CTAC's

pezfor2 · Feb 4, 2009

We only have one Radiology RN--me! We only do the Cardiac CT's when I am here. So, basically Monday-Friday. Our ER cannot order these as a stat. They can be scheduled as an inpatient or an oupatient. Hope that helps!

Editorial Team / Admin · Feb 6, 2009

we offer ctac's (ct angiogram - cardiac) currently as scheduled procedures (outpatient) and in very specific circumstances for inpatients when special arrangements are made by the ordering physicians if the patient is not a candidate for a cath or surgery, but they want to confirm a diagnosis.
there is a initiative at my facility to offer this procedure 24/7, which will potentially present additional on-call responsibilities for my radiology rn's that cover an extensive amt of call already. not to mention the fact that these exams are not read by all radiologists/cardiologists, therefore are often not even read until the next day or later anyway. check with your rads/cards on this, they may assign someone to cover night readings (why go to all the trouble/expense to do an urgent exam when results are not as urgently available?) -- either their own staff or contracted personnel who would read them off-site.
what is everyone else doing? ours are still done m-f, however when i asked our cta md guru about 24/7, he says he sees this as a trend that will become more prevalent in the next 5 yr. the information gained in such a timely manner (cf the time to mobilize cath staff/lab) can help screen those who need urgent caths from those who don't. in his opinon, too, rn is "not necessary" for doing the scan, as long as the md is readily available (according to hospital's policy, of course) during injection of contrast.there has been a suggestion to cross train ed, ccu and pacu nurses to manage these patients, but i know that this will not be a process that will be eagerly embraced by these units.
we currently have 4 full time radiology rn's and they are truly for emergent cases in the interventional area. i fear that this will become a process to prevent/delay calling in the cath lab. as mentioned above, they would utilize it as add'l screening, to not call the cath lab crew in for every suspect mi. besides the cross training issue or the increased on-call burden to the nurses, there are other concerns; one, if something is diagnosed that needs immediate intervention in the cath lab, the patient has already had a signficant dye load, increase cost for the dual procedures are just a few of the many concerns that come immediately to mind. the cardiologist i spoke with did not feel add'l 60ml visipaque load would be a problem, that a cath could be done post cta, if indicated. if calcium scoring is negative and arteries look clear, no need for a cath. i did ask him specifically about the contrast load.
please share your experienes with me so that i might be able assist with setting up this process with reasonable expectations/understanding on all parts.
wouldn't it be good if all involved could sit down and discuss all the pertinent issues, and do a little brainstorming and problem-solving beforehand??? perhaps that will be done, or you can request to be 'in' on the planning/strategizing. all aspects of the proposed change should be discussed, from personnel availability to contrast load to timely image interpretation and reporting . . . bottom line is, what will help the vulnerable patient most, and how may that best be done, from financial and staffing perspective??
thanks,
arnfinally

good luck, keep us posted. do clearly bring up your concerns to the appropriate persons. :)

Radnurse54 · Feb 17, 2009

My experience has been that CCTA's were NOT considered emergent, so no one was required to be on call for these. Also, when we began doing them in the small hospital I came from where I was the only Radiology Nurse, I got them to agree to have the CT techs working with me to attend the ACLS course as well. My premise was that there should be more than 1 person who knew ACLS in the room or nearby. (Radiologists there were not required to have ACLS). I work in a teaching hospital now and if there is someone who absolutely must have a CCTA after hours usually from the ER, then their nurses must do them. As you have guessed, they never need them, now that this is the rule.

Here is the issue, even for really fast CT's it takes quite a long time to reconfigure the images to be read, so by their own standards it would never be emergent.

5780 · May 17, 2009

What would the criteria be for calling in the RN? Would the patient be assessed first to confirm that he/she would need some IV metoprolol and, therefore, monitoring in order to get the scan done? We have fairly recently started doing cardiac CTA's, and the RN has not always been present during the scan - if the patient has not required IV medication to assist with the scan. (This is partly an ownership problem on the part of the charge CT tech.) I don't think we have enough qualified rads to report these scans to justify offering a 24 hour service.

randismom · Jun 1, 2009

We have just started CTA Coronary. We have one Cardiologist and one Radiologist that can be available in the control room throughout and directing the procedure. The Radiologist is brought from another hospital site every other Wednesday afternoon, and the Cardioligist is blocking his schedule for the opposite Wednesdays so we have coverage. I am the only RN here as well. I have one ICU nurse who covers for me and she has gone through applications with us as well. We don't see that we will be doing these outside those designated hours because of MD availability.