I.V.P Radiological procedure

      Intravenous Pyelogram (IVP/IVU)

Definition :--  An Intravenous pyelogram (IVP) is the radiographic examination of Kidneys, Ureters, and Bladder.

In which iodinated contrast is injected into the vein and then the images are taken.

Indication :-- Disease of renal collecting system and renal pelvis

 Differentiation of functions of both kidneys

 Abnormalities of the ureter

 Obstructive uropathy

 TB of urinary tract

 Calculus disease

 Flank pain

 Suspected renal injury

Risk Factors :--Nausia

 Cardiac failure

 Vomiting

 Shortness of breath

 Previous history of drug allergy

 Dehydration

Contrast In intravenous pyelogram the non ionic contrast is used.

The non ionic contrast like omnipaque, visipaque, and ultravist is used in ivp.

The contrast is injected into the prominent vein in the arm within 30 – 60 second according to the body weight.

If the patient weight is > 7 kg then the contrast is given according to the 2 ml/kg.

And when if the patient weight is < 7 kg then contrast is given according to the 3ml/kg.

Equipment :--

X ray unit, Contrast- Ultravist, Dispo syringe, I.V. Cannula, Surgical gloves, Cotton and Compression paid if needed.

Patient Preparation:--

The procedure should be explained to patient before undergoing to procedure.

All metallic ornaments should be removed specially in the KUB region.

Ask for any history of drug reaction.

Ask for any history of diabetes mellitus and renal disease.

The Patient should be fasting for 4 hours.

For bowel preparation : Low residue diet

Dulcolax  is given at bed time.

The serum creatinine should be normal.

Procedure The patient lies supine on the table.

The support is placed under the patient’s knees to reduce the lordotic curvature of lumbosacral spine and provide comfort.

The plain KUB film is taken including kidneys, ureters, bladder and urethral region.

Then the contrast is injected in to the prominent vein in the arm.

The test dose of 1ml of contrast is given and the patient is observed for 1 min to look for any contrast reaction.

Then the rest of the contrast is injected within 30-60 seconds.

The cortical nephrogram is seen within 20 seconds after contrast injection.

This depicts the renal parenchyma opacified by the contrast.

The density of the nephrogram depends on the dose of contrast.

The appearance of pyelogram is seen in 2 minutes after contrast injection.

Filming The low kv (65-75), high mA(50-70) and short exposure should be used to get optimum image contrast.

FILMMAKERS

 Plain x ray KUB/Scout film

 After contrast injection films are :  

 1 minute film supine

 5 minute film supine

 15 minute film supine

 25 minute film supine

 Full bladder (Prevoid) supine

 Empty Bladder (Postvoid) supine

Other Film The prone film is used to viewing ureteral areas which is not seen in supine film.   

 

                    BLOG write by  

                 BHARAT GOYAL 

GEETANJALI MEDICAL COLLEGE AND HOSPITAL