Definition
Intravenous pyelography (IVP) is the roentgenographic visualization of the kidneys, ureters, and bladder after injecting a dye into the vascular system.
Purposes
- To evaluate suspected cysts, tumors, tuberculosis, pyelonephritis, hydronephrosis, vesicoureteral reflux, hypertension, and urinary tract calculi.
- To evaluate the extent of renal injury.
- To evaluate any renal condition in infants where cystoscopy may be unduly traumatic.
- To assess congenital anomalies.
- To assess renal function.
Contraindications
- Hypersensitivity or allergy to iodine preparations.
- Combined renal and hepatic disease.
- Renal failure.
- Patients receiving drug therapy for bronchiolitis and asthma.
- Congestive cardiac failure.
- Uncontrolled diabetes.
- Multiple myeloma
Preparation
Preparing for an Intravenous Pyelography (IVP) procedure involves several important steps:
- Dietary Restrictions:
- Follow a clear liquid diet the day before the procedure. Avoid solid foods and dairy products.
- Drink plenty of water to stay hydrated unless instructed otherwise.
- Bowel Preparation:
- Take prescribed laxatives, such as Magnesium Citrate and Bisacodyl tablets, as directed by your healthcare provider.
- Use a suppository on the morning of the procedure to ensure the bowels are clear.
- Medication Adjustments:
- Inform your doctor about any medications you are taking, especially if you are diabetic or on insulin. Dosages may need adjustment.
- If you have allergies to IV dye, pre-medication may be required.
- Clothing and Accessories:
- Wear loose-fitting clothes and remove any metallic items, such as jewelry, to avoid interference with the imaging.
- Communication:
- Inform your healthcare provider about any allergies, pregnancy, or previous reactions to contrast dye.
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient. | Helps in reducing anxiety and obtaining cooperation of the patient. |
| 2. | Obtain informed consent from the patient. | Prevents legalities to the medical staff. |
| 3. | Arrange for a preliminary X-ray (KUB) with the patient in supine position. | Ensures that the bowel is empty. Visualizes the location of kidneys. |
| 4. | Assess the patient for allergic reactions to the dye. | Prevents allergic reactions during procedure. |
| 5. | Instruct the patient to abstain from all food, liquid, and medications for 12 hours before examination. | Dehydration is necessary for contrast material to concentrate in the urinary tract. |
| 6. | Ensure that bowel and bladder are emptied. | Provides clear visualization of the parts. |
| 7. | Explain to patient that there may be sensations of flushing, warmth, and salty taste in mouth, during dye injection. | Reassures the patient. |
| 8. | Emergency drugs and equipment should be kept ready during the procedure. | Prepares to deal with possible complications. |
| 9. | Contrast medium is injected by physician and rapid films are taken at intervals of 6 minutes, 15 minutes, 1 hour, 2 hours, and 6 hours after injecting dye. | |
| 10. | Arrange for post void film to be taken after 6 hours. | Checks clearance of dye. |
| 11. | Record the date, time, and patient’s response to the procedure. | Helps in communication among health team members. |
Postprocedural care
- Advise patient to resume prescribed diet and activity after the examination.
- Encourage patient to drink sufficient amount of water.
- Instruct patient to take adequate rest.
- Observe and document any mild reactions to the iodine material which may include fever, skin rashes, nausea, and swelling of the parotid glands.
Special Consideration
- Ensure the patient has followed pre-procedure instructions, such as fasting and bowel preparation.
- Confirm the patient has no allergies to iodine-based contrast materials, as these are commonly used in IVP.
- Observe the patient for any adverse reactions to the contrast dye, such as nausea, itching, or hives.
- Be prepared to manage severe reactions, like anaphylactic shock, though these are rare.
- If the patient is pregnant or suspects pregnancy, inform the radiologist, as alternative imaging methods may be necessary.
- Explain the procedure to the patient to alleviate anxiety and ensure cooperation during the imaging process.
- Monitor the patient for delayed reactions to the contrast dye.
- Provide instructions for hydration to help flush the dye from the system.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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