[DutchgirlRN]

I went to my first tilt table yesterday. It was not at all what I had expected. Knowing that the patients sometimes pass out, I envisioned the tilt table being a test that would put them in some sort of upside down position. What on earth was I thinking!?

The patient was a young person. An IV was started, they were strapped to the table and lied there for 10 minutes. A pre-procedure strip was run as well as vitals and they all printed out including stroke volume readings and other similar readings which I don't remember what they were.

After 10 minutes we moved the table, up 70 degrees and the patient was standing up almost completely straight. The patient remained like that for 9 minutes. Then we put a NTG SL under the patients tongue and waited 3 minutes. Nothing happened. Then the patient tilted their head back for 30 seconds. Nothing happened. Another rhythm strip was run as well as the VS and the other readings and it was over.

We had IV fluids readily available in case the patients BP dropped drastically, we also had Atropine available and O2. The nurse does the test alone in a room with only a code button for help. The nurse told me she never does the test without first telling someone in the cath lab that she is in there.

I guess what bothered me was the fact that she told the patient prior to the NTG that they would suddenly experience a horrible awful headache, the worst they would ever have in their life, that they would feel dizzy, nauseated and flushed, and very possible could pass out. I realize that if they do pass out the test is positive and that's the whole purpose.

What I don't understand is why the nurse told the patient that they would suddenly get this terrible awful headache and would get dizzy, nauseated, etc. It was said as though this was a 100% given that things would occur. I could see the fear in the patients face and then absolutely nothing happened.

Can anyone tell me how you handle tilt tables and how it is explained to the patient? Thanks!

[dianah]

Never seen or done a tilt table test, but I recently had a CTA and just before I got the IV contrast, I was given one sl NTG.
I expected a whopping H/A, but didn't get one.
At all.
I agree with your last observation, and would prefer to allow the pt to tell ME what s/he feels, rather than putting words/suggestions in her/his mouth.

[DutchgirlRN]

Originally Posted by dianah

Never seen or done a tilt table test, but I recently had a CTA and just before I got the IV contrast, I was given one sl NTG.
I expected a whopping H/A, but didn't get one.
At all.
I agree with your last observation, and would prefer to allow the pt to tell ME what s/he feels, rather than putting words/suggestions in her/his mouth.

Yes, for sure! The nurse had me scared and I wasn't the one having the test. I hope your CTA turned out ok.

I have a few more questions. Did you get Lopressor prior to your test? The NTG was to further lower your HR? What was your HR prior to any meds? I'm curious because I don't feel like the Lopressor 50mg IV is a good choice. It seems that the first 15mg makes a difference and the additional 35mg is like pushing NS. Our lead cardiologist has made a suggestion that we use IV Esmolol (Brevibloc) Never heard of it. Have you?

http://www.rxlist.com/cgi/generic/esmolol_ids.htm

[dianah]

The NTG was to dilate the coronaries for better imaging w/contrast.
No Lopressor, as they were honing techniques on a new, faster scanner that doesn't require the low HR to produce good images.
My HR was in the 70's and the Cardiologist said that was fine.
This was for a small study he's doing, as well as perfecting protocols.
CTA was good, BTW: all arteries open!!

I've not used Esmolol in CT or Cath Lab (yet).

[DutchgirlRN]

Thanks Di and I'm glad your CTA was 100%! Our scanner is a 64 slice, I hear there are now 128 (?) slice scanners and even faster. We are currently in the process of putting in a new MRI at the hospital so I'm doubtful they would upgrade our CT scanner. Money, ya know! BTW I really don't have a clue as to what CT scans cost. I know a Lumbar MRI is $5,500, a pelvis is $3,500, etc...but didn't have a clue as to CT's. I learned just Friday that a CT Abd/Pelvis is $7,500 and a sinus is $4,000. Of course that's not the reimbursement amount especially with Medicare but whoa.....! Thanks!

[dianah]

Many, many years ago I happened to be the injecting RN for an IVP on one of our ER MDs, a very nice man.
This was before the days of low-osmolar, nonionic contrast agents, so he was getting Conray 60 slowly injected.
Not surprisingly, he vomited during the injection (happened with roughly 30% of injections).
After he felt better, he said, "I knew this would happen [the vomiting]. I tell all my patients to expect it."
I smiled a little and told him, "You know, only about 30% of those receiving IV contrast will vomit. Others just feel the transient warm sensation and that's it."
His eyes widened in surprise. "REALLY???"
I do think he set himself up for the reaction he had, with his preconceived idea of what to expect.
Who knows how many pts he set up for the same, by instructing them to expect the nausea/vomiting!
Which relates back to the nurse telling the tilt-table pt all the bad stuff he "will" feel (power of suggestion!).
Now, preparing a pt for what he MIGHT feel, or saying something like, "People experience different things with this test, and I want you to tell me what you're feeling, OK?"
Before a cath I'll usually tell them, "Don't be shy, and don't be brave. I do need to know how you're feeling during the test. The information obtained from the test is much more accurate when you tell how you're feeling."
Then, if the pt does feel lightheaded or something, you can reassure him/her that it's transient, that some ppl do feel that way during the test, and it will get better.

Many years ago (seems all my stories start this way, lol!!), I researched contrast reactions, in order to present a short talk to new nurses in orientation.
One article (sorry, don't remember the source!) named the pts at high risk for reactions:
previous reaction to contrast (duh)
diabetics
asthmatics/COPD'rs
previous allergic reactions (to any meds)
PTs WHO ARE ANXIOUS

etc.
In light of the last, highlighted area, I think we as Radiology Nurses can do A LOT toward helping allay fears and decreasing anxieties pre- and intra-procedure, thus possibly averting or decreasing untoward events/reactions.
No firm data/evidence here, just connecting a few dots with anecdotes and observation.

Now, if an event is GONNA happen, by golly it will!
But even if one happens, by your interactions with the pt before and during the procedure, s/he hopefully has trust in you, which may go a long way to helping her/him through said event.

Wordy, ain't I??? lol.

'Nuff here. sorry, the description of the RN talking to the pt just set me off, lol!

[DutchgirlRN]

Originally Posted by dianah

Many years ago (seems all my stories start this way, lol!!), I researched contrast reactions, in order to present a short talk to new nurses in orientation.
One article (sorry, don't remember the source!) named the pts at high risk for reactions:
previous reaction to contrast (duh)
diabetics
asthmatics/COPD'rs
previous allergic reactions (to any meds)
PTs WHO ARE ANXIOUS

etc.
In light of the last, highlighted area, I think we as Radiology Nurses can do A LOT toward helping allay fears and decreasing anxieties pre- and intra-procedure, thus possibly averting or decreasing untoward events/reactions.
No firm data/evidence here, just connecting a few dots with anecdotes and observation.

Now, if an event is GONNA happen, by golly it will!
But even if one happens, by your interactions with the pt before and during the procedure, s/he hopefully has trust in you, which may go a long way to helping her/him through said event.

Wordy, ain't I??? lol.

'Nuff here. sorry, the description of the RN talking to the pt just set me off, lol!

Wonderful Post Di and from one oldie to another, very well said indeed!