Transcript MAGNETIC RESONANCE IMAGING - MTMI Continuing Education …

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ETHICAL & LEGAL PRINCIPLES
PATIENT’S BILL OF RIGHTS
Every human being of adult years and sound mind has a
right to determine what shall be done with his/her own body.
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Privacy- Patient has the right to receive notice of privacy
practices.
Extend of Care- A patient has the right to consent to or refuse
treatment (e.g. DNR)
Access Information- A patient has the right to review his medical
records
Living will- These documents express a patient’s choices about
his future care.
Research participation- The patient has the right to consent or
decline to take part in research.
ETHICAL & LEGAL PRINCIPLES
LEGAL ASPECTS OF RADIOLOGY
1.
Who is authorized to order an examination?
MD,DO,PA,ARNP with valid credentials. No
Medical Students,Residents,Fellows or Nurses can
order an examination.
ETHICAL & LEGAL ASPECTS
REQUEST FORM
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The patient’s name to be examine
The exact region to be image (Knee, Liver)
The patient’s diagnosis
The ordering physician (MD)
The date of requisition
ETHICAL & LEGAL PRINCIPLES
INFORMED CONSENT (WRITTEN OR VERBAL)
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The patient has a right to information
A written consent is required for any procedure that
involves substantial risk
Consent forms may be signed by the legal guardian in
the case of minors or incompetent patients
The patient maintains the right to refuse an
examination (At any time during the exam)
• Expressed Consent – Involves obtaining a patient’s
permission to performed the procedure (can be given
orally)
• Informed Consent – Is done for invasive procedure and
includes the risk, benefits and alternative .They are clearly
explained in a language patient fully understand.
• Patient or Legal Guardian (Alert & Oriented x 3) must sign the
informed consent for an invasive procedure
• For Minors ,Parents or Legal Guardian must sign the informed
consent.
• Implied Consent – Occurs when the patient is in need of
immediate medical services ,but is unconscious or unable
to consent for treatment. Services are rendered with the
assumption that the patient would consent if able.
ETHICAL & LEGAL PRINCIPLES
CONFIDENTIALITY(HIPAA)
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HIPAA- Means Health Insurance Portability and
Accountability Act
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Health care provider must provide for the privacy and security of
patient information in any forms (verbal, written, or electronic).
ETHICAL & LEGAL PRINCIPLES
PROFESSIONAL LIABILITY
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ASSAULT- The threat of touching in an injurious way.
BATTERY- An unlawful touching of a person without
consent.
FALSE IMPRISONMENT- An unjustifiable detention of
a person against his/her will.
INVASION OF PRIVACY- When the confidentiality of a
patient information is not maintained.
NEGLIGENCE- The neglect or omission of reasonable
care and caution.
ETHICAL & LEGAL PRINCIPLES
PATIENT IDENTIFICATION
The Technologist has the responsibility for proper
patient identification.
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Wrist band
Questioning patient (Name & date of birth)
INTERPERSONAL COMMUNICATION
COMMUNICATION WITH PATIENT
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Review of patient history
Explanation of current procedure
Empathy, sensitivity to the needs of the patient
Assertiveness, most productive when working with a
reluctant patient.
INTERPERSONAL COMMUNICATION
EQUIPMENT
All MRI Equipment Inside the MRI Suite must be MR
Safe
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IV’S- Check frequently, maintain solution bottle/bag 1820” above the level of the vein.
MONITORS- Check frequently, plug in units.
URINARY CATHETERS,CHEST TUBES- Must be kept
from superimposition and allowed to maintain
operation ( check to see MRI compability ).
INFECTION CONTROL
TERMINOLOGY
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4.
Cleanliness- Avoid transmitting organism by using proper
cleaning, dusting, and hand washing techniques.
Disinfectants (Germicides)- Refers to the used of hand
washing to kill microorganism.
Medical Asepsis- Refers to destruction of bacteria through
the use of disinfectant/antiseptics.
Sterilization (Surgical Asepsis)- The third level of medical
asepsis, involves treating items with heat, gas, or chemicals
to make them germ free. Destroyed all microorganism and
their spores.
