[TexNurse]

I have an issue that I need help with. Our ED recently went from barium to gastrografin for CT's. Supposedly you can do a CT in less time, pt's tolerate it better, move patient's quickly. Everyone's happier. Not happening. This is what is happening now: Contrast is brought to patient, told to drink 3 glasses. Drink one every 30 minutes. (1 1/2 hours to drink). Then, the techs want to wait AT LEAST another 1 hour to scan! That is 2 1/2 hours! Average is 3 hours now from start to finish. THEN we have to wait for the scan to be sent to the radiologist, and when he/she calls back, we can dispo the patient.

I can't believe that every CT done in this country for a possible appy or whatever takes over 3 hours. We did better with barium! We originally changed because the barium is not tolerated as well, and that has proven to be true. Not nearly as many people get nauseated now. BUT! The time factor is unbearable! Please let me know your time frames, protocols, etc.! Then I can present other hospital examples..... Thank you so much for you help!

[athomas91]

ours is the same way - drink 1 - wait an hour - drink 2 - wait an hour and drink 3rd right before scan.... then send to radiol....wait for call.... you are right it sucks!!

[LilgirlRN]

Look at what the average wait time would be anyway for someone who needed an abdominal CT. WIth either type of contrast the patient is one of those that bumps your average stay time up. Perhaps you can do like we did in an ED that I used to work in, we developed a holding area for people who were waiting on test results such as these and it freed up our acute care beds. These patients had a nurse with them and could have pain medication if ordered etc. Whatever the outcome, if they were to go home or be admitted it could be done with equal ease from the holding area. I don't honestly know what to tell you about barium vs gastrografin because when we used barium they were dosed in radiology and I had no idea of the time frame. I just know that if you come in complaining of the kind of abd pain that requires a big workup, you're looking at 4 hrs (at least) in the ED anyway.

[TexNurse]

The problem is that I don't agree. I don't think it is good enough to say "oh well, its going to take 4 hours anyway" It doesn't have to. If you give barium, you can scan in 1 1/2 hours. If you give gastrografin you are looking at 3 hours. That is not progress. There has to be an quick, efficient way to scan these people. I can't believe that with all the progress medicine has made over the years, this is the best we can do..........

[LilgirlRN]

This is some stuff I dug up about contrast. Most of this is no news to any of us. The most important thing you can read here is under the title Is Oral CT Contrast Safe? Look at the 4th sentence in the paragraph, the one that starts with the. Truth is however long it takes to scan someone is beyond our control, we don't get to decide what contrast medium to use. All we can do is try to manage the time and the space to the best use. I've worked in the ED for 14 years and believe me, I am the queen of treat 'em and street 'em (when appropriate). I am all in favor of hurry up, not hurry up and wait. Maybe try talking to some of the techs or radiology nurses where you work or here, maybe they can give you something to work with. Wish I could be of more help


Oral CT Contrast

Note: It is important that patients consult the imaging location performing their CT exam for specific instructions to follow when contrast will be used. The information contained herein is only a general guideline.

Oral contrast is often used to enhance CT images of the abdomen and pelvis. There are two different types of substances used for oral CT contrast. The first, barium sulfate, is the most common oral contrast agent used in CT. The second type of contrast agent is sometimes used as a substitute for barium and is called Gastrografin.

Barium contrast looks like and has a similar consistency as a milk shake. It is mixed with water and depending on the brand used, may have different flavors (for example, strawberry or lemon). Gastrografin contrast is a water-based drink mixed with iodine and has a tinted yellow color. When given orally, gastrografin may taste bitter.

Patients usually need to drink at least 1000 to 1500 cc (about three to four 12 oz. drinks) to sufficiently fill the stomach and intestines with oral contrast.

How does oral CT Contrast Work?

Barium and gastrografin are made up of substances which weaken (attenuate) x-rays. The oral contrast is swallowed and travels into the stomach and then into gastrointestinal tract. During the CT exam which follows, the CT x-ray beam is attenuated (weakened) as it passes through the organs containing the contrast, for example, the large intestine. The organs filled with the contrast are then "enhanced" and appear as highlighted white areas on the CT images.

