RTE 025 Interventional Radiology

Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title: INTRA-ARTERIAL VS. INTRAVENOUS Materials:

Book, pen and notebook, index card/class list
Learning Targets:
References:
Upon completion of this lesson, the radiologic technology student can:
INTRA-ARTERIAL DRUG ADMINISTRATION
1. Define Intra-arterial and Intravenous routes of drug
administration; https://www.ncbi.nlm.nih.gov/pmc/articles/PM
2. Discuss the importance of IV therapy; and C5530902/
3. To know some procedural applications of percutaneous INTRAVENOUS DRUG ADMINISTRATION
approach
https://en.wikipedia.org/wiki/Intravenous_thera
py
PERCUTANEOUS APPROACH
https://en.wikipedia.org/wiki/Percutaneous

LESSON PREVIEW/REVIEW (10 minutes)

After giving you a lecture on Time Interval Difference, Dual Energy Subtraction, and Hybrid Subtraction, it`s time to assess
your understanding through answering the following questions:

1. Define Time Interval Difference?

2. Explain the process of Dual Energy Subtraction (DES)?

3. Differentiate high-kVp and low-kVp techniques in Dual Energy Subtraction.

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 RTE 025 Interventional Radiology
Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

A. MAIN LESSON (50 minutes)

You will gain knowledge and learn about this lesson:

INTRA-ARTERIAL DRUG ADMINISTRATION

Intra-arterial drug injection is a rare emergency. The condition was first reported in 1942 by Van der Post. Such accidental
injections result in acute ischemia of the affected extremity and digital gangrene is common. The problem is increasingly
being encountered in drug addicts (’main liners’). Prompt recognition and early treatment is necessary to prevent amputation
and permanent disability. We report a case of accidental intra-arterial drug injection which was successfully managed by
intra-arterial thrombolytic therapy.

Injection of drug into an artery is a sporadic event. It may be accidental or associated with drug abuse. At first sight it appears
puzzling because the simple expedient of withdrawing blood into the syringe prior to an ‘IV’ injection should preclude its
occurrence. The brachial artery is the commonest site of accidental injection. This has been attributed to a high bifurcation
of the artery above the cubital fossa, resulting in injection in the brachial or the aberrant ulnar artery. Intra-arterial drug
injection may cause vessel injury by one of several mechanisms. The vessel may be obstructed by inert particles or drug
crystals. Hemolysis, platelet aggregation, vasospasm and venous thrombosis are the other contributory factors. All this
leads to acute thrombosis of the artery. Compromised blood supply to the digits due to this thrombosis may lead to gangrene.
Treatment of this injury consists of rest, analgesia, systemic heparinization, antiplatelet agents and anti-sludging agents like
dextran. However, these measures rarely suffice alone and aggressive therapy is mostly indicated. Intra-arterial injection of
vasodilators appears to be beneficial. Intra-arterial tolazoline blocks arterial smooth muscle alpha-adrenergic receptors
causing vasodilation. It also dilates precapillary arterioles and opens precapillary arteriovenous shunts in skin and has been
effectively used in some patients. Steroids decrease progressive tissue necrosis and have been tried orally, intravenously
or intra-arterially. Decadron has been used in the dose of 40-70 mg intra-arterially with encouraging results

This document is the property of PHINMA EDUCATION

 RTE 025 Interventional Radiology
Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

INTRAVENOUS DRUG ADMINISTRATION

Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers a liquid directly into a person's vein.
The intravenous route of administration is commonly used for rehydration solutions or to provide nutrition in those who
cannot consume food or water by mouth. It may also be used to administer medications or other medical therapy such
as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been
recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of
techniques for safe, effective use.
The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body as they are
introduced directly into the circulatory system and thus quickly distributed throughout the body. For this reason, the
intravenous route of administration is also used for the consumption of some recreational drugs. Many therapies are
administered as a "bolus" or one-time dose, but they may also be administered as an extended infusion or drip. The act of
administering a therapy intravenously, or placing an intravenous line ("IV line") for later use, is a procedure which should
only be performed by a skilled professional. The most basic intravenous access consists of a needle piercing the skin and
entering a vein which is connected to a syringe or to external tubing. This is used to administer the desired therapy. In cases
where a patient is likely to receive many such interventions in a short period (with consequent risk of trauma to the vein),
normal practice is to insert a cannula which leaves one end in the vein and subsequent therapies can be administered easily
through tubing at the other end. In some cases, multiple medications or therapies are administered through the same IV
line.

