Gastrointestinal bleeding scanning is a nuclear study performed to assist in locating bleeding sites in the upper tract proximal to the ligament of Treitz or in the lower tract distal to the ligament of Treitz. This study is much more sensitive than is endoscopy, barium-mediated radiography, or angiography in locating a bleeding site in the lower gastrointestinal (LGI) tract, although very slight rectal hemorrhages can be missed. Only the site of the bleeding is revealed, not the cause of it. The radionuclide 99mTc as technetium Tc 99m sulfur colloid or technetium Tc 99m RBC is injected IV, and scanning of the abdominal quadrants is performed. Abnormal flow and static studies reveal a focal area of increased intensity of activity during initial scanning with technetium Tc 99m sulfur colloid. The same abnormalities are revealed to locate slow or intermittent bleeding during delayed scanning of up to 24 hours with technetium Tc 99m RBC. Surgical intervention is usually required to correct a persistent bleeding problem.

• No active bleeding at any gastrointestinal tract site

• Inability of client to remain still during the procedure
• Barium in the tract from previous radiologic studies

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Indications

• Detecting and localizing recent or active bleeding sites before medical or surgical treatments
• Identifying and localizing small sites of bleeding in the lower tract caused by tumor, diverticula, angiodysplasia, or inflammatory bowel disease; sites are revealed by focal area of increased activity
• Detecting and localizing upper tract hemorrhage caused by medications such as heparin, warfarin, aspirin, or corticosteroids or conditions such as gastritis, ulcer, or varices (gastric or duodenal)
• Detecting bleeding from stress ulcer in severely stressed clients
• Diagnosing and detecting bleeding sites in children with intussusception, Meckel's diverticulum, or juvenile polyps
• Determining bleeding in the tract from unknown source revealed by increased focal area of activity in flow and static images

Contraindications

• Pregnancy, unless the benefits of performing the procedure greatly outweigh the risks to the fetus
• Hemodynamic instability that presents a risk because of the prolonged time needed for the study

[Section Outline]

• Indications
• Contraindications

Nursing Care Before the Procedure

Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").

• Inform the client of the scanning schedule for immediate and delayed imaging, and explain that each test takes 30 minutes.
• Take baseline vital signs and monitor if their stability is questionable.
• History should include information about conditions and medication regimen that can lead to hemorrhage.

The client is placed on the examining table in a supine position. The client is requested to remain still during the study, and the radiopharmaceutical is administered IV. Imaging for flow studies is performed immediately every 5 seconds for 60 seconds. Static imaging is performed every 1 to 2 minutes for 30 minutes, then at 45 minutes, and at 1 hour. Lateral and oblique views of the upper abdomen are taken to obtain an image of a higher bleeding site if the lower portion is negative (reveals no focal increase activity of the radionuclide). A longer imaging time is required to detect slow bleeding rate, and the technetium Tc 99m RBC allows intermittent imaging for 24 hours without reinjection.⁴⁷

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").

• Continue monitoring vital signs if bleeding is present.
• Hemorrhage/shock state: Note and report upper gastrointestinal (UGI) or LGI blood loss and amount (vomiting, feces), decreasing blood pressure, increased pulse, and pallor and coolness of skin. Monitor vital signs. Prepare for ordered blood transfusion, surgery, or both, to control bleeding.