Our protocol came out this week on how we are going to start handling patients who are getting CT or MRI IV Contrast.
Anyone 50 or older, diabetic or renal failure of any age, have to have a BUN and Creat drawn within 72 hours of their scan.
If the GFR is 30 or below they must first have clearance from a nephrologist before they can receive the contrast.
If the GFR (CT patients) is 30-60 then we give 600mg PO Mucomyst and infuse 250ccc of 0.45% NS with 1 am of sodium bicarb prior to injecting with the contrast and then repeat the IV fluids immediately after the scan. The patient gets a script for Mucomyst to repeat 600mg in 12 hours and again in 24 hours.
The GFR acceptable level is considerably lower for MRI (like maybe anything over 40 is ok) so I think the main concern is going to be the CT patients.
Several problems...we have been trying like heck to get the doctors to order a BUN and Creat at the same time they order the scan but it's not going well. The patient comes in and we then have to draw the labs to be run stat which still takes 45 min to an hour. I have to draw it and drive up to the hospital to drop it off. We are owned by the hosp but are a free standing building. Talk about a PIA. We have two prep rooms for CT's and two for MRI's. If I'm going to be hydrating these patients where on earth am I going to put them? On top of hydrating some of the patients, I'll still be doing sedation of a few of the MRI patients. Where will I put them now?
Administrations answer is to hydrate the patients in same day surgery. Ok, what a brain storm...what are we going to do then...drive them down to the outpatient center...scan them...drive them back up to the hospital? No...they'll have to be scanned in the hospital and then we won't have any patients at all in the outpatient center and they won't need an ACLS nurse (me).
I have made the suggestion that they hire a $10/hr person to run back and forth to the lab. Turn the employee lounge into a lounge for patients being hydrated with recliners, leave the TV, put a window in the wall so I can keep an eye on them at all times. No one uses the lounge anyway except for putting their lunches in the frig.
Several Nashville hospitals are already hydrating their contrast patients, according to my manager "everybody will be hydrating" very soon.
Sep 30, '07
by dianah, ADN Senior Moderator
There are systems available for point-of-care labs, with results in 1-2 min.
One such is i-Stat Corp., with a "point-of-care analyzer."
I wonder if using this would be more cost-effective and timely than hiring a runner person.
Your idea for turning the lounge into a hydration area sounds good.
They must love you there, for your thinking "outside the box," lol!
Perhaps contact other facilities in your area (or canvass ARNA ppl) to see what other free-standing units are doing?
Last edit by dianah on Sep 30, '07