This document is the property of PHINMA EDUCATION

 RTE 025 Interventional Radiology
Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

IV lines are classified as "central lines" if they end in a large vein close to the heart, or as "peripheral lines" if their output is
to a small vein in the periphery, such as the arm. An IV line can be threaded through a peripheral vein to end near the heart,
which is termed a "peripherally inserted central catheter" or PICC line. If a person is likely to need long-term intravenous
therapy, a medical port may be implanted to enable easier repeated access to the vein without having to pierce the vein
itself each time. A catheter can also be inserted into a central vein through the chest, which is known as a tunneled line.
The specific type of catheter used and site of insertion are affected by the desired substance to be administered and the
health of the veins in the desired site of insertion.
Placement of an IV line may cause pain, as it necessarily involves piercing the skin. Infections and inflammation (termed
phlebitis) are also both common side effects of an IV line. Phlebitis may be more likely if the same vein is used repeatedly
for intravenous access, and can eventually develop into a hard cord which is unsuitable for IV access. The unintentional
administration of a therapy outside a vein, termed extravasation or infiltration, may cause other side effects.

PERCUTANEOUS APPROACH

In surgery, a percutaneous procedure is any medical procedure or method where access to inner organs or other tissue is
done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed
(typically with the use of a scalpel).
The percutaneous approach is commonly used in vascular procedures such as angioplasty and stenting. This involves a
needle catheter getting access to a blood vessel, followed by the introduction of a wire through the lumen (pathway) of the
needle. It is over this wire that other catheters can be placed into the blood vessel. This technique is known as the
modified Seldinger technique.
More generally, "percutaneous", via its Latin roots means, 'by way of the skin'. An example would be percutaneous drug
absorption from topical medications. More often, percutaneous is typically used in reference to placement of medical
devices using a needle stick approach.
In general, percutaneous refers to the access modality of a medical procedure, whereby a medical device is introduced into
a patient's blood vessel via a needle stick. This is commonly known as the Seldinger technique named after Sven Ivar
Seldinger. The technique involves placing a needle through the skin and into a blood vessel, such as an artery or vein, until
bleedback is achieved. This is followed by introduction of a flexible "introducer guide wire" to define the pathway through
the skin and into the passageway or "lumen" of the blood vessel. The needle is then exchanged for an "introducer sheath"

This document is the property of PHINMA EDUCATION

 RTE 025 Interventional Radiology
Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

which is a small tube that is advanced over the introducer guide wire and into the blood vessel. The introducer guide wire
is removed, and exchanged for a catheter or other medical device to be used to deliver medication or implantation of a
medical implant such as a filter or a stent into the blood vessel.
The benefit of a percutaneous access is in the ease of introducing devices into the patient without the use of large cut
downs, which can be painful and in some cases can bleed out or become infected. A percutaneous access requires only a
very small hole through the skin, which seals easily, and heals very quickly compared to a surgical cut down.
Percutaneous access and procedures frequently refer to catheter procedures such as percutaneous transluminal
angioplasty (PTA) ballooning, stent delivery, filter delivery, cardiac ablation, and peripheral or neurovascular catheter
procedures but also refers to a device that is implanted in the body, such as a heart pump (LVAD), and receives power
through a lead that passes through the skin to a battery pack outside the body.

Check for Understanding (25 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You
are given 25 minutes for this activity:

Multiple Choice

1. It is the common site of intra-arterial accidental injection:

a. Brachial artery
b. Coronary artery
c. Femoral artery
d. Antecubital artery
ANSWER: ________
RATIO:___________________________________________________________________________________________

This document is the property of PHINMA EDUCATION

 RTE 025 Interventional Radiology
Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

________________________________________________________________________________________________
________________________________________________________________________________________________

2. Following are contributory factors leading to acute artery thrombosis except:

a. Hemolysis
b. Platelet aggregation
c. Extravasation
d. Vasospasm
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

3. It is a medical technique that is commonly used for rehydration solutions or to provide nutrition in those who cannot
consume food or water by mouth:
a. Intravenous therapy
b. Intra-arterial therapy
c. Angiography
d. PTCA
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

4. It is the fastest route to deliver medications throughout the body:

a. Intramuscular
b. Intra-arterial
c. Intravenous
d. Subcutaneous
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

5. It is a medical procedure or method where access to inner organs or other tissue is done via needle-puncture of the
skin:
a. Intramuscular
b. Percutaneous
c. Subcutaneous
d. Intra-arterial
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

This document is the property of PHINMA EDUCATION

 RTE 025 Interventional Radiology
Module #10 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

C. LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: CAT 3-2-1

(To develop habits on thinking about learning, teacher writes a question or two that may ask students about their learning
experience, if they met the learning target, what they found difficult / easy about the topic or experience, what strategies
worked for them or not, etc. You can use AL strategy like CAT 3-2-1, Muddiest point and the like.)

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