INFECTION CONTROL
ASEPTIC TECHNIQUES
Cleanliness- Is our only defense against infection.
Hand Washing- Should be performed after every
patient, hand washing should last 20 seconds.
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Alcohol Based is approved by Joint Commission
Patient Prepping- Betadine destroy microorganism,
Alcohol prevents the growth of microorganism.
• Medical Asepsis – Microorganism are eliminated through
soap, water, or alcohol based products.
• Reduces the number or spread of microorganism
• Surgical Asepsis – Microorganism and their pores have
been destroyed by heat, or chemical process.
• Sterile Technique – Only the front and above the waist is
considered sterile area.
PATIENT MONITORING
VITAL SIGNS
Blood Pressure
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Systolic range- Represents the pressure created during
contraction of the left ventricle (110-140 Normal)
Diastolic range- Represent the pressure within the vascular
system with the heart at rest (60-80 Normal)
Temperature
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Oral 98.6, Rectal 99.6, Axillary 97.6
Respiration
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Adults 12-20 per minutes, Children 30-50 per minutes
Pulse
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Normal Range- 70-80 beats/minute for adults, 90-120 for
infants/children.
CONTRAST MEDIA
INDICATIONS & CONTRAINDICATIONS
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The best predictor of possible reaction to contrast media
is a history of a previous reaction.
About 5% of patient experience some reaction; of this
population only 5% experience a severe or lifethreatening reaction (5% Rule)
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Idiosyncratic Reactions
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Adverse Reaction - Can be caused by anything other than contrast.It
happens with the release of Histatmine due to injection, anxiety.
Histamine- Can cause muscle constraction,accelarated heart
rate,lower blood pressure,localized edema.
Pre-Meds for allergy are anti-histamine(Benadryl) and Steroids(Medrol)
Use for those at risk of reactions
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90% of reactions are associated with the release of
histamine
 Prednisone is used to reduce the release of histamine (high osmality
contrast stimulates release of histamine).
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Breakthrough reactions
 Most likely similar to initial ,however there is a chance it could be more
severe.
No Premedication could replace state of being ready to treat a reaction
SIGNED INFORMED CONSENT
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Allergies
Pregnancy
Kidney Functions
SELECTION OF VEINS
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Anticubital Veins (Best)
TYPE & SIZE OF NEEDLE
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18/20 Angiocatheter Gauge for MRA
,Perfusion, Dynamic Studies
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Always wear gloves.
Follow OSHA standard precaution and
dispose of all materials.
Place needle and syringe in sharp
containers (DO NOT RECAP
NEEDLES).
Use new needle, and site for second
attempt.
Document injection and all
complication. Also time and amount of
contrast injected
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Wash hands and put on gloves.
Select site and apply tourniquet.
Confirm puncture site and cleanse(Surgical
Asepsis.
Initiate puncture (35-45 degrees angle).
Secure needle and confirm access (drawback
blood)
Flush line and confirm no pain or extravasation.
Proceed with injection.
CONTRAST MEDIA
INTRAVENOUS INJECTION
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IV drugs are injected directly into the circulatory system,
reaction can be instantaneous.
Technologist must not leave the patient receiving a contrast
agent alone.
Patient pulse rate and blood pressure should be taken before
and after exam (Depending on the Hospital Policy).
If patient experiences any changes in their vital signs contact
physician immediately.
Is used to improve the sensitivity and specificity of clinical
diagnoses.
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Reactions to IV Contrast Agents
Higher injection rates,larger total volume are all associated with
increase of adverse reactions
Minor
Moderate
Severe
Nausea
Hives
Anaphalaxys
Vomiting
Wheezing
Cardiac Arrest
Headaches
Bronchospasm
Respiratory
Arrest
Itching
Facial Edema
• Moderate reactions may require treatment and close observation
• Severe reactions are rare ,but are required immediate attention.
CONTRAST MEDIA
ADVERSE REACTIONS
Assessment of Patient :
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How do they look,sound(voice),breathing ?
