nurses consenting for iv contrast

Editorial Team / Admin · Mar 17, 2005

Practice varies here.

Here in CA we can EDUCATE but can't obtain the informed consent for procedures; only the MD obtains an informed consent.

At the three places I've worked, we didn't consent pts for contrast administration. I know in Georgia it is a law that pts MUST be consented before being given IV contrast. We discussed this issue every now and then, the Radiologists and RNs (especially in the days of distinguishing high-risk pts, who would then receive non-ionic agents -- more $$ --, whereas the lower-risk pts would receive the old ionic agents. The Radiologists finally committed to giving ALL pts nonionics, as the risks of side effects, untoward and allergic reactions were GREATLY reduced when they were used. And, as our Chief Radiologist commented, "If I were getting a study, I'd want the best used on me, even if I'm low risk!"). Our Chief Rad. gently opposed consenting pts, as he felt it might increase anxiety which, according to the literature at the time, increased chances of untoward reactions. The risks and benefits of being given contrast were always explained to the pt (either by the tech or the RN), who could then decline the injection if s/he so desired.

Also, the techs here in CA are empowered to start IVs (with proper training). So, one hospital might have the CT techs starting all the IVs, as long as a RN and MD are in the immediate area (the RN might be starting an IV in another room, the MD might be in a different room, reading images). We always required an RN be in the room, and we started most of the IVs -- for continuity, as we felt more assured of the IV we'd started ourselves, AND (very important) had interviewed the pt ourselves, noting expressions and nuanceswith the answers given, and our own intuition as we asked the necessary questions.

I'm afraid I haven't answered your question the way you wanted. I think it's admirable and certainly quite an ideal goal (for primary nursing), for many reasons. But because of the nature of the beast in a busy Radiology Dept, the nurse who has other responsibilities within the Dept as well, may not be able to do the whole exam, start-to-finish. If you do have a dedicated RN (and only one CT room), it might be more attainable, in my opinion.

I'll be interested to see others' responses. :)

kiwilinda59 · Mar 17, 2005

Thanks for replying Dianah, my assignment I'm in the midst of completing is based on the argument if RN's admit, cannulate and inject contrast to the patient we are therefore the best person to consent.

This discussion based on the fact that the nurse - patient repoire at this stage has defused any untoward anxieties therefore reinforcing this belief that stress can aggravate a contrast reaction.

Do you use Ultravist310 or 370?

Great to get such an informative response

Editorial Team / Admin · Mar 18, 2005

I don't work in Radiology anymore, am exclusively Cath Lab now. BUT, when I did work CT, we gave Omnipaque 300. In angio suite and cath lab we gave either Omnipaque 350 or Visipaque 320.

In the Cath Lab I work now we use same: Omnipaque 350 if creatinine is normal, and Visipaque 320 if creat is >1.5.

BTW, just had an inservice from the Visipaque rep (which inservices I always take w/a grain of salt, as, of course, there WILL be bias!) re: use of Visipaque. I'd like to use it exclusively d/t its renal protection, but the Cardiologists insist it diminishes the contrast in the images, making them possibly less-than-optimal, diagnostically. Hmmmmmmmmm, I'm not sure of that, myself. But, to get back to my original point: we now monitor estimated glomerular filtration rate (eGFR), as well as BUN and creatinine, and base our choice of contrast on the three indicators rather than just the two (BUN and creat). Just an interesting side note. :)

I'd be interested in the outcome of your study. :)