytes and dietary supplements. Implement NPO as ordered with NGT to low suction. Monitor and trend specific laboratory studies (lipase, amylase, albumin, total protein, electrolytes, glucose, calcium, iron, folic acid). Facilitate dietary consultation and collaboration when oral fluids and diet are ordered.
CT Pituitary
Infection, risk
- Facilitate management of infection risk.
- Interventions/actions related to infection risk include the following: Assess the surgical site for redness, warmth, and drainage. Monitor and trend temperature, WBC count, and CRP. Obtain an ordered culture and sensitivity of drainage if present. Administer ordered antibiotics. Monitor and trend temperature, WBC count, and CRP.
CT Spine
Mobility
- Facilitate management of altered mobility.
- Interventions/actions related to management of altered mobility include the following: Facilitate physical therapy to review proper movement and positioning. Push instead of pull. Use large muscles to lift objects. Avoid twisting. Place pillows under the knees or between the knees in bed.
CT Spleen
- Facilitate management of traumatized spleen. Review and trend Hgb and Hct.
- Interventions/actions related to traumatized spleen include the following: Administer ordered blood and blood products. Monitor and trend vital signs. Provide ordered oxygen as necessary.
Nutritional Considerations
Cardiac
- Note that nutritional therapy is recommended for those with identified CAD risk, especially for those with elevated low-density lipoprotein cholesterol levels, other lipid disorders, diabetes, insulin resistance, or metabolic syndrome. Consider cultural influences with dietary choices to ensure better adherence to lifestyle changes.
- Discuss how a variety in dietary patterns is beneficial for people with ASCVD; for additional information regarding nutritional guidelines, refer to the study titled “Cholesterol, Total and Fractions.”
- Discuss ideal body weight and the purpose of the relationship between ideal weight and caloric intake to support cardiac health.
- Discuss ways to decrease intake of saturated fats and increase intake of polyunsaturated fats. Limit intake of refined processed sugar and sodium. Limit cholesterol intake to less than 300 mg per day.
- Encourage the intake of fresh fruits and vegetables, unprocessed carbohydrates, poultry, and grains.
- Consider a discussion of changeable risk factors warranting education to include strategies to encourage regular participation of moderate aerobic physical activity three to four times per week and eliminate tobacco use.
- Advise those with elevated triglycerides to eliminate or reduce alcohol.
Clinical Judgement
- Consider what can be done to assist those with negative results to cope with their fears and anxiety related to a possible terminal diagnosis.
Follow-Up Evaluation and Desired Outcomes
Chest
CT colonography
- After CT colonography, recognizes colon cancer screening options and understands that decisions regarding the need for and frequency of occult blood testing, colonoscopy, or other cancer screening procedures may be made after consultation between the patient and HCP. Colonoscopy should be used to follow up abnormal findings obtained by any of the screening tests. The most current guidelines for colon cancer screening of the general population as well as of individuals with increased risk are available from the ACS (www.cancer.org), USPSTF (www.uspreventiveservicestaskforce .org), and American College of Gastroenterology (http://gi.org). For additional information regarding screening guidelines, refer to the study titled “Colonoscopy.”
CT studies
- After CT angiography or cardiac scoring, acknowledges contact information provided for the American Heart Association (www.heart.org/HEARTORG), National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov), or the U.S. Department of Agriculture’s resource for nutrition (www.myplate .gov).
- After all CT studies, recognizes the importance of taking ordered medications and adhering to the therapy regimen.