RAD316 - PPT.10 Urinary Tract

Radiography II
RAD316
Urinary System and
Venipuncture
Mrs. Zahra Juma
Research and Teaching Assistant
Radiologic Technology Program – Allied Health Department
CHSS
 To discuss urinary tract anatomy and
clinical indications.
Objectives  To discuss the venipuncture
procedure.
 To explain urinary tract procedures.

Attendance
Urinary System
Anatomy
Urinary System
Urinary System
Kidneys are located halfway
between xiphoid process and iliac
crest.
Which is between T11-T12 and L3
When one stands upright, the
kidneys normally drop about or 5
cm (2 inches).
If the kidneys drop farther than
this, a condition termed
nephroptosis.
Urinary System – Renal Blood Vessels
Urinary System – Urine Production
Urinary System – Microscopic Structure
Collecting System
Cortex: Nephrons
▼
Medulla: Renal pyramids (8-18)
▼
Renal papilla (openings)
▼
Minor calyces (4-13)
▼
Major calyces (2-3)
▼
Renal pelvis
▼
Ureter
Urinary System – Ureter
It measures 28-34 cm long, 1 mm to 1
cm in diameter.
It lie on psoas muscles.
It enters posterolateral bladder.
Three constricted points exist along
the course of each ureter.
Points of constriction
1. Ureteropelvic junction (UPJ)
2. Pelvic brim
3. Ureterovesical junction (UVJ)
Urinary System – Urinary Bladder
The urinary bladder is a

Musculo-membranous sac that
serves as a reservoir for urine.
Urinary System
 IVU Demonstrating Kidneys,

Ureters, and Bladder
Urinary System - Male Pelvic Organs
Urinary System - Female Pelvic Organs
Urinary System
 Full-Term Pregnancy and

Relationship to Bladder
 During pregnancy, as shown in

the Figure, the fetus can exert
tremendous downward
pressure on the bladder.
Urinary System – Anatomy Review
A. Minor calyces
B. Major calyces
C. Renal pelvis
D. Ureteropelvic junction
E. Proximal ureter
F. Distal ureter
G. Urinary bladder
Venipuncture
Urinary System – Venipuncture
 Venipuncture is the percutaneous
puncture of a vein for withdrawal
of blood or injection of a solution
such as contrast media for
urographic procedures.
 Confirmation of the correct

contents of the container, route of
administration, amount to be
administered, and expiration date
is important.
Routes of Administration
Bolus injection Drip infusion

 A bolus injection is one in which the entire
dose of contrast medium is injected into
the venous system at one time.
 The rate of bolus injection is controlled by

the following:
o Gauge of needle or connecting tubing
o Amount of contrast medium injected
o Viscosity of contrast medium
o Stability of vein
o Force applied by the individual who is
performing the injection
 Drip injection is a method whereby
contrast medium is introduced into the
venous system via connective tubing
attached to the IV site.
 A specified amount of contrast medium is

introduced over a specified period.
 The rate of infusion, which may be gradual

or rapid, depending on the needs of the
study, is controlled by a clamp device
located below the drip chamber on the IV
tubing.
 Venipuncture Supplies
Urinary System – Types of Needles
Urinary System – Selection of Veins
 Avoid sclerotic veins.
 Avoid twisted (tortuous) veins.
 Avoid rolling veins.
 Avoid overused.
 Avoid veins that lie above
arteries.
 Avoid veins that has shunts,
central line, or vascular
catheter.
 ensure that the vessel is not an
artery.
Urinary System – Venipuncture Procedure
 Step 1: Handwashing and Gloves
 Step 2: Apply tourniquet 3-4 inches (8-10 cm) above site
 Step 2 (cont’d): Select Vein and Cleanse Site
Palpate vein to confirm site Cleanse site
 Step 3: Initiate Puncture
Insert needle with bevel up at 20°
Over-the-needle catheter to 45° angle; advance slightly
 Step 3: Initiate Puncture
Butterfly needle in posterior aspect Insert needle with bevel up;
of hand advance slightly
 Step 4: Confirm Entry
 Observe “flashback” of
blood, withdraw needle, and
release tourniquet.
 Step 4: Secure Needle
Tape catheter in place
 Step 5: Prepare and Proceed with Injection
Ready for injection
 Step 6: Needle or Catheter Removal Secure gauze or cotton ball in place
Keep in place for approximately 20 minutes
Butterfly needle
 Safety Considerations
1. Always wear gloves during all aspects of procedure.

