[brain_rn]

I'm the only evening nurse for a 250-bed hospital in-patient radiology department and we're trying to improve our patient care by finding out procedure and protocols at other hospitals.

For example:

- if a patient on O2 would the Rad RN hook the patient up to the oxygen (from tank to wall or vice-versa) or the CT tech/x-ray tech?
- do other hospitals have a protocol on when a floor nurse would either call report or accompany a patient for an exam in radiology (i.e. restraints, stat exam, confused, on 15L O2 via nonrebreather, isolation precautions, etc.)

Those seem to be some of the questions that have popped lately. If you have any other information or ideas that you use for radiology nursing please share! Thanks so much!

[sunnymqt]

All techs and CT techs are able to connect O2 to a patient. The staff nurse should accompany the patient to the department if patient is unstable. Any concerns the floor nurse should call the rad nurse to give them a heads up.

[nursie-babie]

I, too, am the only RAD RN in the evenings(1200-2030) at a very large hospital. Our RAD techs can hook the pt to o2, etc. If we have a pt from the ICU, the nurse must accompany the pt. We have had the floor send pt's down in restraints before, but we call and request the nurse come down for the scan(either to medicate or hold the restraints) because we can not restrain the pt during a CT.

[vandebar]

JCAHO has a new band wagon where they are concerned with COMMUNICATION involving patients transferring from point A to point B. The primary nurse should give the RAD RN a report on the patient prior to the transfer. This report can be given to the RT if this is a stable patient that does not require nursing interventions. The techs connect O2 and transfer all the time. They do call backs for exams and the nurse is not on call for a routine CT chest r/o PE. If this is stat and the patient is compromised, the RAD nurse if available needs to receive report or the ER nurse or CCU nurse or primary must accompany the patient. When the exam is complete, the RN must report back to the primary any special considerations. We usually document in the progress note that CT or whatever the exam was completed and note the total amount of contrast given or any meds given in radiology.

[MCSpecialsRN]

I am a Rad RN and also have questions about protocols for contrast administration for CT and Medication Reconciliation. Has anyone been working on this and do you have any ideas you would be willing to share? We are just in the beginning phase of writing new policy and procedure on this in Radiology. (doing med list review) mostly involving outpatient scans, pharmacy involvment????? Thanks for any help!!!

[yankeescot]

Hi! I am a RN is a busy CT dept. in NYC Only an RN, MD or a PA can inject Intravenous contrast in our hospital. Unfortunately for the patients, New York State is now going to let technologists inject. My supervisor is concerned about our exstravsation rates going up. I'm concerned not only for the patients but for our techs too. It is a lot to ask a tech to put in an IV, inject the pt., watch out for any reactions and scan the patient. We have a staffing shortage of techs as it is.

O.K., I know I got off the subject. In our hospital we have a Radiology Nursing Progress note we fill out with every contrast injection that is done by a nurse. The MD and PA do not have to fill out any forms. On the nursing form we ask if the patient has any of the following conditions......Asthma, Emphysema, Cardiac disease, Renal disease, Diabetes, are they taking Metformin if they are a diabetic, Seizures, Multiple Myeloma, Myasthenia Gravis, Sickel Cell, Over Active Thyroid, Gout, and women are asked if there is any chance they are pregnant. We also ask if the pt. has any allergies. We take the patient's blood pressure, pulse, resp. rate and O2 Sat. before and after getting IV contrast. We document where the IV is and if we put it in or not. We document the type, amount and rate of the contrast. We request that all adult patients have a current (within 3 months) BUN and creatinine. Our creatinine cut off for injecting contrast is 1.5 unless the pt. gets has ESRD and will have dialysis within 24 hours after getting the IV contrast. The floor doctors get the pt.'s consen for IV contrast, the radiology doctors or the PA get the out patient's concents. We never inject in a lower extremity vein. We never power inject EJ's, IJ's, Central lines, piccs or ports unless the port/piccc line is a power port/picc. Regular ports, central lines, EJ's and IJ's all need to get IV contrast by hand injection only.
If a patient has a reaction, the radiologist must ordered the medication (benadryl, epi, methylprednisolone, IV fluids, etc.) If a radiologist is not available then we call the rapid responce team or a medical code depending on the patient's condition. When the scan is done we flush the IV with saline and then give a verbal report to the RN caring for the pt. and put our Radiology Nursing Progress Note in the pt.'s chart. I hope this has helped you. Sincerely, Rosemary