Zofunikira Zosamala Musanagwiritse Ntchito Majekeseni Osiyanasiyana Otsutsana ndi Mphamvu Yaikulu

Ma injector a high-pressure contrast media injectors—kuphatikizapoInjektara imodzi ya CT, Majakisoni a mitu iwiri a CT, Majakisoni a MRIndiangiography majakisoni othamanga kwambiri—ndizofunikira kwambiri pakuwunika bwino zithunzi. Komabe, kugwiritsa ntchito kwawo molakwika kumabweretsa mavuto akulu monga kuchotsedwa kwa utoto wosiyana, kufalikira kwa minofu, kapena zotsatira zoyipa za thupi. Kutsatira malangizo ozikidwa pa umboni kumathandizira kuti wodwala akhale otetezeka komanso kuti zithunzi zake zigwire bwino ntchito.

1. Kuwunika ndi Kukonzekera kwa Odwala

Kuwunika Ntchito ya Impso ndi Kugawa Zoopsa

Kuwunika kwa GFR: Kwa mankhwala okhala ndi gadolinium (MRI), fufuzani odwala ngati ali ndi vuto la impso kapena matenda aakulu a impso (GFR <30 mL/min/1.73 m²). Pewani kupereka mankhwalawa pokhapokha ngati ubwino wodziwira matenda ukuposa chiopsezo cha NSF (nephrogenic systemic fibrosis).

Anthu Omwe Ali Pachiwopsezo Chachikulu: Odwala matenda a shuga, odwala matenda oopsa, ndi okalamba (opitirira zaka 60) amafunika kuyezetsa ntchito ya impso asanayambe opaleshoni. Kuti mupeze kusiyana kwa ayodini (CT/angiography), fufuzani mbiri ya nephropathy yomwe imayambitsa kusiyana.

Kuwunika kwa ziwengo ndi matenda a comorbidity

- Lembani zomwe zinachitika kale pang'ono/pakati (monga urticaria, bronchospasm). Perekani mankhwala a corticosteroids/antihistamines kuti mugwiritse ntchito mankhwala akale.

- Pewani maphunziro osankha a kusiyana kwa matenda a mphumu yosakhazikika, kulephera kwa mtima, kapena pheochromocytoma.

Kusankha Kulowa kwa Mitsempha ya Mtima

Kukula kwa Malo ndi Catheter: Gwiritsani ntchito ma catheter a 18–20G IV m'mitsempha ya antecubital kapena ya mkono. Pewani mafupa, mitsempha ya manja/dzanja, kapena miyendo yomwe magazi amayenda bwino (monga, pambuyo pa mastectomy, dialysis fistulas). Pa kutuluka kwa magazi >3 mL/sekondi, ma catheter a ≥20G ndi ofunikira.

Kuyika kwa Catheter: Pitani patsogolo ≥2.5 cm mu mtsempha. Yesani patency ndi saline flush pansi pa direct visualization. Kanani ma catheter omwe ali ndi kukana kapena kupweteka mukatsuka.

2. Zipangizo ndi Kukonzekera kwa Zosiyanasiyana

Kusamalira Wothandizira Wosiyanitsa

Kuwongolera Kutentha: Tenthetsani zinthu zokhala ndi ayodini mpaka ~37°C kuti muchepetse kukhuthala ndi chiopsezo cha kutuluka kwa madzi m'thupi.

Kusankha Mankhwala: Sankhani mankhwala a iso-osmolar kapena otsika osmolar (monga iodixanol, iohexol) kwa odwala omwe ali pachiwopsezo chachikulu. Pa MRI, mankhwala a macrocyclic gadolinium (monga gadoterate meglumine) amachepetsa kusungidwa kwa gadolinium.

Kukonza Injector & Air Kuchotsa

Malire Okhudza Kupanikizika: Ikani machenjezo oletsa kulowa (nthawi zambiri 300–325 psi) kuti muzindikire kulowa kwa mpweya msanga.

Ndondomeko Yotulutsira Mpweya: Sinthani machubu, yeretsani mpweya pogwiritsa ntchito saline, ndikutsimikizira mizere yopanda thovu. Pa ma injector a MRI, onetsetsani kuti zinthu zomwe sizili ndi ferromagnetic (monga Shenzhen Kenid's H15) zikugwira ntchito kuti mupewe zoopsa zomwe zingachitike.

Tebulo: Makonzedwe Oyenera a Injector Potengera Modality

| Kusinthasintha | Kuthamanga kwa Madzi | Kuchuluka kwa Kusiyanitsa | Kuthamanga kwa Saline |

|————————|——————|——————|——————-|

| Angiography 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 |

| Peripheral Angiolysis | 2–4 mL/s | 40–60 mL | 20 mL |

3. Njira Zotetezera Zoperekera Jakisoni ndi Kuwunika

Kuyesa Jakisoni ndi Malo Oyikira

- Chitani jakisoni wa saline pa 0.5 mL/s kuposa momwe munakonzera kuti mutsimikizire kuti mzere uli ndi patency komanso kuti palibe kufalikira kwa magazi.