2. Follow Occupational Safety and Health Administration (OSHA) Standard
Precautions.
3. Place needles and syringes in a designated sharps container.
4. If unsuccessful during initial puncture, use new butterfly or over-the-
needle catheter.
5. If extravasation of contrast media occurs, elevate affected extremity
and provide cold compress over site of injection for approximately 20
minutes, followed by warm compress.
6. Document procedure.
Urinary System
Procedures
Urinary System – Contrast Media
 Contrast Media in Urography
 Water-soluble, iodinated
contrast media
 Ionic or nonionic
 Injected intravenously or
through a catheter
 Ionic organic Iodides - Hyperosmolality
 Increases osmolality in the blood plasma.
 Can cause vein spasm, pain at injection site,

and fluid retention.
 Common commercial names of ionic

contrast media include Hypaque, Conray,
and Renografin.
 Non-Ionic organic Iodides - Hypo-osmolality
 Do not increase the osmolality of the

blood plasma
 Are less likely to have severe side

effects
 Common commercial names of nonionic

contrast media include Omnipaque,
Isovue, Amipaque, and Optiray.
 Common side effects

o Temporary hot flash
o Metallic taste in mouth
 Reaction:
o An unexpected outcome of
injected contrast media
Urinary System
 Technologist Responsibilities
1. Patient history
2. Selection and preparation
of contrast media
◦ Read label several times
◦ Have empty container
available
Urinary System – Patient History
 Management of non–insulin-dependent diabetes: Glucophage (metformin
hydrochloride)
 Check chart and/or ask patient the following:
o “Are you currently taking glucophage or other medication for diabetes

mellitus?”
o To be withheld 48 hours following iodinated contrast media procedure
o Must verify normal kidney function before resuming medication

Urinary System – Patient Preparation
Check blood chemistry—normal ranges
◦ Creatinine level (adult)—0.6 -1.5 mg/dL
◦ BUN levels (adult)—8-25 mg/100 mL

Urinary System – IVU
 Excretory Urography—Intravenous Urography (IVU)
 It is a radiographic examination of the urinary system.
 IVU visualizes the minor and major calyces, renal pelvises, ureters, and urinary
bladder after an intravenous injection of contrast medium.
 IVU vs IVP; What's the difference?

 Excretory Urography—Intravenous Urography (IVU)
The three purposes of IVU are as follows:

1. To visualize the collecting portion of the urinary system
2. To assess the functional ability of the kidneys
3. To evaluate the urinary system for pathology or anatomic
anomalies
 Contraindications to Intravenous Urography (IVU)
Hypersensitivity to iodinated contrast media
Anuria
Multiple myeloma
Diabetes, especially diabetes mellitus
Severe hepatic or renal disease
Congestive heart failure
Pheochromocytoma (fe-o-kro″-mo-si-to′-mah)
Sickle cell anemia
Renal failure, acute or chronic
 Clinical Indications
 Bladder calculi are stones that

form in the urinary bladder.
 These stones are not as common

as renal calculi, but they can grow
large in the bladder.
 Renal calculi are calcifications that occur in the luminal aspect of the urinary tract.
 Staghorn calculus is a large

stone that grows and fills the
renal pelvis completely, blocking
the ow of urine.
 prostate Carcinoma: The second most

common malignancy in males over the
age of 50 years. It is often a slow growing
tumor and may not be detected for years.
The most common metastases of
prostate cancer is to bone.
 The figure demonstrates prostate cancer

with metastasis to the spine and pelvis.
 Hydronephrosis is a distention of the renal pelvis and calyces of the kidneys that
results from some obstruction of the ureters or renal pelvis.
Urinary System – Patient Preparation
 Patient Preparation
 Light evening meal prior to procedure
 Bowel-cleansing laxative
 NPO after midnight (minimum of 8 hours)
 Enema on the morning of examination
 Voiding prior to procedure
* Suggested protocol; prep may vary among departments and clinical needs
Urinary System
 Ureteric Compression
 Method to enhance filling of pelvicalyceal system
Urinary System
 Contraindications to Ureteric Compression
 Possible ureteric stones (difficult to distinguish between the

effects of compression versus the appearance caused by a stone).
 Abdominal mass (may present the same radiographic appearance
as ureteric compression).
 Abdominal aortic aneurysm (compression device may lead to
leakage or rupture of the aneurysm).
 Recent abdominal surgery.
 Severe abdominal pain.
 Acute abdominal trauma.
Urinary System
 Ureteric Compression
 Trendelenburg Position as alternative to Ureteric Compression
Urinary System - IVU
 IVU Basic Routine
 Scout radiograph
 Injection
o Note time at beginning of injection
 Sample imaging routine
o 1 min nephrogram or nephrotomography
o 5 min AP supine
o 10-15 min AP supine
o 20 min posterior obliques
o Postvoid (prone or erect)
Scout radiograph
Urinary System
 Nephrogram Versus Nephrotomogram
 Radiographs taken early in study to