If needed , stop exam immediately and remove patient from Zone 4
Call for Help
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Code or Radiologist/MD (Follow your Hospital Policy)
Vital Signs: Get Baseline
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Heart Rate – Less than 40 bpm or greater than 130 bpm (except Pedi)
Systolic Pressure – Less than 90
Respiration Rate – Less than 8 per minute
Oxygen Saturation – Less than 90
CONTRAST MEDIA
ADVERSE REACTIONS
Mild Reaction- Nausea and vomiting, Hives, Itching, Sneezing.
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Monitor and comfort patient (Document reaction).
Moderate Reaction- Excessive hives, tachycardia, excessive
vomiting.
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Call for medical assistance, monitor & comfort patient (Document
reaction)
Severe Reaction (Anaphylactic)- Very low blood pressure,
cardiac or respiratory arrest, convulsion, cyanosis.
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Call for immediate assistance, prepare for CPR, prepare for antihistamine
(EPINEPHRINE).
MEDICATIONS:
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Benadryl (Diphenhydramine)– Relieve allergic
symptoms,can be given IV or PO.
Epinephrine - Use for management of severe allergic
reaction,can be given IM (Epi Pen) or IV(MD).
Atropine Sulfate– Is use to increase heart rate (IV)
Albuterol (Inhalers) – Is a bronchodilator, increases air flow
to the lungs
Nitroglycerin – Use for chest pain , blood vessel dilator,
increases blood flow.
MEDICATIONS:
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Dextrose 5% - Is injected into a vein through an IV to
replace lost fluids(helps increase BP) and provide
carbohydrates to the body.
Nifedipine – Is a type of calcium blockers,is use to decrease
blood pressure.
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Cardiac Arrest
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Seizure
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Can cause a patient to demonstrate convulsive moments or period
of unconsciousness
Stroke
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CPR should be started on any patient demonstrating cardiac failure
Lack of blood flow to the brain. Could result in inability to speak,
facial numbness,limb paralysis.
Shock
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Can result due to blood loss(trauma) or massive vasodilation can
occur due to allergy to iodine contrast
CONTRAST MEDIA
LOCAL ADVERSE REACTIONS
Extravasations- Escape contrast media into the interstitial
tissues at the site of injection
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Symptoms-Pain, swelling and redness. Care by applying
warm/cold compress and elevating the effecting extremity.
Most common experience is pain, swelling or tightness/burning at the
site
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Most Extravasation are limited to adjacent soft
tissue(skin).Usually no permanent damage (Less than 100ml)
 All extravasation should have a close clinical follow.
 Always have a Radiologist examine patient and provide discharge
instruction
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Compartment Syndrome – Is a severe injury from large amount
of extravasation. Causing result of mechanical compression.
 Do not inject more than 20 ml saline flush with power injector.
TREATMENTS
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Elevation of affected extremity
 Keeping the extremity above the level of the Heart, decrease capillary
pressure and promotes reabsorption of extravasated fluids.
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Apply Cold or Warm compresses
 No evidence of favoring warm versus cold compress.
 Cold help relieved pain at the site
 Warm/Heat helps improving absorption of extravasation, improving blood flow.
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Surgical Consultation
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For severe extravasation.
Progressive swelling or pain
Altered tissue perfusion,blistered,and/or ulcer skin
Increase Patient Risk
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Patient who cannot communicate (Elderly/Pediatrics)
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Hand,Wrist,Foot and Ankle are more likely site for extravasation
IV longer than 24 hours and multiple punctures in the same vein ,also increase risk
for extravasation.
Need to be medically necessary and approved by ordering physician and OB-GYN
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Contrast on Pregnancy – Placenta transfer contrast (Gad) to Fetal
Circulation.
Lactation– Recommended 24 – 48 hours after contrast injection,
babies not to be fed.
 Excreted milk has shown very low levels of Iodine.
Pregnancy Test is required for Child Bearing age female
patients
CONTRAST MEDIA
LONG TERM EFFECTS
Nephrogenic Systemic Fibrosis (NSF)- Mostly seen in
patient with decrease renal function. It causes fibrosis
over tissues, including joints,lungs,kidney,diaphragm.
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Symptoms-Swelling ,tighness,and redness of the skin. Patient
must contact Referring physician if seen are seem.
