Name of the Procedure:

High Osmolar Contrast Material Injection (Technical Name: Administration of High Osmolar Contrast Media, 150-199 mg/ml iodine concentration, per ml - HCPCS Q9959)

Summary

High osmolar contrast material injection is a diagnostic procedure used to enhance the visibility of internal structures in imaging tests such as X-rays, CT scans, and angiography. The contrast material contains iodine, which helps to improve the clarity and detail of the images taken by these medical imaging devices.

Purpose

The primary purpose of using high osmolar contrast material is to help radiologists and other medical professionals obtain clearer images of blood vessels, organs, and tissues. This improved clarity assists in the accurate diagnosis of a variety of medical conditions, including blockages, tumors, and abnormal blood vessels.

Indications

This procedure is indicated for:

• Patients undergoing imaging studies like CT scans, angiograms, or X-rays where enhanced visualization is required.
• Diagnosing cardiovascular diseases, cancer, gastrointestinal conditions, and vascular abnormalities.

Patient factors:

• Must be evaluated for allergies to contrast material.
• Renal function should be assessed before administration.

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Hydration is often recommended both before and after the procedure.
• Patients should disclose any allergies, especially to iodine or contrast material.
• Lab tests to assess kidney function might be required prior to the procedure.

Procedure Description

1. The patient is positioned appropriately for the imaging study.
2. An intravenous (IV) line is inserted to administer the contrast material.
3. The high osmolar contrast material, measured per milliliter of iodine concentration (150-199 mg/ml), is injected through the IV line.
4. During the injection, the imaging study (e.g., CT scan) is performed to capture detailed images.
5. The procedure may involve a single or multiple injections depending on the diagnostic requirements.

Tools/Equipment:

• IV cannula and tubing
• Imaging equipment (CT scanner, X-ray machine)
• High osmolar contrast material

Anesthesia:

• Typically, no anesthesia or sedation is required. Local anesthesia may be used for IV placement.

Duration

The injection and imaging study usually take around 30 minutes to an hour, depending on the complexity and area being examined.

Setting

Typically performed in hospitals, outpatient clinics, or specialized imaging centers equipped with appropriate imaging technology.

Personnel

• Radiologist or imaging technician
• Nurse or medical assistant to administer the contrast material and manage patient care
• Sometimes a supervising physician, depending on the facility and patient condition

Risks and Complications

• Common risks: mild allergic reactions (itching, rash), warm sensation at the injection site.
• Rare risks: severe allergic reactions (anaphylaxis), kidney function impairment, and extravasation (leakage of contrast outside the vein). Management:
• Immediate medical attention for severe reactions.
• Hydration to help flush the contrast material from the body.

Benefits

• Provides enhanced imaging that aids in precise diagnosis.
• Helps in planning appropriate treatments based on clearer images.
• Results are often available relatively quickly, facilitating timely medical intervention.

Recovery

• Patients can generally resume normal activities immediately.
• Increased fluid intake is advised to help flush the contrast material from the body.
• Follow-up imaging or appointments as directed by the healthcare provider.

Alternatives

• Non-contrast imaging studies (e.g., ultrasound, MRI without contrast)
• Lower osmolar contrast materials Pros and Cons:
• Non-contrast options may be less detailed but avoid contrast-related risks.
• Lower osmolar contrast materials might reduce risk but are not suitable for all imaging needs.

Patient Experience

• During the procedure: a possible warm or flushing sensation when the contrast is injected.
• After the procedure: typically no significant discomfort; instructions on hydration. Pain Management:
• Local discomfort at the injection site can be managed with simple analgesics if needed.
• Patients are informed about potential sensations to alleviate anxiety.