demonstrate renal parenchyma or
functional portion of kidney.
 Timing is critical
 Nephrogram
o Single radiograph (1 min)
 Nephrotomogram
o Series of tomograms starting at 1 Nephrotomogram—1 min
min
Urinary System Procedures
Hypertensive Intravenous Urography
Retrograde Urography
Retrograde Cystography
Voiding Cystourethrography
Retrograde Urethrography
 Hypertensive Intravenous Urography
 Purpose:
o IVU for patients with high blood pressure.
 Suggested protocol:
 The exposure intervals in hypertensive IVU is
shorter than standard IVU procedure.
o Radiographs taken every minute, up to 5 minutes.
o After 5-minute IR, standard IVU routine.
o Check with radiologist to determine additional
images to be taken.
 Retrograde Urography
 A non-functional examination of the urinary system.
 Considered a minor procedure done as outpatient surgery.
 Contrast is introduced retrograde into the pelvicalyceal system.
Scout radiograph taken

Series of radiographs taken as
requested
Ureterogram taken once catheter
has been removed
Contrast media is delivered through
catheter
It is done to R/O trauma, calculi,
and inflammatory disease of the
urinary bladder
Gravity flow of contrast media
150-500 mL
Fluoro
AP and posterior oblique
projections
 Voiding Cystourethrography
Purpose: Functional study of the bladder and urethra.

Performed after routine cystogram.
Catheter removed and imaged while voiding.
Female—AP Male—30° RPO

 Retrograde Urethrography
Purpose: Nonfunctional
radiographic study of the male
urethra.
Contrast medium is injected

retrograde into the distal urethra
until the entire urethra is filled.
Use of Brodney clamp

Patient in 30° RPO position Brodney clamp
Rarely performed
 Retrograde Urethrography
 Ideally, the urethra is

superimposed over the soft
tissues of the right thigh.
 This RPO position prevents

superimposition of any bony
structures except for the lower
pelvis and proximal femur
Male urethrogram—30° RPO
Urinary System Projections
 Nephrotomogram and Nephrogram
CR midway between xiphoid and iliac crest
 Cystogram
CR 2 inches (5 cm) superior to symphysis pubis
AP: 10° to 15° Posterior oblique: 45°

caudad to 60°
 Cystogram
AP: urinary bladder not superimposed by pubic bones
Posterior obliques: urinary bladder not superimposed by lower limbs
END

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Radiography II

 To explain urinary tract procedures.

The urinary bladder is a

 IVU Demonstrating Kidneys,

 Full-Term Pregnancy and

 During pregnancy, as shown in

 Confirmation of the correct

Bolus injection Drip infusion

 The rate of bolus injection is controlled by

 A specified amount of contrast medium is

 The rate of infusion, which may be gradual

1. Always wear gloves during all aspects of procedure.

 Contrast Media in Urography

 Increases osmolality in the blood plasma.

 Can cause vein spasm, pain at injection site,

 Common commercial names of ionic

 Do not increase the osmolality of the

 Are less likely to have severe side

 Common commercial names of nonionic

 Common side effects

 Check chart and/or ask patient the following:

o “Are you currently taking glucophage or other medication for diabetes

o To be withheld 48 hours following iodinated contrast media procedure

o Must verify normal kidney function before resuming medication

Check blood chemistry—normal ranges

◦ Creatinine level (adult)—0.6 -1.5 mg/dL

◦ BUN levels (adult)—8-25 mg/100 mL

 It is a radiographic examination of the urinary system.

 IVU vs IVP; What's the difference?

The three purposes of IVU are as follows:

 Bladder calculi are stones that

 These stones are not as common

 Staghorn calculus is a large

 prostate Carcinoma: The second most

 The figure demonstrates prostate cancer

 Light evening meal prior to procedure

 NPO after midnight (minimum of 8 hours)

 Enema on the morning of examination

 Voiding prior to procedure

 Possible ureteric stones (difficult to distinguish between the

 Radiographs taken early in study to

Scout radiograph taken

Purpose: Functional study of the bladder and urethra.

Female—AP Male—30° RPO

Contrast medium is injected

Use of Brodney clamp

 Ideally, the urethra is

 This RPO position prevents

AP: 10° to 15° Posterior oblique: 45°

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