• Chloral Hydrate– Is a sedative, is used in the short-term
treatment of insomnia(oral).Usually given for pediatric cases
in CT.
• Versed - Belongs to a class of drugs called
benzodiazepines.Is given intravenous and has a short term
effect.
• Morphine– Is a narcotic used for severe pain
• Valium – Is used as an anti-anxiety medication
Joint Commission (JC) – Accredits and certifies more
than 20,500 health care organizations and programs in
the United States.
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Every Three Years
Improve Patient Safety
Improve Health Care Quality
MRI SAFETY
MRI Safety Officer- Every department needs an MRI
Safety Officer.
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Recommended a dedicated MRI Safety Committee
Yearly In-Service/Training for entire Hospital Staff
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MRI Zones must be label throughout the department
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Dedicated In-Service for MRI Technologist
Meet Yearly with local Fire Department & Police Department
Restrict access to Zone III, Only MR Personnel Level 2 Zone IV
5 Gauss Line ,must be marked/visible on the room/floor.
MRI SAFETY(Cont…)
MRI Safety Officer- Every department needs an MRI
Safety Officer.
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Patient Identifiers(Two) ,name and date of birth or MR#
MRI Screening forms to anyone entering the MRI Suite
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Have two different MRI Personnel review the forms
All Equipment must be mark for MRI Safety within the department.
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Stickers with MR Safe or UnSafe
Fire Estiguisher,Wheelchairs,Stretchers,IV Pole,Vital Sign Machine
Hand Held Magnet (Exclusion Criteria Equipment)
INFECTION CONTROL
Hand Washing- Needs to be followed per guidelines
below.
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Before touching patients
After touching patient
After touching patient room equipment
After exposure to body fluids
After removal of gloves
Soap & Water is required if exposure to body fluids(Blood).
Alcohol Gel can be used if no soap & water available.(Unless Body
Fluid Exposure)
INFECTION CONTROL
Infection Control Policy - Dedicated policy for MRI
Department.
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Cleaning Pads and Coils after each use
Have PPE ready in every room.
Cleaning MRI Safety Equipment routinely(even if not used)
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Using correct cleaning solution for infection control
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MR Vital Signs, Anesthesia Machine,etc
Requires two minutes(wet) to destroy microorganism
Check for specific brand for your Hospital
Have sticker for date and check expiration dates
Inspect Pads routinely, replaced if needed
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MRSA can grow in old/tear pads
Hospital Policies & Procedures
Policies – Everyone should know where to locate
Hospital and Departmental specific policies.
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Chemical Spills & Material Safety Data Sheet (MSDS)
Code Red(FIRE)
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MRI Safe Fire Extinguishers
Pull Station & Fire Exits
Fire Evacuation Routes must be posted throughout the department.
Hallways should be clear by at least 36 inches
Informed Consent Forms.
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Sedation (Claustrophobia) needs to provide patient/family with a
copy.
MR Conditional (Programmable Shunts,DBS,Pacemarker,etc)
“Time Out” for Invasive Procedures (Biopsies,Wire Placement)
Hospital Policies & Procedures
Policies – Everyone should know where to locate
Hospital and Departmental specific policy.
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Emergencies or Code Blue/Cardiac Arrest
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Know the Policy & Who to contact
Know your ABCD
Never performed in Zone IV
Mock Code should be performed every quarter with entire staff.
Maintained Log/Inventory for AED,Refrigarator,Contrast
Warmer,Eye Wash Station.
Do not store anything in carton boxes
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Nothing under sinks
MEDICINE
MEDICINES – All medicines need to be store and locked.
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Do monthly checks for expired medication
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Check biopsy supplies monthly for expiration
Keep a log
All medications should be label ,including contrast
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Power Injector, label syringes with contrast and saline
Label needs to include medicine,dose,time,date,and initials
PRIVACY
HIPPA – Privacy must be maintained by all Hospital
Personnel
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Employees should only have access to information needed.
No cameras in Private Patient areas
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Changing rooms, Bathrooms
Patient Chart should have a cover/folder(No papers).
All computers Screen must be close when not in used.
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Always log off medical records,PACS,RIS.
All CPU must have a privacy protector screen.