Hepatobiliary (Gallbladder, Biliary) Imaging with Cholecystokinin: Patient Education and Nursing Interventions

Indications for Hepatobiliary Imaging with Cholecystokinin (HIDA-CCK):

HIDA-CCK is a nuclear medicine imaging study used to diagnose gallbladder and biliary tract disorders. It combines radioactive tracer technology with the hormone cholecystokinin (CCK), which stimulates the gallbladder to contract and release bile. This test is indicated for:

• Diagnosing acute cholecystitis: inflammation of the gallbladder, often caused by gallstones.
• Evaluating gallbladder function: Assessing the ability of the gallbladder to store and release bile.
• Identifying biliary leaks: detecting leakage of bile from the bile ducts.
• Differentiating choledocholithiasis (gallstones in the bile ducts) from other causes of jaundice.

Patient Education for HIDA-CCK:

• Explain the purpose of the test: Explain why the test is being ordered and what information it is expected to provide.
• Describe the procedure: Outline the steps involved in the procedure, including the injection of the radioactive tracer and the imaging process.
• Address concerns about radiation: Reassure the patient that the radiation exposure is minimal and comparable to a standard X-ray.
• Explain the effects of CCK: Inform the patient about the possibility of experiencing mild abdominal discomfort, nausea, or flushing during the test due to CCK injection.
• Review dietary restrictions: Explain the need to fast for 4-6 hours prior to the test and the importance of following any specific instructions regarding food and drink intake.
• Address medication considerations: Inform the patient to discuss any medications they are taking with their doctor, as some medications may interfere with the test results.
• Answer any questions: Encourage the patient to ask questions and address any anxieties or concerns they may have.

Key Nursing Interventions for HIDA-CCK:

• Verification: Verify the patient’s identity, allergies, and medical history.
• Explanation: Explain the procedure and answer any questions the patient may have.
• Pre-procedural care: Ensure the patient has fasted as instructed and is comfortable.
• Catheter insertion: Assist the technician with inserting an intravenous catheter for tracer injection.
• Monitoring: Monitor the patient’s vital signs and general condition during the procedure.
• Injection administration: Assist with the administration of the radioactive tracer and CCK injection.
• Image acquisition: Assist the technician with positioning the patient for imaging.
• Post-procedural care: Monitor the patient for any adverse reactions and provide post-procedural instructions.
• Documentation: Document the procedure, including the time of administration of the tracer and CCK, the patient’s vital signs, and any observations.

Patient Education for Breast Biopsy for ERA/PR Studies:

1. Higher Prevalence of Positive ER and PR: Women with the following characteristics are more likely to have positive estrogen receptor (ER) and progesterone receptor (PR):
   • Postmenopausal women
   • Women with well-differentiated tumors
   • Women with smaller tumors
   • Women with tumors that are node-negative
   • Women with a family history of breast cancer.
2. Tumors Rarely Responding to Antiestrogen Therapy: The following types of breast tumors are less likely to respond to antiestrogen therapy:
   • Triple-negative breast cancer (ER-negative, PR-negative, HER2-negative)
   • Medullary carcinoma
   • Inflammatory breast cancer
3. Interpretation of ER-Positive and PR-Negative Tumor:

This result indicates that the tumor cells have ER receptors but lack PR receptors. This suggests that the tumor may be responsive to certain antiestrogen therapies, such as tamoxifen, but may not respond to other antiestrogen medications that target both ER and PR. The specific treatment plan will be determined by the oncologist based on the patient’s individual characteristics and other tumor markers.

Additional Considerations:

• Encourage communication: Encourage the patient to ask questions and express their concerns throughout the process.
• Provide emotional support: Acknowledge the patient’s anxieties and offer support during this time.
• Coordinate care: Ensure effective communication between the healthcare team members involved in the patient’s care.

It is important to remember that each patient is an individual, and their specific needs and concerns will vary. By providing clear and concise information, addressing individual concerns, and offering emotional support, healthcare providers can help patients feel more informed and empowered during their healthcare journey.