Weird incident in the MRI room..

Specialties Radiology

Published

A tech who is a type 1 diabetic accidently walked into the MRI room wearing an insulin pump.. the pump flew into the gantry...luckily the patient wasnt harmed... however the tech recieved a large bolus (over 30 units) of insulin as the pump failed (because of the MRI magnet). He later was seen by a volunteer to be confused and then he was brought to the ER for treatment....treated with IV D50 x2 and released....

There are nurses in the department who are diabetic and use insulin pumps. Unlike the tech they rarely walk into the MRI room (maybe once or twice a shift to push contrast or start an IV) The management has made this tech (mentioned above) leave his insulin pump locked up in a locker and insist he do manual injections of insulin.... policy is being discussed as to what to do with the other staff members who use an insulin pump.... this is insane.:idea:.. does anyone see anything wrong with that? :down:

In my oppinion anyone can make a mistake and walk into the room with say a CELL phone... I've never heard management mandating a persons treatment of their disease to fit institutional policies. Any comments? Discuss......

This is a very 'sticky-wicket' from the practical standpoint. I agree that telling the tech that (s)he is forbidden from using their portable pump is a bad decision for anyone to make, particularly a healthcare provider, but I would be even more determined to prevent anyone carrying ferrous material, even as a part of their job... such as a tool belt, to circulate within the MRI suite without appropriate protections.

Given the typical workloads and throughput pressures common to most MRI facilities, it borders on fantasy to think that techs would be willing to both turn away from patient care at the same time several times per day for one to repeatedly screen the other. Current technology and best practices, however, might provide a solution that would also enhance the safety of ALL persons entering the MRI scanner room.

The 2007 ACR Guidance Document and the recent Joint Commission Sentinel Event both suggest the use of ferromagnetic detection (FMD) devices as an adjunct to conventional screening. This diabetic tech's pump, if it is ferromagnetic enough to go flying into the bore, is likely ferromagnetic enough to light up a ferromagnetic detector like a Christmas tree. While most facilities might be reluctant to take such steps for an issue raised by one tech, if the FMD was positioned in the path of everyone entering the MRI suite, it could provide redundant screening for everyone, not just the one tech.

I served on the ACR's MR Safety Committee and am a contributing author to the Guidance Document. While today I work for a company that manufactures FMD (full disclosure), the proposal to include the recommendation for the use of FMD screening in the Guidance Document was that of Dr. Emanuel Kanal, noted guru of MRI safety issues.

I'd hate to see a trained and talented technologist be forced to choose between the career that they've chosen and effective management of their health, particularly when there are options out there that might allow both options to coexist and provide safety benefits to everyone else in the MRI suite, too.

Tobias Gilk

I have run into a similar situation and had some questions for Kevin. How could I get him my questions?

Specializes in PNP, CDE, Integrative Pain Management.

Absolutely this tech cannot be required by an employer to revert to injections! Contact the American Diabetes Association for details regarding discrimination against persons with diabetes.

Specializes in Home Health, Outpatient Med, Radiology.

I can see why the facility is concerned. There have been innocent mistakes with metal in MRI rooms which have killed patients. MRI techs, for the most part, are very diligent at making sure no "metal" accidents occur but there is always that time when they may be in a hurry or have an emergency patient that needs to be attended to. Although I don't agree with the facility forcing the tech to take insulin injections the facility always has a defense when it comes to patient safety. If another incident like this were to occur that resulted in injury, everyone would be wondering why the facility did not take action to correct the possibility of patient injury. The facility may not have "forced" the tech to take injections but may reassign him to xray or possibly CT if he is qualified if he doesn't take injections.

Specializes in ER, OR, ICU, PACU, POCU, QA, DC Planning.

I sure wouldn't want to be working in that kind of situation! It's great that a specialty has been learned, but aren't there limits somewhere? Should my patient's and my safety be pitted against someone else's common sense? I'm sorry that there has to be limits, but there must be limits on what is allowed. So many times my tech has run into the room because the patient is beginning to vomit, or moving uncontrollably...just a few steps ahead of me. Many times that help, that second pair of hands, is needed right then, not in a few minutes. Time for a reality check by everyone concerned.

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