Ingingo z'ingenzi zo kwirinda mbere yo gukoresha injectors zikoresha umuvuduko mwinshi

Injekteri zikoresha umuvuduko mwinshi w'ubuhanga—harimoInshinge imwe ya CT, Inshinge za CT zifite imitwe ibiri, Inshinge za MRI, nainshinge zitera umuvuduko ukabije wa angiography—ni ingenzi cyane ku ireme ry’isuzuma ry’ibizamini. Ariko, ikoreshwa ryabyo nabi rishobora guteza ingorane zikomeye nko gusohora ibara ry’uruhu, kwangirika kw’ingirabuzima fatizo, cyangwa ingaruka mbi ku mubiri. Gukurikiza amabwiriza ashingiye ku bimenyetso bihamya bitanga icyizere cy’umutekano w’umurwayi no gukoresha neza amashusho.

1. Isuzuma ry'umurwayi n'imyiteguro ye

Gusuzuma imikorere y'impyiko no gushyira mu byiciro ibyago

Isuzuma rya GFR: Ku miti ishingiye kuri gadolinium (MRI), suzuma abarwayi barwaye impyiko cyangwa indwara zidakira z’impyiko (GFR <30 mL/min/1.73 m²). Irinde guhabwa iyo miti keretse inyungu zo kuyisuzuma zirenze ibyago bya NSF (nephrogenic systemic fibrosis).

Abantu bafite ibyago byinshi: Abarwayi ba diyabete, abarwaye umuvuduko ukabije w'amaraso, n'abageze mu zabukuru (barengeje imyaka 60) bakeneye gupimwa imikorere y'impyiko mbere yo kugeragezwa. Ku bijyanye n'itandukaniro rya iyode (CT / angiography), suzuma amateka y'indwara ya nephropathy iterwa n'itandukaniro.

Isuzuma ry'indwara y'ubwivumbure n'indwara ya kanseri

- Andika uko byagendekeye mbere mu buryo bworoheje/buciriritse (urugero: urticaria, bronchospasm). Shyira imiti ya corticosteroids/antihistamines ku bintu bya kera bya reaktors.

- Irinde inyigo zishingiye ku gutandukanya ibice mu mubiri (electible contrast strain) mu birebana na asima idakora neza, indwara y'umutima idakora neza, cyangwa pheochromocytoma.

Guhitamo uburyo bwo kugera ku mitsi

Ingano ya Catheter: Koresha catheter ya 18–20G IV mu mitsi ibanziriza gukira cyangwa mu kuboko. Irinde ingingo, imitsi y'amaboko/ukuboko, cyangwa amaguru afite ubumuga bwo gutembera kw'amaraso (urugero, nyuma yo kubagwa, fistula ya dialysis). Ku bijyanye n'amazi atemba >3 mL/segonda, catheter ya ≥20G ni ngombwa.

Gushyiramo Catheter: Shyira ≥2.5 cm mu mitsi. Gerageza patency ukoresheje saline flush ukoresheje direct visualistic. Wange catheter zifite ubwirinzi cyangwa ububabare mu gihe cyo gusohora.

2. Ibikoresho n'uburyo bwo kwitegura ikoranabuhanga ryo gutandukanya ibintu

Gucunga ibikoresho bitandukanya ibintu

Kugenzura ubushyuhe: Gushyushya ibintu bifite iyode kugeza kuri ~ 37°C kugira ngo bigabanye ubushyuhe n'ibyago byo gusohora imvange.

Guhitamo imiti: Gukunda imiti ya iso-osmolar cyangwa imiti ifite osmolar nke (urugero, iodixanol, iohexol) ku barwayi bafite ibyago byinshi byo kwandura. Kuri MRI, imiti ya macrocyclic gadolinium (urugero, gadoterate meglumine) igabanya kubika gadolinium.

Imiterere y'imashini zitera inshinge no kuzikuraho umwuka

Imipaka y'umuvuduko: Shyiraho amabwiriza y'umuvuduko (ubusanzwe 300–325 psi) kugira ngo umenye kwinjira hakiri kare.

Porogaramu yo Gukuramo Umwotsi: Hindura imiyoboro, sukura umwuka ukoresheje saline, kandi wemeze imirongo idafite utubumbe. Ku inshinge za MRI, menya neza ko ibice bitari ferromagnetique (urugero, Shenzhen Kenid's H15) birinda ibyago byo gushoka.

Imbonerahamwe: Ibyifashishwa mu gutera inshinge hakurikijwe uburyo

| Uburyo bwo gupima | Igipimo cy'amazi | Ingano y'itandukaniro | Umuvuduko w'amazi | Umuvuduko w'amazi |

|———————|——————|———————|——————-|

| Angiografiya ya CT | 4–5 mL/s | 70–100 mL | 30–50 mL |

| MRI (Neuro) | 2–3 mL/s | 0.1 mmol/kg Gd | 20–30 mL |

| Angio yo mu gice cy'imbere | 2–4 mL/s | 40–60 mL | 20 mL |

3. Uburyo bwo gutera inshinge mu buryo bwizewe no gukurikirana

Gupima inshinge no gushyira mu mwanya wazo

- Kora inshinge za saline ku gipimo cya 0.5 mL/s ugereranyije n'umuvuduko wateganyijwe wo gutandukanya ibipimo kugira ngo wemeze ko umurongo uhagaze neza kandi ko nta ngaruka zikomoka ku biyobyabwenge zishyirwamo.