- Letsani miyendo ndi manja pogwiritsa ntchito ma splints/tepi; pewani kupindika mkono wanu mukamachita scan ya pachifuwa/m'mimba.

Kulankhulana ndi Kuwunika Nthawi Yeniyeni

- Gwiritsani ntchito ma intercom polankhulana ndi odwala. Uzani odwala kuti anene za ululu, kutentha, kapena kutupa nthawi yomweyo.

- Yang'anirani malo omwe jakisoni amaonekera nthawi yomwe si yokhazikika. Pa CT automated striking, perekani antchito kuti aziyang'anira patali.

Zoganizira Zapadera Zofikira

Mizere Yapakati: Gwiritsani ntchito ma PICC/CVC okha omwe amabayidwa ndi mphamvu (omwe ali ndi chiwerengero cha ≥300 psi). Yesani magazi kuti muwone ngati akubwerera komanso ngati saline ikuyenda bwino.

Mizere Yolowa M'mimba (IO): Sungani nthawi yadzidzidzi. Chepetsani kuchuluka kwa mankhwalawa kufika pa ≤5 mL/s; perekani chithandizo cha lidocaine kuti muchepetse ululu.

  4. Kukonzekera Zadzidzidzi ndi Kuchepetsa Zoopsa pa Zochitika

Ndondomeko Yosiyanitsa Kuchuluka kwa Zinthu

Yankho Lachangu: Siyani jakisoni, kwezani mwendo, ikani ma compress ozizira. Ngati mulingo woposa 50 mL kapena kutupa kwambiri, funsani opaleshoni.

Chithandizo cha Pakhungu: Gwiritsani ntchito jeli ya dimethylsulfoxide (DMSO) kapena gauze woviikidwa mu dexamethasone. Pewani kupopera mankhwala opopera.

Anaphylaxis ndi Kupewa kwa NSF

- Sungani zida zochizira mwadzidzidzi (epinephrine, bronchodilators) mosavuta. Phunzitsani ogwira ntchito ku ACLS kuti aone ngati pali zovuta (0.04%).

- Yesani ntchito ya impso isanafike MRI; pewani mankhwala ogwiritsira ntchito gadolinium mwa odwala omwe amadalira dialysis.

Zolemba ndi Chilolezo Chodziwitsidwa

- Fotokozani zoopsa: zotsatirapo zoopsa (nseru, ziphuphu), NSF, kapena kutuluka magazi m'thupi. Lembani chilolezo ndi manambala a wothandizira/malo.

 Chidule 

Ma injector otsutsana ndi kuthamanga kwa magazi amafuna njira zodzitetezera zolimba:

Chisamaliro choyang'ana kwambiri kwa wodwala: Konzani zoopsa (za impso/allergy), pezani mwayi wopeza mankhwala m'mitsempha, ndikupeza chilolezo chodziwitsidwa.

Kulondola kwaukadaulo: Kulinganiza ma injector, kutsimikizira mizere yopanda mpweya, ndikusankha magawo oyendetsera madzi payekhapayekha.

Kusamala mwachangu: Yang'anirani nthawi yeniyeni, konzekerani zadzidzidzi, ndikutsatira malangizo okhudzana ndi wothandizira.

Mwa kuphatikiza njira zodzitetezera izi, magulu a radiology amachepetsa zoopsa pomwe akuwonjezera kuchuluka kwa matenda - kuonetsetsa kuti chitetezo cha odwala chikadali chofunikira kwambiri pakujambula zithunzi zomwe zili pachiwopsezo chachikulu.

"Kusiyana pakati pa njira yokhazikika ndi chochitika chachikulu kuli mu tsatanetsatane wa kukonzekera."   — Yotengedwa kuchokera ku Buku Lophunzitsira la ACR Contrast, 2023.

LnkMed

Ndi chitukuko cha ukadaulo wa kujambula zithunzi zachipatala, pali makampani ambiri omwe amatha kupereka zinthu zojambulira zithunzi, monga majakisoni ndi ma syringe.LnkMedUkadaulo wa zamankhwala ndi umodzi mwa iwo. Timapereka zinthu zonse zothandizira matenda:Injektara imodzi ya CT，Injector ya mutu wa CT iwiri,Jakisoni wa MRIndiInjector ya DSA yothamanga kwambiriAmagwira ntchito bwino ndi mitundu yosiyanasiyana ya CT/MRI scanner monga GE, Philips, Siemens. Kupatula injector, timaperekanso syringe ndi chubu chomwe chingagwiritsidwe ntchito pa mitundu yosiyanasiyana ya injector monga Medrad/Bayer, Mallinckrodt/Guerbet, Nemoto, Medtron, Ulrich.
Izi ndi mphamvu zathu zazikulu: nthawi yotumizira mwachangu; Ziyeneretso zonse za satifiketi, zaka zambiri zokumana nazo zotumiza kunja, njira yabwino kwambiri yowunikira zinthu, zinthu zomwe zimagwira ntchito bwino, tikukulandirani ndi manja awiri kuti mufunse.