vandebar

JCAHO has a new band wagon where they are concerned with COMMUNICATION involving patients transferring from point A to point B. The primary nurse should give the RAD RN a report on the patient prior to the transfer. This report can be given to the RT if this is a stable patient that does not require nursing interventions. The techs connect O2 and transfer all the time. They do call backs for exams and the nurse is not on call for a routine CT chest r/o PE. If this is stat and the patient is compromised, the RAD nurse if available needs to receive report or the ER nurse or CCU nurse or primary must accompany the patient. When the exam is complete, the RN must report back to the primary any special considerations. We usually document in the progress note that CT or whatever the exam was completed and note the total amount of contrast given or any meds given in radiology.

Patients having a coronary CTA either inpatient or outpatient may receive up to 5 doses of metoprolol to bring the HR down or below 60. Our policy is 5mg IVP over 2 minutes. The patient is monitored for 5 minutes and the 2nd dose is given if indicated. Monitoring again for 5 minutes and then repeated for a total dose of 25 mg IVP. There has been occasions when the cardiologist ups this to 6 or 7 doses. (Our standing order is for 5). There are also times when the cardiolgist may switch to diltiazem after exhausting the betablocker. This will usually not exceed 2 doses of 10 mg each. I felt the same way when I started in CTA & felt like this was a LOT. It is very well tolerated and I have had no adverse sxs with any patient receiving the betablockers or calc channel blockers.

Our patients identified with a contrast allergy during the phone triage process get tagged for a plan of care for contrast allergies and standing orders are followed. This includes prednisone 60mg po the night prior to the procedure and repeated the morning of the procedure. Also benadryl 25 mg po the night before the procedure and 25mg po benadryl repeated one hour prior to the procedure. Please note that this is a cardiologist standing order. These patients will receive on arrival Solumedrol 125mg IVP prior to the procedure. Any patient having any kind of reaction to iodine, (including seafood) will be given the above order by the cardiologist. NOW whats INTERESTING is that our radiologist use a completely different standing order which is the prednisone 13 - 7 - 1 hour prior to procedure, an H2 blocker. Any patient having a rash or hives would receive that order. For our radiologist, patients who experienced a reaction that included SOB, swelling, edema, bronchospasm...etc... then the 13-7-1 PLUS H2 blocker, plus an IV steroid. The oral prep is called into the patients pharmacy by the triage nurse. A standing order is flagged in the chart for the radiology nurse.

Debbie, It is standard protocol to hold any medication containing Metformin for 24 hours prior to a procedure requiring IV or IT iodine contrast media. The medication should be held also the day of the procedure and for an additional 48 hours post procedure. These patients should be given an order for a bun/creatinine lab to be drawn 48 hours post exam. In some facilities, the lab work is reviewed prior to the patient restarting their medication. There are a total of 19 medications containing metformin which I have listed for your reference. Any of these medications can cause a drug-drug interaction with the contrast media. Glucophage, Metformin, Glucophage XR, Avandamet, Glucovance, Actoplus Met, Glumetza, Riomet, Metaglip, Fortamet, Glucovan, Alti-Metformin, Apo-Metformin,Glycon, Novo-Metformin, Nu-Metformin, PMS-Metformin, Rhoxalmetformin FC, and Rho-Metformin Good Luck, Vanita DeBar