Radiology Nurse Question

Editorial Team / Admin · May 2, 2003

Hi nograd. I can TRY to answer you, and I say try because the Radiology Nurse's duties vary from facility to facility. Mainly, we take care of the patients!

We sedate (mild to moderate) and monitor pts for diagnostic and interventional procedures (angiograms, TIPS procedures, biopsies, placement of drains in abscesses, placement of percutaneous nephrostomy tubes, placement of tunneled dialysis catheters, interventional radiology procedures: thrombolysis of AV grafts/fistulae, embolization of AVMs (arteriovenous malformations), chemoembolizations of hepatomas, vertebroplasties, . . .), "working up" the patient beforehand (making sure there are no surprises before or during the procedure, e.g., checking that the patient to receive an angiogram has normal BUN and creatinine, platelets and a fairly normal CBC, as well as NOT being allergic to the iodine contrast, and also making sure that if the patient is diabetic and taking metformin, the patient has withheld the dose for the appropriate time before and after the angio), doing patient teaching about the procedure and post teaching afterwords; Setting up for the procedure and circulating during it (gotta know the pattern of how the procedure should go, anticipate the Radiologist's needs with supplies). Some nurses start all the out-pt IVs for CT scans (we had two scanners and doing one exam every 20-30 min, could start as many as 20-40 IVs per day, not to mention the nurse monitors each patient receiving the contrast for allergic reactions: recognize, treat quickly, do pt. teaching post), which may include doing post-exam teaching for hydration and watching for delayed s/sx of allergic reaction. Some do post-procedure recovery in a special area. Usually, though, in the dept, nurse-to-patient ratio is 1:1.

Some Radiology nurses assist with Persantine-Thallium Stress Tests in Nuclear Medicine. Some sedate or provide oral meds for anxiolysis for claustrophobic pts who need an MRI.

You use a lot of assessment skills, critical thinking, COMMUNICATION SKILLS, and what I like to think of as creative thinking skills :).

As I said at the beginning, the duties vary from place to place. Some institutions may have things set up so the nurse helps with a narrower range of procedures, but does more follow-up and case management-type duties.

Hope this helps. You may PM me if you have any more questions, I'll be around this weekend and usually check in at least twice a day. Good luck! -- D

nograd · May 4, 2003

Dianah,

I just wanted to get back to you and thank you for responding with such thorough information so fast!!!

Like I said in the first post the nurses I met with were very nice and tried to provide me with some info, however, it was too basic, not exactly what I needed...So you have helped me enormously!!! I had a basic understanding, now I realize what a huge responsibiltiy that RAD RNs have and how it can be difficult to be in 20 different places all at the same time...So KUDOS to you and your profession.

Anyways, I have to finish that paper, and I just wanted to get back to you and say:

Thanks, I really couldn't have done it without you!!!

Nicole

Editorial Team / Admin · May 5, 2003

Glad it helped, good luck with your paper!! -- D

2banurse · May 11, 2003

Hi dianah, I too, would like to thank you. I've always been interested in radiology, and should I be accepted into the ADN program, this is the route I wish to go. Thank you for giving a clearer view of what a Radiology RN would do.

Kris

Editorial Team / Admin · May 11, 2003

Good luck to you, Kris (as they say, hang in there!) -- D

smittybike · Sep 29, 2003

Dinah,

I am a cath lab nurse transitioning into radilogy, I've worked in IR for 3 1/2 years, and now I am assisting in CT, ultrasound, xray. nuc med. I don't have much to go on as far as policy and procedure, documentation of my time etc. Any resources you could recommend would be great!

gbuchman · Apr 23, 2004

Dear Deanah:

My name is Galina and I am psychiatric nurse in NY state. I just read your reply about scope of practice for radiology nurse and really impressed by it. I am trying to be involved in politics and support nurses all ower the country. Recently I read New York State AFL-CIO opose memo to Bill A-1524-B to allow radiation technitians to administer IV drugs. Personally I think its wrong, the radiation technicians are not educated and trained for this procedure. What possible intended and unintended impact on cost, quality and access of health care this Bill will have if passed? I just would like to hear an oppinion of radiology nurse.

Thank you .