What Preparation is Needed Before Taking Oral CT Contrast?

It is important to eliminate as much food as possible from the stomach and intestines in order to help the sensitivity of the CT exam using oral contrast. Food and food remains can mimic disease when the oral contrast is present. Thus a regimen of not eating and/or drinking for several hours before the CT exam is required. The preparation time varies depending on the actual exam as well as the imaging center's requirements. Patient preparation varies from center to center, depending on a number of issues. Some types of oral CT contrast are taken at home well before the CT examination.

Is Oral CT Contrast Safe?

In general, barium and gastrografin contrast are safe and pass through the gastrointestinal tract in the same fashion as food or drink. Minor side effects, such as constipation, may occur. Certain medical conditions such as a perforated ulcer may indicate the use of gastrografin instead or barium. The referring physicians and or radiologist will decide which type of contrast material is most appropriate based on a patient's specific condition. Some people have reported sensitivity to the flavoring substance used in oral barium contrast.

In some cases a CT can still provide valuable information without the administration of a contrast agent, and the physician may decide this is the best course for the patient at risk of reaction to contrast.

[TexNurse]

Thanks for all the info. We pretty much did decide to change to gastrografin. Some of the docs- not long out of residency- had used it at larger, out of the area hospitals. They had great experiences with it- said a patient drank quickly- gastrografin traveled quickly- cut down wait time for everyone.
So we changed. And the techs continue to add more an more wait time. I don't know if it is really necessary, or a passive-aggressive move. I am going to push for rectal contrast- no wait time on those rule out appy's- i know the tech's hate those.
Anyway, what I was trying to find out I guess is what other hospital protocols were for the gastrografin. I know we are not stat care, but this is getting ridiculous! Thanks for all your help!

[dianah]

At our Rad. Dept, how long to wait from the drink to the scan depends on what we're looking for. E.g., for possible ruptured appy, that contrast has to move down south aways before it highlights the area of interest -- thus the increased drink-to-scan time. For other CT scans, the drink-to-scan time can be as short as 1/2 - 1 hr. There should be protocols in the CT department for the different drink times. Or the Radiologist directs each and every scan, after reviewing the requisition (I doubt this happens, too time-consuming).

Seems it's a multifacted problem. The techs (hopefully) want good diagnostic imaging. You need a quicker move thru the ED for the pt, while waiting for that good diagnostic imaging.

Have you considered either having your manager talk with the RADIOLOGIST (who should be the one setting up the protocols, as s/he is the one responsible for reading and interpreting the images. Poor technique or bad scanning produces poor imaging and s/he can't read 'em to aid in the diagnostic process.), or speaking w/the Rad yourself? The techs answer to the Radiologist(s), they are not on their own (in my experience). Our Rads are very understanding (hopefully yours are too ), and if the CT drink protocol is creating an ED flow problem, perhaps they can tweak protocol to something more workable. I think, tho', the 3-hr drink is pretty standard for certain needs, as I mentioned before.

Yes, one option is the "triple contrast" study (IV, po and rectal) -- it does work (but as you can imagine, is not our most favorite protocol!) We only use it in extreme cases when there is high suspicion of an abscess in a weird location, and we absolutely need a good contrast study in that particular area.

Good luck. I'd be interested to know what happens. -- D

[erdiane]

our ct scans are sent (in off hours ) from our er in arizona to radiologists on call in Austrailia!!! Because if it's night time in AZ, it's daytime in austrailia. The docs there have licenses to practice in AZ.

[Deaconess]

Our CT scan standard is 20ml gastrograffin in 500ml of water or clear juice to be consumed over 20 to 30 minutes. CT scan to follow in 1 and 1/2 to 2 hours or later if they are trying to view further down the GI tract. On the overnight we get prelim results back within 45minutes. The radiologist views the films at home via computer and faxes the results.

[avigail]

Gastrograffin + Reglan 10 mg IVP = scan in 1 1/2 hours.