DIMPSRN

I understand the issue about the documentation of Lexiscan with the one minute increments on your sheet. Our sheet only has the lines for the minutes and we write the times in ourselves. We document Supine HR, BP and Pain Level (0-10) [Joint Commission NPSG] on our sheet; then the nurse injects the Lexiscan, the NucMed tech injects the isotope, and the treadmill tech will run an EKG so that there is a HR for documentation during the test. Rarely can the tech get a blood pressure done during that time. The test is put into the recovery stage and there is a BP and another EKG performed giving a HR post procedure. [We document the pain level again for Joint Commission.] This is all we document on tests without any type of complications. Perhaps you can draw a dash through the times you do not use. Does this make sense?

We have been using Lexiscan, a second generation Adenosine medication, since November and are delighted with it and its ease of administration. We have just about done away with all Adenosine and Dobutamine infusions. There is that doctor or two who will insist on Dobutamine, but that is rare. We have never done a walking Dobutamine! I would question the safety of that. We have done walking Adenosine tests to lessen the side effects and to improve image quality. I had the privilige of going to a presentation by Dr. Maharian who did some of the trials and he stated that walking Lexiscans do promote better images. Our Astellas rep is wonderful and supportive; she has been there to hold our hand if we needed it, and is actually planning a follow up with us. There are so many benefits to the Lexiscan and one being that if the patient is a stress DIMPS and cannot get his heart rate up and is ready to call it quits, he can be injected with Lexiscan then the isotope and the test will be a valid one. There is a bit of a question about how fast to bolus the medication. PI says over 10 seconds, but we inject over 20-30 seconds to reduce any side effects. I have heard that it caused bowel incontinence and I did have one patient who complained about a sudden urge, but he made it to the bathroom with no problem or radioactive poop. The greatest complaint we have had is headache and nausea. Aminophylline can be given to attentuate protracted sysmptoms, but we have our patients drink coffee or cola right after the test. One patient required Zofran for nausea. I am not sure about the asthma question. I know that we have used it safely for COPD patients, but we have not faced the dilemma of actively wheezing asthmatic patients. I would certainly have the mid-level or cardiologist evaluate the patient. As far as scope of practice goes, Nuclear Medicine techs can and in some doctors' offices administer the Adenosine, Dobutamine and Lexiscan, but nurses cannot inject an isotope. We will always have a PA or NP with us when we stress the patients, the MDs (aka cardiologists will sometimes leave and wander around running two or more tests) We do have some of the doctors stay with us in a patient who may be a higher risk to develop complications. We all joke and say that we cannot imagine life before Lexiscan! (Adenosine and Persantine are so 20th Century!) If your stress lab is thinking about trying Lexiscan, I would urge you to contact Astellas and give it a try.

In our Cardiology department we have nurses administer dobutamine and adenosine while there is a PA or cardiologist present. We are having an inservice on Lexiscan on 11/12 and then will start using it. I will have to write a policy on its administration. Does anyone have a policy written already. My concerns still are those patients with COPD/asthma. Anyone have any bad experiences with those patients?