TGreen

I am currently an RN in Diagnostic Imaging and I love it. I worked CCU and ER for years and have been in DI for one year and I can't imagine going back to the floor or ER. In DI at my hospital we have many responsibilities. We insert PICC lines, assist with biopsies CT or US guided, assist with paras, thoras. Our DI does arteriograms which is very similer to heart caths but we look at every other vessel in the body such as lower extrem, kidneys, illiacs, carotids, etc. The DI nurses also assist with the CT angios. plus numerous other procedures. We work 4 10 hour shifts with weekends and holidays off. We rotate weekend call about every fourth weekend. The great thing is we care for 1 patient at a time. there may be four nurses in four different procedures but your patient in your procedure gets your full attention until you send them home or back to the floor. Occasional stress on busy days but much different than ccu or er stress. We work from a procedure board so you don't leave until all procedures are completed. Some days you may be out at 1630 and others not untill 7-8 or later. All in all I feel blessed to have the amazing job that i do.

We leave the decision to give vit k up to the ordering Dr. and or cardiologist. Basically we are saying this is where we need their INR to be to do the procedure. How do you want to proceed. I have not noticed much trouble regarding plavix and liver or lung biopsies but according to our interventionalist new studies have shown a high risk for hematomas if the patients have not been off plavix for three days for any type of spinal procedures such as a myelogram etc.

In our DI department we do the procedures that you mentioned above and I'd be glad to share our protocols with you. For all outpatient interventional procedures ASA is to be held for 7 days, plavix for three days. If the patient is on coumadin it is held until the INR is

I would feel much better if the HR required was 50 as it is with your card we had heard that the preferred rate was 32 and this had us a little nervous due to the fact that our 64 machine is across the street from the hospital in the MOP building. If a pt were to code we have a code cart but then you must call 911. This seems silly but it is hospital policy. One of the most frustrating things with Radiology nursing for me is that the Director of Radiology is a technologist and has no idea when it comes to nursing and what is considered safe practice. Prior to three years ago there were no nurses in DI and the techs were performing nursing skills and there was no charting. Things are much better now and we have worked very hard to create policies and procedures and documentation to protect ourselves. But as in this instance when something new comes along it is up to us to present new nursing policies. thanks fo your input.

Our Hospital just purchased a 64 CT machine and DI nurses will be responsible for administering Iv medications to decrease HR during the procedure. Does anyone have guidelines that they have been following to do this safely? Standing orders etc. Guidelines for D/C? I would appriciate any feedback to help develop policy and procedures. The cardiologist are new to this also and have not been very helpful. The Radiologist usually look to us for guidance concerning meds etc. and the only education being done so far is for the techs to run the machine.

I am a DI nurse in Florida. There are five nurses in our Radiology Dept. all of whom insert Picc lines. We use the Modified Seldinger technique. Our PICC lines are placed without a Radiologist present. The placement is confirmed by a Radiologist prior to Picc line use. We use ultrasound guidance always to place the pick and prefer fluoro to confirm placement and to correct any problems such as the picc line looping, or going to the wrong place and can be easily corrected. If the patient is in ICU we will place the Picc line at the bedside using ultrasound but a portable CXR is used to confirm placement. This is much more difficult because you do not have the real time view of flouro and if there is a problem with placement multiple CXR may be needed and any problems are corrected blindly. The Picc is usually completed but occasionally the pt may need to be taken to DI for fluoro. This also takes longer because the film has to be taken to DI for developing and then shown to the radiologist for approval. We are assisted by a specials tech 90% of the time because they are the ones who know how to work the fluoro. If done at the bedside we are assisted by a XRay tech or another DI nurse and a PCXR is called for. Our Hospital sends the DI nurses to a PICC class that is required but you recieve a certificate stating that you completed the class but not an actual certification such as a CCRN would get. I hope that this information is helpful to you.