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To lamazeteacher - there is obviously a variety of approaches. I certainly have had patients with contrast allergies who do just fine with only a prednisone prep (the man I'm thinking of has had two fistulograms in the last six weeks). It is up to the ordering physician to order the prep as well, but the techs in our department usually call the nurse if they have a patient with an allergy, even if the patient has been prepped. I don't know if there is any standard prep for contrast allergies. This now gives me something new to learn! (I love my job!)

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.

I don't think you would ever see a pathologist from my institution come to pick up a specimen. I certainly don't think it's necessary. The specimen and the requisition are both labelled - we make sure of this, and that they match, otherwise the speicimen will be rejected. If a specimen is time-sensitive, then we have to take measures to ensure that the specimen arrives at its destination in a timely fashion. I don't believe our pathologists ever leave their labs. Do you think your pathologist is going overboard, or why do you ask?

Thanks, dianah - these are all good points. I will try to find out what other centres do about follow-up, then go from there.

Hello, all. I have a question: One of our radiologists was asking me the other day about how to create a position in our department. He needs someone to do follow-up on our big procedures - embolizations, carotid stents, UFI's. Does anyone work in a place where such a position exists? I know what he wants, but I'm not quite sure how to start. He is looking at probably two days per week, and definitely a nursing position. Thanks for your input.

I have another question. How long are patients monitored after the metoprolol? And what is the half-life/peak effect of IV metoprolol? I always feel like I'm letting these patients go too soon. Maybe it's just lack of familiarity. . . Thanks.

Hi, jfelicia71. We have just fairly recently started doing cardiac CTA's. Our guy will use up to probably 20 mg of metoprolol - he says he has never had to use more. But it is in 1 mg increments, rather than 5 mg increments. He is more likely to use only 5 - 10 mg of metoprolol. I have heard of other centres using higher doses - up to 50 mg. It will be good to get some cases under our belts, so we can see what works, and how fast, and beyond what dose there's really no point in adding more. . .

Yes, having that anaesthetist there does lighten the load a little, doesn't it?:)

At our hospital, a TIPS may be done on an emergent basis for a gi bleed. All of our TIPS' are done under general anaesthesia, so the patient goes to PACU after, then back to their ward.

We use a sterile occlusive dressing even for those short-term IV's. It's not that hard to take the dressing off.