Galina

Editorial Team / Admin · Apr 24, 2004

Hmmm, weighty issue, Galina. Does the bill specify WHICH medications the Techs would be allowed to give, and under what conditions?

For years the techs started IVs, then it was TABOO for them to. Then, in response, I think, to the needs of small free-standing imaging centers (who needed to image pts but didn't have access to RNs, and only had an on-site Radiologist reading images), the view softened. Guidelines were modified and a pathway created for them to start the IVs AND administer contrast media, under the wing of the attending Radiologist (in case of allergic reactions). Each facility had to develop their own p/p, though: tech must take an IV class and perform so many IV starts (perhaps with both butterfly and abbocath-type IV), for example. Then after completing the requirements, tech was "certified" to start the IVs. Some facilities also outlined which vessels the tech was limited to use (no lower extremity vessels, for example).

Nuclear Medicine technologists already inject the IV isotopes needed for their imaging (they have special permission - at least, in California, and perhaps in other states as well). The isotopes, however, do not subject the patient to the risk of allergic reactions.

So, I'd like to know which "drugs" are being considered for the techs to inject, and under what clearly defined circumstances (and what is the background of this?)?

Thanks. --- D

gbuchman · Apr 24, 2004

Dear Deanah:

Thank you for your reply. That is true that radiology technicians have been starting IV for a long time now. NY state radiology technicians are not allowed to inject contrast media without supervision of the physician (intravascular). If this bill will pass they can do it without supervisoin. You are working as radiology nurse and know better then I am what kind of complications to expect. What if this is small free-standing imaging center and patient develops complication and there is no physitian or RN available?

From what I read, Radiology technicians trained more to work with humans under supervision of physician and their training and job description has more to do with imaging procedure.

Thanks Buchman :)

Editorial Team / Admin · Apr 24, 2004

With the new nonionic, low and iso-osmolar contrast agents, there is a MUCH lower incidence of complications. However, I have still seen pts go into flash pulmonary edema with a nonionic, low osmolar contrast injection. Anaphylaxis is rare but it is still a real possibility. Most common reactions are facial/upper body hives and itching; somtimes facial edema. That's only anecdotal, but can be substantiated by doing a search for articles/literature re: allergic-type reactions to the contrast.

From what I understand, most free-standing centers call 911 if they have a problem.

I have known and worked with techs who have the wits, the knowledge, the experience and the discernment to be able to recognize and accurately treat any emergency or event that may arise in, say, CT. It is not a question of ability, that nurses possess some innate sense of what to do that no one else may acquire. Rather, it is the crossing from the area of helping the Radiologist ("under the physician") to that of practicing medicine themselves. We RNs never pushed contrast without a Radiologist in the department, even with a full code team ready in the facility. It is my opinion that techs, if allowed to push the contrast without an RN, must still operate with a Radiologist in the department. This is a liability and safety issue.

As for any other meds, I think the safest way to go would be to have an RN or a Radiologist push them.

Was this legislation change in the works for just your state (NY) or a nation-wide push?

Editorial Team / Admin · Apr 24, 2004

With the new nonionic, low and iso-osmolar contrast agents, there is a MUCH lower incidence of complications. However, I have still seen pts go into flash pulmonary edema with a nonionic, low osmolar contrast injection. Anaphylaxis is rare but it is still a real possibility. Most common reactions are facial/upper body hives and itching; somtimes facial edema. That's only anecdotal, but can be substantiated by doing a search for articles/literature re: allergic-type reactions to the contrast.

From what I understand, most free-standing centers call 911 if they have a problem.

I have known and worked with techs who have the wits, the knowledge, the experience and the discernment to be able to recognize and accurately treat any emergency or event that may arise in, say, CT. It is not a question of ability, that nurses possess some innate sense of what to do that no one else may acquire. Rather, it is the crossing from the area of helping the Radiologist ("under the physician") to that of practicing medicine themselves. We RNs never pushed contrast without a Radiologist in the department, even with a full code team ready in the facility. It is my opinion that techs, if allowed to push the contrast without an RN, must still operate with a Radiologist in the department. This is a liability and safety issue.

As for any other meds, I think the safest way to go would be to have an RN or a Radiologist push them.

Was this legislation change in the works for just your state (NY) or a nation-wide push?