Norm of Renal Angiogram (Renal Arteriogram)
Radiopaque iodine contrast material should circulate symmetrically and without interruption through the renal parenchyma and renal vasculature.
Usage of Renal Angiogram (Renal Arteriogram)
Visualization of the renal parenchyma and renal vasculature; assists in differentiation of renal masses; identification of renovascular abnormalities such as abscesses, aneurysms, arteriovenous fistula, hypervascularity, hypovascularity, emboli, fibrosis, infarction, intrarenal hematoma, parenchymal laceration, polyarteritis nodosa, renal artery dysplasia, stenosis, thrombolic occlusions, and accidental injury; and evaluation of chronic renal disease, renal failure, and transplant donors and recipients as well as posttransplantation evaluation of vascular flow and rejection of the donor organ.
Description of Renal Angiogram (Renal Arteriogram)
Renal angiogram is an invasive radiographic procedure involving injection of iodine radiopaque contrast material through a catheter inserted into the aorta near the bifurcation of the renal arteries or directly into the renal arteries. For clients with preexisting renal impairment, gadolinium-enhanced magnetic resonance angiography or magnetic resonance urography is a better choice than this procedure, because it is non-nephrotoxic.
Professional Considerations of Renal Angiogram (Renal Arteriogram)
Consent form IS required.
Embolus, hematoma, hemorrhage, infection, allergic reaction to contrast material (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), renal toxicity from contrast medium.
Previous allergy to iodine, shellfish, or radiographic dye; renal insufficiency. The procedure may be contraindicated during pregnancy if iodinated contrast medium is used, because of the radioactive iodine crossing the blood-placental barrier. Caution should be taken with clients who have bleeding tendencies and those with renal failure because of end-stage renal disease. Sedatives are contraindicated in clients with central nervous system depression.
- Establish intravenous access.
- A narcotic or sedative may be prescribed.
- The client should void and remove all jewelry and metal objects.
- Have an emergency cart readily available.
- Obtain local anesthetic, povidone-iodine solution, intravenous fluid, contrast material, guidewire, vascular and renal catheters, and sterile gloves.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is positioned supine.
- A peripheral intravenous infusion is started.
- The arterial site is cleansed and anesthetized.
- A catheter is introduced in accordance with the Seldinger technique into the femoral artery or into the transaxillary, transbrachial, or translumbar vessels, and advanced under fluoroscopy to the aorta. Test aortograms with a small amount of contrast material are completed.
- The catheter is then replaced with a renal catheter, and larger amounts of radiopaque contrast material are injected through the catheter directly into the aorta near the bifurcation of the renal arteries or directly into the renal arteries.
- Rapid, serial radiographic films are then taken to record circulation of the contrast material through the renal parenchyma and vasculature.
- The catheter is removed, and a pressure dressing is applied over the insertion site.
- If sedation was used, continue assessment of respiratory status. If deep sedation was used, follow institutional protocol for post sedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds to commands spoken in a normal tone.
- Monitor the catheter insertion site for bleeding, inflammation, or hematoma formation.
Client and Family Teaching
- This test determines the adequacy of blood flow through both renal arteries.
- Fast for 8 hours before the procedure.
- For 5 minutes after injection of the contrast material, an urge to cough, a flushed sensation, nausea, or a salty taste may occur.
- It is important to lie motionless throughout the procedure. Sedation may be used to help you relax.
Factors That Affect Results
- Interpretation of the results may be impaired by the presence of gas, feces, or contrast material such as barium in the gastrointestinal tract.
- Movement of the client during the procedure obscures the radiography.
- Calcium antagonists can cause false-positive captopril renograms.