patient preparation instructions for intravenous urogram (ivu)

PATIENT PREPARATION INSTRUCTIONS FOR INTRAVENOUS
UROGRAM (IVU)
PREPARATION FOR THE TEST:
For 3 days before the appointment, the patient should follow a low-waste diet (free of
bread, pasta, rice, vegetables and pulses).
ON THE DAY OF THE TEST
1. Do not eat or drink for at least 6 hours prior to your appointment.
1. On the day of the appointment the patient must bring along the following test results
(necessary for the use of iodine-based compounds):
•
•
•
Creatinine
Glycaemia
Protein electrophoresis with chart
The above tests are valid for 3 months.
On the day of the test take your usual medication at home as prescribed by your family
doctor except for:
- Metformin, to be suspended for the 3 days before and the 2 days after the
examination.
Notes
In case of allergy to the contrast agent or serious allergy to any other drugs or substances
please refer to your family doctor and fill in and bring the attached pre-medication form with
you.
On the day of the test the patient must bring all their medical records that relate to
the clinical problem being tested.
Istituto Clinico Città Studi SpA
Via A.M.Ampère, 47 – 20131 Milano
www.ic-cittastudi.it
e-mail: [email protected]
ModRad05 rev. 03 Urografia rev. 00_english_REV.doc
Tel. 02/2393.1
Fax 02/2393 4124
Capitale Sociale 28923483,50 i.v.
Cod Fisc e p.iva 09444340153
Page 1 of 2
ALLERGY TO CONTRAST AGENT PRE-TREATMENT FORM
(iodinated and paramagnetic contrast agents)
24 HOURS BEFORE THE TEST, TAKE:
•
•
•
DELTACORTENE – 1 25 mg tablet
CETIRIZINE - 1 10 mg tablet
ZANTAC - 1 150 mg tablet
13 HOURS BEFORE THE TEST, TAKE:
•
•
•
DELTACORTENE - 1 25 mg tablet
CETIRIZINE - 1 10 mg tablet
ZANTAC - 1 150 mg tablet
7 HOURS BEFORE THE TEST, TAKE:
•
•
•
DELTACORTENE - 1 25 mg tablet
CETIRIZINE - 1 10 mg tablet
ZANTAC - 1 150 mg tablet
1 HOUR BEFORE THE TEST, TAKE:
•
CETIRIZINE - 1 10 mg tablet
Istituto Clinico Città Studi SpA
Via A.M.Ampère, 47 – 20131 Milano
www.ic-cittastudi.it
e-mail: [email protected]
ModRad05 rev. 03 Urografia rev. 00_english_REV.doc
Tel. 02/2393.1
Fax 02/2393 4124
Capitale Sociale 28923483,50 i.v.
Cod Fisc e p.iva 09444340153
Page 2 of 2

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