I am curious to know what other children's hospital MRI suites/experiences are like

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I am just curious to find out what other children's hospital MRI suites/experiences are like. I ask this because ours seems to be TERRIBLE and we have had many serious safety issues going down there. I had to take my critical, intubated newborn down this past weekend and it was a nightmare!

We have to put all our drips onto special MRI compatible pumps/tubing so prior to going down (if we're lucky enough to get enough pumps beforehand) we have to change everything over and get it running on their pumps. If you're not so lucky you have to do that down in the waiting area where there is no ventilator so RT has to bag the entire time. The pumps only run out to the 0.1 decimal so my drips that had been running @ 0.26ml/hr had to be rounded up or down to 0.2 or 0.3. They also don't run dose rates, only ml/hr.

It took us no less than 45 minutes to get her hooked up to the monitor, they do not have infant sized anything! The leads weren't picking up and kept reading a HR of 60 while I with my finger on her brachial tried to get them on her appropriately so they were reading. They also only have the adult type sat probe which on a 2.6kg infant does not work so well. Takes FOREVER to get an appropriate reading on it then has to be taped into place and you hope that it stays on through the scan. Then there was the a-line. My patient had a borderline blood pressure as it was and I did not want a cuff pressure I wanted her a-line working, well we had to go through 3 different monitors to find one that worked.

It is so frustrating! Everyone hates going to MRI and our hospital is doing studies on congenital heart defects/neurological impacts so all pre-op open heart babies have to have a brain MRI. And it's not just difficult on the little ones, we have these issues throughout the hospital. It never seems to be a smooth process and we always end up down there for a min of 3 hours with the majority of that time having to bag the patient (there is a vent for the scan but travel and set up the pts must be bagged).

Not to mention if the patient codes in the scanner you can't resuscitate them in the MRI room but have to pull them out and back into the prep area...though that is probably similar at all places but still scary!

What are your MRI experiences like?

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

Let me guess... you're not working in a free-standing, fully-resourced children's hospital. Neither am I. BUT... we do so many peds cardiac surgeries that we have a cardiac MRI suite and a second MRI suite for the rest of the body. We do have to switch over our infusions and cap our a-lines, but we have a battery-operated ventilator we take with us until the MRI RT is able to switch over to their vent. I haven't been to MRI with a patient in a long time so I'm trying to dredge up info here... We have a pediatric transport team that does all intra-hospital transports (except transfers to the wards) and they take responsibility for getting things set up and ready to go.

One memorable trip to MRI was many years ago in a different hospital. The patient was an infant with a metabolic disorder and intractable seizures that responded only to paraldehyde. It was the first kid I'd taken to our brand new MRI suite. They didn't have an MRI-compatible ventilator so the RT had to bag through the whole thing. He was the only one in the room with the kid. The doc and I were in the control room with the tech and the radiologist, chatting about what we thought we might find. I happened to glance into the scan room to see the RT jumping up and down. I gestured to him, "What??" and he pantomimed a seizure. (It was pretty funny but he got his point across!) So the scan had to be stopped, I had to go in and give paraldehyde and then we could continue.

umcRN, BSN, RN

867 Posts

No Jan! I AM working in a free standing fully resourced children's hospital. Supposedly one of the best in the country! It drives me (and everyone else) crazy! And they just re-did the entire MRI suite...but not any of the other equipment used, i think most of it is still from the 80's!

We also all take our own patients down, we have a transport team but they are for in/out of hospital transports. NICU transport will help take those babies down but are not utilized outside their unit. Being that I used to work in the NICU I do miss them...

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU.

