Digital angiography of the vein (UIV)

The article is made by Master, Doctor Ton Nu Tra My - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.

Digital urography intravenous (UIV), also known as pyelonephritis by intravenous line, is a technique that uses X-rays, intravenous contrast to examine the kidneys, ureters, bladder and kidneys. urethra.

An intravenous urogram is a method to help evaluate problems in patients such as kidney stones, urinary tract infections, blood in the urine, blockage or damage to the urinary tract. Therefore, intravenous urography is indicated to investigate the morphology of the urinary tract, the excretory function of the kidneys such as kidney stones, ureters, kidney tumors, renal cysts, renal tuberculosis... as prescribed by a specialist doctor. Faculty treatment.
In addition, cases with contraindications to iodine-contraindicated drugs such as severe renal failure, pregnant women, iodine allergy, diabetes, Kahler, severe cardiovascular disease are relatively contraindicated to intravenous urography. circuit. The absolute contraindication is a useless intravenous urogram.

Equipment and machinery such as radio-enhanced television, film, cassette, image storage system... need to be prepared for normal operation to perform venous urography. The radiologist or radiologist will perform the scan for the patient.
In addition, the consumables to be prepared include:
Syringe 20m Needle 18-20G

Water-soluble iodinated contrast agent Skin antiseptic Distilled water or physiological saline Set of pea trays, surgical forceps Surgical cotton, gauze, Ureteral compression set Male or female urinal Medicine box and tools Contrast drug accident emergency

For patients, before taking digital urography, it is necessary to pay attention to prepare by informing the doctor about the history of allergies whether there are contraindications. It is necessary to ensure that the patient is not pregnant, if pregnancy is suspected, it should be postponed and beta HCG testing should be postponed. 3 days before the examination, the patient did not take any drugs that cause contrast, and at the same time made two injections of contrast agent at least 5 days apart.
Patients also need to pay attention to a diet without residue, fiber, take a light laxative, abstain from drinking water that produces gas, and eat a lot of starch 2 days before the procedure. The patient underwent fecal enema the day before and the next morning before intravenous urography.
Right before the test, the patient needs to prepare psychologically, urinate before going to the x-ray table. Fasting for 4 hours before injecting vascular contrast, avoid eating solid food, can drink water < 50 ml.

Patients with a history of severe reactions to contrast agents, patients with risk factors, patients with no known special risk factors.
Group 1: Patients with a history of severe reactions to contrast agents
If possible, avoid injecting contrast again, so it is very important to consider indications in the following cases:
Conduct in hospital (with adequate means of resuscitation). Use a non-ionic contrast agent, low osmolarity. Prophylactic drugs: according to the anti-shock regimen of the Ministry of Health. Many authors give 3 days pre-test prophylaxis: Antihistamines (anti H1): Clarityne, Polaramine. Corticosteroids: Celestene orally or intravenously, Médrol, Hydrocortancyl Anti-anxiety: Atarax, Xanax, Hypnovel

Group 2: Patients with risk factors
Patients: history of allergies, advanced age (>60 years), severe cardiovascular disease, renal failure, diabetes, multiple myeloma (Kahler), are taking bata blockers (b bloquants), mood anxiety. Use low osmolarity non-ionic contrast media, prophylactic drug. Group 3: Some special prepared cases
Patients being treated with beta-blockers: Do not stop taking the drug; enhanced tracking; prophylaxis as a risk group. Patients with multiple myeloma (Kahler): Alkalize the urine (Foncitril) Patients with diabetes: Discontinue treatment 2 days before and 2 days after the test (avoiding the risk of renal failure and blood acidosis). Patients should be tested for creatinine before having an intravenous urogram.

3.1 Unprepared urinary tract film 3.2 Venous needle puncture Any vein can be inserted, usually in the elbow crease, avoiding the dorsal or dorsal veins that can cause contrast leakage. It is recommended to use 18-21G or butterfly needles to save needles during and after examination. Secure the needle to the skin with tape to save the needle for the duration of the test. 3.3 Contrast injection The radiologist must supervise intravenous injection. Let the patient know in advance of a temporary feeling of heat (20-30 seconds). Warm the contrast medium (32-350C). Dosage: 1ml/kg body weight, not more than 2ml/kg body weight. Injection rate 5-6 ml/sec.