- Kubuza amaguru n'amaboko kugenda ukoresheje udupira/agatambaro; wirinde guhindagurika kw'ukuboko mu gihe cyo gupima igifu n'inda.

Itumanaho n'igenzura ry'igihe nyacyo

- Koresha intercoms kugira ngo uganire n'umurwayi. Ubwire abarwayi gutanga amakuru y'ububabare, ubushyuhe, cyangwa kubyimba ako kanya.

- Reba neza aho bateye inshinge mu gihe kitari ikoranabuhanga. Ku bijyanye no gutera icyuma mu buryo bwikora, shyira abakozi mu mwanya wabo bareba kure.

Ibitekerezo byihariye ku bijyanye no kwinjira

Imirongo yo Hagati: Koresha gusa PICC/CVC ziterwa n'amashanyarazi (zifite amanota ≥300 psi). Gerageza amaraso agaruka kandi urebe niba ashobora gusohoka mu mubiri.

Imirongo yo mu nda (IO): Bika igihe cy'ibibazo byihutirwa. Gabanyiriza igipimo kugeza kuri ≤5 mL/s; banza uvure lidocaine mbere kugira ngo ugabanye ububabare.

  4. Kwitegura mu bihe byihutirwa no kugabanya ibyago

Porogaramu yo Gukoresha Ingufu mu Gutandukanya Ibyuma

Igisubizo cyihuse: Hagarika gutera urushinge, shyira hejuru amaguru, shyiramo udukoresho dukonje. Niba ufite ingano iri hejuru ya 50 mL cyangwa kubyimba gukomeye, gana muganga.

Uburyo bwo kuvura hakoreshejwe uruhu: Koresha gel ya dimethylsulfoxide (DMSO) cyangwa gauze ya dexamethasone. Irinde koza uruhu.

Kurwanya Anaphylaxis no kwirinda NSF

- Komeza ibikoresho by'ubutabazi (epinephrine, bronchodilators) bibe hafi. Gutoza abakozi bo muri ACLS ku bijyanye n'ingaruka zikomeye (iziba: 0.04%).

- Gupima imikorere y'impyiko mbere yo gusuzuma MRI; wirinde gukoresha imiti igabanya ubukana bwa gadolinium ku barwayi barwaye dialyse.

Inyandiko n'Uruhushya rutanzwe

- Garagaza ingaruka: ingaruka zitunguranye (isesemi, ibisebe), NSF, cyangwa gukurura. Inyandiko y'ubwemere n'inomero z'umukozi/ibibanza.

 Incamake 

Injekteri zikoresha umuvuduko mwinshi zisaba amabwiriza akomeye y’umutekano:

Kwita ku murwayi: Kugabanya ibyago (kurwara impyiko/allergie), kubona uburyo bwo gukoresha imiti igabanya imitsi mu buryo buhamye, no kubona uburenganzira busesuye.

Ubuhanga mu bya tekiniki: Gupima inshinge, kwemeza imirongo idafite umwuka, no guhindura ibipimo by'amazi ku giti cyayo.

Gukurikirana mu buryo bwimbitse: Gukurikirana mu gihe nyacyo, kwitegura ibibazo byihutirwa, no gukurikiza amabwiriza yihariye y’umukozi.

Mu gushyira hamwe izi ngamba zo kwirinda, amatsinda ashinzwe ubushakashatsi ku ndwara ya radiyo agabanya ibyago mu gihe arushaho kunoza umusaruro w’ibipimo—atuma umutekano w’abarwayi ukomeza kuba ingenzi mu gupima indwara mu buryo bukomeye.

"Itandukaniro riri hagati y'ibikorwa bisanzwe n'ibyabaye bikomeye riri mu buryo burambuye bwo kwitegura."   — Byakuwe mu gitabo cy’amabwiriza agenga itandukaniro rya ACR, 2023.

LnkMed

Bitewe n'iterambere ry'ikoranabuhanga ryo gufata amashusho mu buvuzi, hasohotse amasosiyete menshi ashobora gutanga ibikoresho byo gufata amashusho, nk'inshinge n'inshinge.LnkMedIkoranabuhanga mu by'ubuvuzi ni rimwe muri yo. Dutanga urutonde rwuzuye rw'ibikoresho by'inyongera byo gusuzuma indwara:Inshinge imwe ya CT，Inshinge ya CT ifite imitwe ibiri,Inshinge za MRInaInshinge ziterwa n'umuvuduko mwinshi wa DSAZikorana neza n'ibirango bitandukanye bya scanner bya CT/MRI nka GE, Philips, Siemens. Uretse injector, tunatanga seringe na tube bishobora gukoreshwa ku bicuruzwa bitandukanye bya injector birimo Medrad/Bayer, Mallinckrodt/Guerbet, Nemoto, Medtron, Ulrich.
Ibi bikurikira ni byo dushoboye cyane: igihe cyo gutanga ibicuruzwa byihuse; Impamyabushobozi zuzuye zo kwemeza ibicuruzwa, uburambe bw'imyaka myinshi mu kohereza ibicuruzwa mu mahanga, inzira nziza yo kugenzura ibicuruzwa, ibicuruzwa bikora neza, twishimiye cyane ikibazo cyawe.