We don't even have compatible IV pumps...we have to us this tubing that is coiled and we have to use like 3 of them...pharmacy hates it when we go because they have to make all new things for us to prime those bad boys! We don't even have a peds vent...and we have a NICU, PICU and 2 peds floors! I hate going down there...the tech don't get it. We do have pads we can cut and a peds pulseox though. And with the kids totally out or paralyzed, the poor RT is the only one in there!

umcRN, BSN, RN

867 Posts

We don't even have compatible IV pumps...we have to us this tubing that is coiled and we have to use like 3 of them...pharmacy hates it when we go because they have to make all new things for us to prime those bad boys! We don't even have a peds vent...and we have a NICU, PICU and 2 peds floors! I hate going down there...the tech don't get it. We do have pads we can cut and a peds pulseox though. And with the kids totally out or paralyzed, the poor RT is the only one in there!

yes we also use crazy coiled tubing but that is probably the norm and the pumps can be in the MRI room...they are just different pumps than we use in the unit. And yes pharmacy has to make all new meds/fluids and its such a waste for all of three hours of the day!

I actually avoided paralyzing my kiddo this past weekend because her blood pressure was so low already and we were trying to stay off dopa because no one in the hospital (I'm not exaggerating!) could get a central line in her (and three failed UVC attempts) I won't even get started on that but luckily she behaved on her baseline sedation.

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

Our pharmacy doesn't prepare our infusions - that's entirely on us. We don't have coiled tubing, just the least expensive extension tubing and there has to be enough slack for the kid to be completely inside the scanner. So we remix our drips, leave the three extension sets as the come from the package so they aren't dragging on the ground, prime them as is and hook them up. Switching over can take several hours; inotropes will need to be double-pumped and we don't have enough pumps to set up a complete separate pole. Most of the time we can only spare one or two more pumps and may need to switch epi, norepi, milrinone, nitroprusside and anything pushing them. Once we get to the MRI suite the paper bands keeping the tubing neatly corralled are torn off and the scan commences. At the end, they have to be recoiled and secured with tape to keep them from being run over. It's majorly labour intensive and the techs have NO clue what is involved in taking or kids to them. They'll call and say, "We'll do your patient in 20 minutes." I always laugh.

The transport team must be involved in all intrahospital transports if the child is intubated or unstable. Our team is physician-less so that means they can take kids when there isn't a physician available - most of the time. This decree came down from on high some time ago when there was a huge budget crunch and the team had to find a way to justify their existence. It's all very political.

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU.

Jan, I love when they say, ok you come right now...yeah, how about...NO. Then they get all huffy because we throw them behind...hey I called and told you about this kid on all these drips and on a cooling blanket and all this other good stuff...don't know what to tell you! Ugh. We always have to have a fellow or attending with us, we can't conscious sedate without them present.

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.

"Okay, lemme just throw my patient with the open sternum and four chest tubes who is on nitric and CRRT into a wheel chair and we'll be right down..." They need to get their collective stuff together and either do our kids first thing int he morning or at the end of the day so we have the heads-up in time to have the kid packed. We RNs in the PICU have "specialized clinical competencies" that allow us to use conscious sedation in the absence of a physician. Our transport RNs and RRTs have even more transferred functions.

umcRN, BSN, RN

867 Posts

I am unbelievably thankful for our portable CT scanner...makes a quick tentative diagnosis a lot easier in those ECMO patients :yeah:

Pediatric Critical Care Columnist

NotReady4PrimeTime, RN

5 Articles; 7,358 Posts

Specializes in NICU, PICU, PCVICU and peds oncology.
I am unbelievably thankful for our portable CT scanner...makes a quick tentative diagnosis a lot easier in those ECMO patients :yeah:

jealous.gif

Oh... I WISH!!!! But on a positive note, I learned last week that my ID badge will let me into radiology through the back door... saves about 5 minutes of hallway safari time.

imaginations

125 Posts

I am unbelievably thankful for our portable CT scanner...makes a quick tentative diagnosis a lot easier in those ECMO patients :yeah:

Where do you work?! That is awesome!!!

Gem1210390

175 Posts

Specializes in Critical Care/NICU.

In our nicu we have a transport incubator capsule that the baby goes in and all equipment and it detaches and fit on the MRI table thus baby does need to be disconnected from any equipment it is safe in one end and baby can have MRI.

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