Norm of Intravenous Cholangiography
Even filling of the hepatic and biliary ducts. Complete filling of the gallbladder occurs. Negative for stricture or filling defects.
Usage of Intravenous Cholangiography
Alternative to oral cholecystography when client cannot tolerate oral iodopaque tablets or in clients with active intestinal inflammation; and detection of calculi (or their movement), strictures, or leaking anastomosis or anastomoses in the biliary ductal system.
Description of Intravenous Cholangiography
Intravenous cholangiography involves taking a series of radiographs of the gallbladder and hepatobiliary duct systems over several hours after the intravenous administration of a radiographic contrast medium. The contrast medium is allowed to circulate to the liver through the hepatic artery and empty into the biliary tree. Strictures or stones cause defects in the pattern of filling and can be visualized on the radiograph. Strictures occurring in the hepatobiliary ducts may be congenital or caused by ductal damage during exploratory or therapeutic biliary surgery or may be caused by benign or malignant tumor or inflammation. Intravenous cholangiography carries a diagnostic accuracy of 99% for detection of stones in the common bile duct; however, it has NOT been shown to provide incrementally superior information than other tests used to evaluate the hepatobiliary system. Gallbladder and biliary system ultrasound, a noninvasive procedure, is the test of choice for evaluating the biliary system and has largely replaced the use of intravenous cholangiography.
See Endoscopic retrograde cholangiopancreatography; Gallbladder and biliary system ultrasonography; Percutaneous transhepatic cholangiography. These three tests that are used more commonly than intravenous cholangiography.
Professional Considerations of Intravenous Cholangiography
Consent form IS required.
Hypotension, infection, nausea, respiratory failure, tachycardia, vomiting, allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), renal toxicity from contrast medium.
Respiratory failure; previous allergy to iodine, shellfish, or radiographic dye; renal insufficiency; during pregnancy (because of radioactive iodine crossing the blood-placental barrier).
- A laxative or cathartic may be administered 24 hours before the procedure.
- A cleansing or tap-water enema may be given the morning of the procedure.
- Establish intravenous access.
- Have emergency equipment readily available.
- See Client and Family Teaching.
- The client is positioned supine on the scanning table.
- A radiographic contrast medium is injected intravenously or infused by drip and allowed at least 30 minutes to circulate to the liver and become excreted into the bile ducts. Radiographs of the hepatic and bile ducts are taken at this time.
- 2–3 hours are then allowed to pass to allow the gallbladder to fill with contrast medium. Radiographs may be taken of the gallbladder and biliary system at intervals for up to 8 hours after injection.
- Resume previous diet.
- Assess for allergy to contrast medium for 24 hours.
- Dysuria is not uncommon because the contrast medium is excreted in the urine.
Client and Family Teaching
- Fast from food and fluids overnight before the test.
- Morning insulin may be withheld for diabetics because the test may take up to 8 hours.
- A burning or flushing sensation may be experienced when the dye is injected.
- Bring something to read, if desired, because the test may take several hours.
- Blockage of the gallbladder can be caused by stones formed from natural bile salts and substances similar in nature to cholesterol. A low-fat diet is generally recommended for clients with gallbladder disease.
- In women who are breast-feeding, formula should be substituted for breast milk for 1 or more days after the procedure.
Factors That Affect Results
- Hepatic failure with bilirubin >3.5 mg/dL (58 mmol/L, SI units) will interfere with gallbladder visualization. The dye must be processed in the liver before it passes into the gallbladder. The test will be canceled for a high bilirubin level.