Can a nurse obtain informed consent for a CT /MRI scan?

DutchgirlRN, ASN, RN · Mar 20, 2008

mike rt why is multiple myeloma a contraindication for contrast.... any literature? thanks in advance.

multiple myeloma is a progressive hematologic (blood) disease. it is cancer of the plasma cell which is a part of the immune system. if patient who has multiple myeloma are injected with contrast they could potentially go into renal failure. i questioned that when i first started doing medical imaging. i thought it meant someone who had had multiple skin cancers but no.

KEVIN88GT · Mar 20, 2008

I know what multiple myeloma is...just didn't know that with IV contrast you can cause renal failure.... that is why I asked for supporting literature... I've never even read about this on the American College of Radiologist website...

DutchgirlRN, ASN, RN · Mar 21, 2008

i know what multiple myeloma is...

i didn't

didn't know that with iv contrast you can cause renal failure....

hopefully you mean just in the case if multiple myeloma?

KEVIN88GT · Mar 21, 2008

yup.. i meant with multiple myeloma

mike RT · Mar 21, 2008

I have attached 2 journal articles that will hopefully answer your question about multiple myeloma and contrast media. Multiple myeloma is not a direct contraindication but, these patients often have some renal imparement.

http://radiology.rsnajnls.org/cgi/reprint/183/2/519.pdf

http://ndt.oxfordjournals.org/cgi/reprint/15/3/301.pdf

If your patients are at risk of contrast induced nepropathy (CIN) this article may be of help:

http://content.nejm.org/cgi/reprint/354/26/2773.pdf

This is the premedication regime that the radiologists @ my facility use for patients with prior contrast media reactions:

http://ndt.oxfordjournals.org/cgi/reprint/15/3/301.pdf

Americal College of Radiology (ACR) guidelines for MRI Contrast (gadolinium) safety:

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/MRSafety/recommendations_gadolinium-based.aspx

ACR guidelines on Iodinated contrast media:

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.aspx

I hope this helps - Its all about the patient

Mike

FireStarterRN, BSN, RN · Mar 21, 2008

I had no idea this requires a consent, I've sent many patients to a CT with contrast, I only have to make sure that if it is a chest CT that they have a 18 gauge anticub IV. I have accompanied critical patients down to CT and have never seen an x-ray tech get a consent either.

mike RT · Mar 22, 2008

Consent is not required , Check with your facilities polocy and procedures. Patients should be screened to insure that the possibility of a reaction or injury is present. The screening process also has the added benefit of patient education about the procedure.

Editorial Team / Admin · Mar 22, 2008

Consent is not required.

In some states (for example, in Georgia) it is the law to obtain informed consent before giving IV iodinated contrast.

Mike is absolutely right: check your hospital's policy and procedures.

And your state laws/requirements.

KEVIN88GT · Mar 25, 2008

mike RT thanks for the info...luckily at my facility we require a BUN under 32 or a Creatnine 1.5 or lower which would cover renal impairment... thanks for the info though...

DutchgirlRN, ASN, RN · Mar 25, 2008

mike rt thanks for the info...luckily at my facility we require a bun under 32 or a creatnine 1.5 or lower which would cover renal impairment... thanks for the info though...

a bun under 32 or a creatnine 1.5 or lower does not cover renal impairment. i've seen a creatnine of 1.1 and after calculating the gfr it was below 50. it depends on the patients age and race. the bun is of no consequence when considering ct contrast.

a gfr needs to be calculated and needs to be under 60 for ct contrast to be considered renal safe, followed by 80 ounces of caffeine-free fluids the day of and day after the contrast infusion.

a gfr of 30-60 requires mucomyst x 3 plus a 250 cc 0.45%/sodium bicarb iv infusion pre and post contrast.

a gfr of less than 30 requires an order from a nephrologist.

DutchgirlRN, ASN, RN · Mar 25, 2008

http://radiology.rsnajnls.org/cgi/reprint/183/2/519.pdf
http://ndt.oxfordjournals.org/cgi/reprint/15/3/301.pdf
if your patients are at risk of contrast induced nepropathy (cin) this article may be of help:
http://content.nejm.org/cgi/reprint/354/26/2773.pdf
this is the premedication regime that the radiologists @ my facility use for patients with prior contrast media reactions:
http://ndt.oxfordjournals.org/cgi/reprint/15/3/301.pdf
americal college of radiology (acr) guidelines for mri contrast (gadolinium) safety:
http://www.acr.org/secondarymainmenucategories/quality_safety/mrsafety/recommendations_gadolinium-based.aspx
acr guidelines on iodinated contrast media:
http://www.acr.org/secondarymainmenucategories/quality_safety/contrast_manual.aspx
i hope this helps - its all about the patient
mike

thanks mike! there's always something new to be learned

rnjd05 · Oct 20, 2011

Informed consent is required for essentially any procedure which carries risks of complications unless those complications are minor or extremely rare. While I am not familiar with all state law, I do know that California requires the physician who will be performing the procedure to expain the rationale for the procedure, the risks, benefits and options and must obtain the patient's consent. A nurse may not obtain informed consent because the likihood of risks/benefits and other medical options are outside of nursing scope of practice and the nurse is not the one performing the procedure. While a nurse may be able to explain the procedure, answer questions, etc., it is fundamentally a physician's duty to obtain informed consent (at least in California). This should be distinguished from having a patient sign a piece of paper stating that the risks and benefits have been explained to them and they consent to the procedure (after the physician has already obtained informed consent and documented such consent in the medical record.)