Interventional radiology extender

Advanced Practice Columnist / Guide · Feb 13, 2015

I think what you need to sort out is the logistics and how you could legally perform the procedure while maintaining compliance with your state's practice act. The myelogram procedure itself is not that complicated as it involves a spinal tap to inject dye followed by a CT scan is done. The technique would be similar to an LP and there are NP's performing LP's. However, these procedures are typically done in IR and yet you mentioned you work with a neurosurgeon. Your state requires a collaborative agreement and in such states, the rule is that whatever procedure you perform should parallel the role of your collaborating physician (i.e., Thoracic Surgery NP can insert chest tubes, ICU NP can insert central lines, Oncology NP's can do bone marrow biopsies). That said, it almost means that you should have a collaboration agreement with an IR attending since myelograms are not something Neurosurgeons do (they order it, but they don't perform it).

Xlorgguss · Feb 14, 2015

To piggy back off of this question, how do nurse practitioners do imaging in general? One of the girls I work with is in a program for diagnostic medical sonography and we got to talking about it. From what I deciphered nurse practitioners could perform ultrasound so long as it wasn't for a diagnostic reason. This may be a dumb question but where is the line between diagnostic and surveillance? I know nurse practitioners do perform sonography but what is there specific function (as in what do they call the reason for performing it)? How about for other imaging?

Advanced Practice Columnist / Guide · Feb 14, 2015

Sonography is now widely used across many medical and surgical specialties. Its use is not limited to the traditional diagnostic imaging obtained by a sonographer with images later interpreted by a trained physician. Because nurse practitioners are licensed independent providers alongside physicians, we are able to perform the same ultrasound applications as physicians in the specialty we work under.

I work in Critical Care and sonography is big in this field (along with Emergency Medicine). We train our fellows and NP's in ultrasound technique for various clinical applications from:

1. Vascular access by using a linear probe in real time while visualizing large veins for central venous catheter placement or visualizing arterial cannulation sites for placement of arterial lines. This has tremendously made a difference in procedure safety and accuracy minimizing the risk of multiple pokes and complications.

2. Assessing cardiac status by using a phased array probe to obtain multiple views of the heart and great vessels to determine cardiac function and volume status. This is basically surface "echocardiography light". We still rely on formal echocardiograms interpreted by cardiologists in diagnosing wall motion abnormalities, valvular disease, tamponade physiologies, etc. However, ultrasound helps as part of physical examination in assessing a hemodynamically unstable patient in determining shock physiologies, pericardial effusions, and intravascular volume status by making a general assessment of contractility and IVC size and compressibility.

3. Assessing the pleura and lung parenchyma by visualizing evidence of pneumothoraces, pleural effusions, pulmonary edema. It can be used as a tool to direct accuracy of needle placement in thoracentesis or chest tube placement.

4. Assessing the abdomen in trauma using the FAST protocol which relies on quick assessments of the abdominal quadrants and identifying abdominal organs and the pericardium to look for fluid collections that could be a source of hemorrhage.

Of course, one has to be trained in the techniques of performing the above applications but both NP's and physicians can receive training in them. They are part of physical exam in many cases similar to using a stethoscope to listen to heart and lung sounds. As a provider, you own the images and your interpretation of the findings when using ultrasound.