I work with many MRIs around the country and have first hand knowledge of actual practices. The use of contrast agents and power injection vs hand injection depends on the study and are used in both CT and MRI. As I said before, state regs, your facility policies and the knowledge level of the Rad techs all effect how lines are cared for, as well as whether or not there are RNs available in Radiology. So, there is no “rule” for what happens in any facility, you will need to find out how different lines are handled in your facility. Both contrast agents and heparin are considered drugs, but some Rad tech state regs and facility policies will permit injection of contrast but not heparin, some will. In some cases, it is a matter of knowledge.
Chris Cavanaugh, CRNI
----- Original Message -----
From: "Fritz, Donna" <[EMAIL PROTECTED]>
Date: Tuesday, May 16, 2006 1:11 pm
Subject: RE: "breaking the system"
To: Nancy Costa <[EMAIL PROTECTED]>, Chris Cavanaugh <[EMAIL PROTECTED]>, Marilyn Patterson <[EMAIL PROTECTED]>, Lynn Hadaway <[EMAIL PROTECTED]>, "Janousek, Patricia" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
> I believe that hand injections are done for MRIs and power
> injection for IV contrast CT. Some CTs are done without contrast
> or with only oral contrast. Maybe a Radiology-based PICC
> insertion nurse can comment on this.
>
> I also think that radiology techs are undertrained in the use of
> CVCs. At least that is my experience.
>
>
> Donna Fritz, MN, RN, OCN
> Oncology Clinical Nurse Specialist
> The Reverend Roger Patrick Dorcy Cancer Center
> St. Mary-Corwin Medical Center
> 719.560-5215
> [EMAIL PROTECTED]
>
> -----Original Message-----
> From: [EMAIL PROTECTED] [mailto:owner-
> [EMAIL PROTECTED] Behalf Of Nancy Costa
> Sent: Tuesday, May 16, 2006 2:56 AM
> To: Chris Cavanaugh; 'Marilyn Patterson'; 'Lynn Hadaway';
> 'Janousek, Patricia'; [EMAIL PROTECTED]
> Subject: Re: "breaking the system"
>
>
> Heparin flush is considered a medication, so the regs are more
> strict re: injection by RTs. They may be able to heparinize a
> line if there is a specific written protocol.
> Nancy Costa CRNI
>
> ----- Original Message -----
> From: Chris <mailto:[EMAIL PROTECTED]> Cavanaugh
> To: 'Marilyn Patterson' <mailto:[EMAIL PROTECTED]> ;
> 'Lynn Hadaway' <mailto:[EMAIL PROTECTED]> ; 'Janousek,
> Patricia' <mailto:[EMAIL PROTECTED]> ; [EMAIL PROTECTED]
> Sent: Monday, May 15, 2006 9:45 PM
> Subject: RE: "breaking the system"
>
>
> Procedures differ at every hospital, and the best answer perhaps
> is just to go to your CT and MRI departments and ask them what
> they do. From what I have seen at various facilities: 1) not
> every injection of contrast is given via a power injector. Many
> are given by hand. It depends on what type of study they are
> doing. 2) Although I see NS used before and after contrast
> injections, both with a power injector and by hand, I have never
> seen heparin used after. Why not? Not really sure-perhaps the
> techs are unaware of the need for heparin, and need to be
> educated, and have heparin supplied to their department for this
> purpose. This applies to PIVs and central lines. NS, contrast,
> NS. I have never seen heparin used. Not to say that applies to
> all facilities, of course.
>
> 3) I have also never seen a tech remove an injection cap from a
> line, again, no matter what type of line is used, just to inject
> the contrast.
>
> 4) Some facilities do not have the techs inject the contrast if
> the pt has a central line or PICC, they have nurses available to
> do this. Again, depends on the state regs and the facility
> policies.
>
> 5) I have never seen injection caps stocked in a CT or MRI area.
> This means that if they do remove them, they cannot replace them.
>
>
>
> What is best practice here? A dialogue with your radiology
> department-who takes care of lines in the department? What is
> their procedures? Do those procedures match and follow what
> happens in the rest of the facility?
>
> This conversation can go far to improve patient outcomes.
>
>
>
> Chris Cavanaugh, CRNI
>
>
> _____
>
>
> From: [EMAIL PROTECTED] [mailto:owner-
> [EMAIL PROTECTED] On Behalf Of Marilyn Patterson
> Sent: Monday, May 15, 2006 2:30 PM
> To: Lynn Hadaway; Janousek, Patricia; [EMAIL PROTECTED]
> Subject: RE: "breaking the system"
>
>
>
> More questions along the same line:
>
> The manufacturer's (Bard) recommendation for using a power
> injector with Power PICCs includes instructions to remove the
> injection cap prior to use. I know the CT techs infuse through the
> injection caps on peripheral IVs, why the difference?
>
> Does anyone have experience with CT techs doing this? Doesn't that
> open yet another door for introducing infections?
>
> Do the CT techs heparinized them after use, or do the floor nurses
> do this?
>
> As always, thanks in advance for sharing all your expertise and
> experience.
> Marilyn Patterson
>
> Olympic Medical Center
>
> Port Angeles, WA
>
> [EMAIL PROTECTED]
>
>
>
>
> _____
>
>
> From: [EMAIL PROTECTED] [mailto:owner-
> [EMAIL PROTECTED] On Behalf Of Lynn Hadaway
> Sent: Monday, May 15, 2006 7:31 AM
> To: Janousek, Patricia; [EMAIL PROTECTED]
> Subject: Re: "breaking the system"
>
>
>
> The literature on catheter-related bloodstream infection is filled
> with information about hub manipulation being a major source of
> the organisms that lead to infection. Opening the system and
> anything done to the catheter hub should be kept to a minimum by:
>
> 1. extending the tubing from 72 to 96 hours - both CDC and INS
> state "no more frequently than 72 hours"
>
> 2. changing fluid container and tubing at the same time
>
> 3. limiting the number of times the line is opened for any reason.
> I would not consider opening the line for the patient to shower to
> be a valid reason. Neither is it acceptable to disconnect the
> tubing to change gowns. The fluid container and all tubing should
> be run through the sleeve just like the arm.
>
>
>
> Lynn
>
>
>
> At 12:07 PM -0500 5/12/06, Janousek, Patricia wrote:
>
> Hi, Does anyone know of any supporting literature for NOT
> disconnecting IV fluids from an IV site for the "convenience" of
> the patient so that they can shower, and/or go to Xray? We
> recently had a BSI related to a PIV on a long-term patient (high-
> risk OB), that Epidemiology was able to track it back to the
> management of the line being broken many times for the patient to
> shower without being connected to the IV fluids. We would like to
> change the practice. Thanks, Patty
>
>
>
> Patty Janousek, BSN, CRNI
>
> Team Leader, IV Team
>
> Methodist Hospital
>
> 8303 Dodge Street
>
> Omaha, NE 68114
>
> (402)354-8760
>
> FAX: (402)354-5266
>
> PAGER: (402)577-9527
>
> EMAIL: [EMAIL PROTECTED]
>
>
>
>
> This message and any included attachments are from Nebraska
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>
>
>
>
> --
>
> Lynn Hadaway, M.Ed., RNC, CRNI
> Lynn Hadaway Associates, Inc.
> 126 Main Street, PO Box 10
> Milner, GA 30257
> http://www.hadawayassociates.com
> office 770-358-7861
>
>
>
> _____
>
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