Re: Radiology

Mon, 02 Oct 2006 09:55:15 -0700

Excellent points Michael!  Couldn't agree more - We need rad techs in AVA!
Nancy Costa CRNI
----- Original Message -----
Sent: Friday, September 29, 2006 7:01 PM
Subject: RE: Radiology

I think we will see a lot more changes then what we think, not only in technology. Some of these devices are first generation and only using them will tell us what will work and what will not. That will be our job, to give feed back and improve things.
It seems to me that there are great differences depending where and in what setting one is practicing.
Our Radiology dep. will not bother much with starting IV's on inpatients. They love the power PICC's and I am sure the ports too.
There is not only a Nursing shortage, there is a Rad Tech one too.
May be it is time to involve Rad Techs more in AVA.....
We will have to keep an open mind.

Chris Cavanaugh <[EMAIL PROTECTED]> wrote:
You are right, things do change, I am not disputing that fact at all.  And I realize power ports are only 2 months old, you are the one that said they are being used now….I am glad to see that the need for education is being addressed in CT, please do not forget the MRI departments also, as they use power injectors also.  The more education we can provide for the radiology RNs and the Rad Techs the better off our patients will be. 
 
Chris Cavanaugh, CRNI
From: Kokotis, Kathy [mailto:[EMAIL PROTECTED]
Sent: Wednesday, September 27, 2006 9:16 AM
To: Chris Cavanaugh; Denise Macklin; venous
Subject: RE: Radiology
 
Things change
The educational programs for power injection are just starting in CT now as we speak
Power injectable ports are only two months old
kathy 
 
 
 
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Chris Cavanaugh
Sent: Tuesday, September 26, 2006 7:43 PM
To: Kokotis, Kathy; 'Denise Macklin'; 'venous'
Subject: RE: Radiology
Kathy, I hope you are right, I would love to see heparin free VADs, if the research supports it.  I think decreasing infection risk is just as important as preventing clotting.  And I hope all VADs will be power injectable, but I think that will depend on the manufacturers making them less costly, so they can be used for every patient,  in the long run it would be safer for those patients in an acute care setting.  No need for homecare or LTC, were they are not used now.  As far as port being used….well I have to disagree.  In the last year I have been in over 100 MRI units, mostly in major university hospitals, some in smaller medical centers and some community settings.  I have NEVER seen a mediport used for hand injection of contrast.  In fact, I did not ask at all facilities, but most had a policy not to use the port and to have the patient sent to MRI with it DEACCESSED.  That way they did not have to worry about reinforcing the needle in the scanner.  Perhaps it is different in CT.  But in MRI, even those that had radiology nurses who would come into MRI, the ports were not to be used.   Bard will have to keep this in mind as they sell their port, that MRI departments, and perhaps CT also, will need to look at their policies for use of a mediport, and have RNs available to use them.  This is currently not in the scope of practice for most RTs.  I believe the scope of practice will change as the nursing shortage will force the issue.   But even so, it will be such a rare occurrence  and so many checks will need to be done –does it feel like a power inj port? Do we have the right huber needle? Do we get a blood return? Is the needle taped securely for MRI?  That my guess is that most techs would just find it easier to start a PIV for the contrast.  
The overall feeling after talking to a lot of techs is that it is easier to just start a PIV then wait for a nurse to access a central line now….they hate to hold up a scan and this way they do not have to learn which central lines can be power inj and which cannot.  I am guessing they will feel the same about the ports. 
 
I wish it was different, but that is the CURRENT state.  Who knows what 2010 will bring?  I would like to see these great devices used to decrease venipuncture on these patients, but we shall see…..
 
Chris Cavanaugh, CRNI
From: Kokotis, Kathy [mailto:[EMAIL PROTECTED]
Sent: Tuesday, September 26, 2006 6:22 PM
To: Chris Cavanaugh; Denise Macklin; venous
Subject: RE: Radiology
 
Power ports are already being used for CT and MRI
 
By the year 2010 all Vascular access devices will be power injectable.  It will be a standard in the industry
 
By the year 2010 heparin for central lines will no longer be used.  Facilities will be heparin free
 
But than I believe techs will be cross trained to do vascular access procedures as there will be no new nurses to end the shortage
 
Kathy
 
 
 
 
 
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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Chris Cavanaugh
Sent: Tuesday, September 26, 2006 7:28 AM
To: 'Denise Macklin'; 'venous'
Subject: RE: Radiology
Denise, you are absolutely correct.  My focus has been MRI, not CT, however, I would not be surprised that what I have found in MRI departments mirrors what you have seen.  There are many MRI techs who have no idea what a “power PICC” is.  There are departments who have no nursing backup, techs only and they have rules not to touch a central line.  These patients will always get a PIV, or a butterfly just for the contrast, then it is removed.  Some departments have radiology nurses who come into MRI when needed.  Rarely is there an MRI with a dedicated nurse.   When there is a nurse, the contrast injections, either by hand or power injectors can be done through the central line.  The nurses do seem more knowledgeable regarding Power PICCs, in general, though some have never seen one.  I am sure the Power Ports will never be used—too confusing for staff that do not access ports now.  Ports are NEVER used for hand or power injection in the MRI area.  As far as accessing the Power PICC, mostly I have seen the connection through whatever end cap is on the Power PICC.  Rarely have I seen it removed.  I have never seen them replaced.  It is also very rare that the saline flush of the power injector is followed by a heparin flush, I have only been in one MRI department that had heparin flushes available.  I addressed these and some other safety issues in my talk at AVA.
 
Chris Cavanaugh, CRNI
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Denise Macklin
Sent: Monday, September 25, 2006 11:39 PM
To: venous
Subject: Radiology
 
You may respond to me privately, but I bet many on the list would be interested.  I have found in my travels that radiology departments are doing many different things when it comes to infusing contrast into power piccs for CT scans etc.  Some infuse through the connector, some take it off and mainline, some change the connectors others do not.  If you would like to share what procedure your radiology department is currently using, I am putting together some data on this topic. 
 
Let me thank you for all your input in advance.  This is really an interesting question
 
Denise Macklin



Michael Drafz RN, OCN, CRNI
Clinical Lead Vascular Access Service
Sharp Memorial Hospital Metropolitan Campus
San Diego, California

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