3.4 Films It is important to pay attention to some principles in photographic film as follows:
Less film but more information. There is no standard procedure for all venous urographs, only a general scheme. Clinical indications will guide the technique and radiographs, but the radiologist must review the results after each scan to change the technique and adapt to each specific case. 3.5 General flowchart of the imaging process, for normal renal function 5-minute film (3 minutes for high osmolality drugs, calculated at the start of injection) to assess excretory function; The next 1-2 films in the first 15 minutes show the pyelonephritis, the ureters are normal, and the bladder is nearly full of contrast. 30 minutes to remove the needle, allow eating and drinking 2-3 cups of water. If need to examine the bladder and urethra: Hold urine, after 2-3 hours when the bladder is distended, return to the imaging room. The image is taken before urinating, the film is completely straight and sometimes the bladder is tilted. Photographs are taken after urinating immediately after the patient has finished urinating in the toilet.

3.6 Additional technical details The doctor may consider injecting more contrast agent after 15 minutes, 1 ml/kg, if the excretory function is poor. Urinate if there is bladder-prostatic disease, Difficulty urinating, urinary tract infection. Take 3/4 position, 2 films, see the posterior urethra and anterior urethra, large film (30x40 cm), the penis is horizontal. Horizontal X-ray, focal point between navel and pubic joint; for female patients: standing, slightly slanted, the focal point is 3-4 cm higher than in men. If excretion is delayed, after 15 minutes, the time to take the next film is twice the time of the previous film. Ureteral compression film when the upper urinary tract is not clear. Contraindications to compression: pregnancy, recent abdominal surgery, urinary tract obstruction syndrome, acute abdominal pain, aortic aneurysm, abdominal tumor, kidney transplant. Scan straight, then remove the compression immediately to see the ureter. A low head position (Trendelenbourg) can sometimes replace ureteral compression. Film lying on the stomach easily shows the ureteral circulation and the ureteral junction. Standing film easily shows the ureters, see the mobility of the kidneys. The kidney is tilted really, really straight: 600 . behind

3.7 Intravenous urogram in some diseases Renal failure: do not fast, increase dose by 2.5 ml/1 kg, use low osmolality contrast agent, take radiographs as late as 24 hours (conclude dumb kidney) . Narrowing of the ureteral junction: prostrate, standing, diuresis test: when the pyelonephritis is seen, give 3 cups of water to drink, intravenously inject 1 tube of Lasilix 20mg, 10 minutes after taking the film, at 5 intervals. minutes for 30 minutes. Obstructive syndrome: increase dose of low-osmolar contrast agent, late radiograph, do not compress the ureter. Perineal prolapse: slant film to urinate, study the bladder at rest, when urinating, when standing, urinating. Urinary tract injury: no pressure. Can be replaced by postscan film (abdominal film after computed tomography with contrast injection) Kahler's disease: do not fast, alkaline urine 2 days before and 2 days after the test. Kidney transplant: no pressure, taken behind the transplanted kidney.

Digitizing intravenous urogram can show the function of excretory and excretory function, clearly see the morphology of the renal pelvis and calyces of the urinary tract including dilatation, narrowing, obstruction, convex shape, defect shape, pressure. The doctor reads the lesion, describes it on the computer and can explain it professionally to the patient and family if required.

Contrast-related and non-contrast-related complications such as vagal hypertrophy, convulsions, spasms, hypoglycemia ... will be handled by the doctor in accordance with each condition of the disease. core.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its examination and consultation services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.

Master. Dr. Ton Nu Tra My is currently a Doctor of Radiology, Vinmec Central Park International General Hospital. Dr. Tra My used to be a lecturer in the Department of Diagnostic Imaging, Hue University of Medicine and Pharmacy and had a long time working at the Department of Diagnostic Imaging, Hue University of Medicine and Pharmacy Hospital.
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