Background

Adjunct-Subcutaneous-urography is a form of urography that involves the use of contrast agents administered through subcutaneous route in diagnosis of urinary system with emphasis on the kidneys, ureters and the bladder. This procedure is used to improve the delineation of the tract in cases or investigations where conventional urography could be suboptimal or borderline. 

Indications

Evaluation of Obstructive Uropathy: 

These includes, for patients whereby obstruction in the urinary tract is strongly suspected but cannot adequately be investigated by other imaging studies. 

Follow-Up of Renal Pathologies: 

In those individuals with underlying renal diseases, for example, tumors or congenital disabilities that require the change or progression track to be traced. 

Assessment of Trauma: 

When there is imaging of the bladder or renal tract is needed after injury, and primary assessment shows no signs of injury. 

Contraindications

• Allergy to Contrast Agents: Patients with known contraindications to the contrast agents employed in ASU should not receive this procedure. In this case, other imaging procedures should be used. 
• Severe Renal Impairment: ASU given in chronic kidney disease patients could be harmful because the disease may worsen or react with renal complications from the contrast agents. 
• Pregnancy: While ASU therapy is not explicitly studied in pregnant patients, ASU is usually considered unsafe for pregnant women if no other safer treatment options are available. Thus, there is possible harm to the fetus since radiation will be taken during this procedure. 
• Acute Infection or Inflammation: They include patients with acute infections or patients with severe inflammation of the urinary system where the procedure may be postponed avoiding worsening the status of the patient. 

Outcomes

Equipment

• Adjunct-Subcutaneous-Urography Device 
• Contrast Media 
• Syringes and Needles 
• Patient Monitoring Equipment 
• Cleaning Supplies 
• Calibration Tools 

Patient Preparation

Patient Education: 

Before performing adjunct-subcutaneous urography, explain the objective and procedure to the patient. 

Dietary Restrictions: 

Let the patient have only clear liquids two hours before the procedure if required. 

Medication Management: 

Check the previous and current medications being taken by the patient. 

In addition, provide any recommendations concerning the patient’s medications that should be either discontinued or changed prior to the procedures. 

Technique

Step 1-Positioning: 

Ensure the patient is placed on the imaging table correctly about the specific process that is lined up to be conducted. 

Position and reassure the patient to make them comfortable and in the correct position for imaging. 

Step 2-Sterilization: 

Sterilize the injection site with an antiseptic solution to prevent infection. 

Step 3-Contrast Media Administration: 

Preparation of Contrast Media 

The contrast media should be prepared according to the instructions provided by the manufacturers. 

Fill the syringe with the appropriate volume of contrast media. 

Step 4-Injection: 

Choose the site for injection. It is usually subcutaneous tissue. 

In this case, the contrast media should be given subcutaneously using a sterile needle and syringe. 

Some side effects are noticeable at the injection site; hence, one should monitor the area for any adverse effects. 

Step 5-Imaging: 

Initial Imaging 

To begin imaging, perform the scan or as the procedure protocol, indicate at which intervals the imaging has to be done. 

Alter the imaging settings if required depending on the size of the patient’s structures and distribution of contrast. 

Step 6-Continuous Monitoring: 

Pay attention and record any alteration in the imaging outcomes in the process. 

Ensure proper image acquisition to capture all necessary views. 

Step 7-Post-Procedure: 

Site Care 

Apply a sterile bandage to the injection site. 

Always watch out for areas of infection or reactions that counter what is intended. 

Patient Instructions 

Give instructions to the patient for post-operative care and the symptoms of complications. 

Advise on any necessary follow-up appointments or tests. 

Complications

Allergic Reactions: Possible side effects of contrast agents that can be used during the procedure. 

Either administering antihistamines or corticosteroids, close observation of the patient’s condition, or preparation for immediate intervention if needed. 

Infection: Possible to intra-site infection or within the urinary system. 

Aseptic measures should be taken during the procedure; antibiotics should be given when an infection is suspected. 

Hematoma: Swelling of blood in the affected tissue that applies to the place where the injection was done. 

Monitor for significant changes; seek further medical evaluation if symptoms worsen. 

Contrast-Induced Nephropathy: Possible adverse effects of the contrast medium on the kidneys. 

Take adequate water before and after the procedure and observe renal function tests; check with a physician specializing in kidney-related diseases if possible. 

Extravasation: Leakage of contrast agent into the surrounding tissue rather than the intended area. 

Stop contrast infusion; lie flat with the affected limb raised above the patient’s heart level; apply warm or cold towels; observe for signs and symptoms of tissue ischemia. 

Urinary Tract Injury: Injury to the urinary tract during the procedure is also another factor that may occur, in addition to the complications of the surgery. 

Always look for signs that the patient had an injury; do more tests if necessary. 

References

[Urography of infants and small children with subcutaneous injection of the contrast medium supplemented by hyaluronidase] – PubMed (nih.gov)

References

[Urography of infants and small children with subcutaneous injection of the contrast medium supplemented by hyaluronidase] – PubMed (nih.gov)