画像診断 VII：血管イメージング

A renal angiogram is an imaging test that examines the kidney's blood vessels and evaluates blood flow through arteries, capillaries, and veins. It helps diagnose vascular abnormalities including blockages, aneurysms, narrowing, stenosis, thrombosis, and vascular tumors. The procedure also evaluates kidney function and guides interventional treatments like angioplasty or stent placement.

Before the procedure, patients must fast for 6-8 hours and empty the bladder. The nurse obtains informed consent, reviews medical history including allergies to iodine or contrast dye, and conducts renal function tests such as serum creatinine or eGFR. An IV line is established, baseline vital signs are recorded, and the patient receives education about sensations like warmth from the contrast dye and the importance of staying still during imaging.

The patient is positioned supine on the imaging table and receives mild sedation. Using aseptic techniques, the physician inserts a catheter into the femoral artery and guides it to the renal arteries using fluoroscopy. Contrast dye is then injected into the renal arteries, and the radiologist captures X-ray images as the dye travels through blood vessels. The nurse continuously monitors vital signs and oxygen levels throughout the procedure.

Contrast dye is injected into the renal arteries to make blood vessels visible on X-ray images. The dye travels through arteries, capillaries, and veins, allowing the radiologist to visualize blood flow and identify vascular abnormalities. Patients may experience warmth or flushing from the dye during injection, which is a normal sensation.

After catheter removal and pressure application to prevent bleeding, the nurse monitors vital signs, checks the insertion site for bleeding or swelling, and encourages fluid intake to help flush contrast dye from the kidneys. The patient remains on bed rest for several hours with the accessed leg kept straight to prevent bleeding. The nurse observes for complications such as decreased urine output or elevated serum creatinine levels.

Adequate hydration before the procedure reduces potential complications from sedation and contrast dye. After the procedure, oral or IV fluids promote kidney filtration and help eliminate contrast dye from the system, reducing the risk of contrast-induced nephropathy. Encouraging fluid intake is a key nursing intervention in post-procedure recovery.

Nurses should monitor the insertion site for bleeding, swelling, or hematoma formation. They must also watch for signs of contrast-induced nephropathy, such as decreased urine output or elevated serum creatinine levels. Regular vital sign monitoring, particularly blood pressure and heart rate, helps identify immediate complications and ensures patient safety during recovery.