Joint Practice Guideline for Sterile Technique during Vascular and Interventional Radiology Procedures
There is a need for current formal recommendations in the interventional radiology (IR) literature concerning the use of sterile technique during IR procedures. This is particularly important given the increasing incidence of antibiotic resistance, complications from nosocomial infection, cost of health care, and emphasis on quality of care. This document summarizes the findings from the available surgical and IR literature on this topic. There is, however, a general lack of published randomized controlled studies on this subject. This guideline represents a joint effort with our nursing colleagues from the Association of periOperative Room Nurses (AORN) and the Association for Radiologic and Imaging Nursing.
ARIN endorses the routine use of capnography for all patients who receive moderate sedation/analgesia during procedures in the imaging environment. This position is based on an extensive literature review demonstrating technical superiority and cost advantages with capnography use.
The obese patient presents specific challenges within the imaging department because of the constraints of imaging technology design, weight limits, positioning limitations; potential respiratory depression related to sedative and analgesia medications combined with cardiac and respiratory system factors unique to the obese patient; and availability of instruments of appropriate length to target the identified lesion. Screening may reveal that anesthesia may be the most appropriate level of care to maximize safe and successful outcomes.
Occasionally, contrast agents (either iodinated or gadolinium based) are indicated for an imaging study on a breastfeeding mother. The patient and the physician may be concerned about contrast media being excreted into breast milk and the contrast media exposure to the infant.
Recent news has announced the increased incidences of Zika virus cases being reported within the United States. The Association for Radiologic and Imaging Nursing encourages its members to stay well informed on the latest information and updates from the Centers for Disease Control and Prevention (CDC). Additionally, the American Nurses Association (ANA) has launched a webpage providing members the latest information and recommendations. Please visit www.nursingworld.org/zika-virus-information for more details.
Imaging nurses influence patient care in a variety of settings and nursing roles. Imaging nurses are involved in the assessment, care planning, and direct care of patients before, during, and after diagnostic and therapeutic imaging procedures. Imaging nurses promote high quality patient care in those environments.
Healthcare professionals in the medical imaging setting face unique challenges to ensure patient safety. Broad process and systems interventions are required to ensure that patient safety initiatives are carefully developed, implemented, and maintained ensuring a culture of safety (Emergency Nurses Association, 2005). The Association for Radiologic and Imaging Nursing (ARIN) is dedicated to the success of research, education, and implementation of evidence-based measures that ensure the well-being of patients receiving care and treatments in the imaging setting. In addition, the core purpose of ARIN is to foster the growth of nurses who advance the standard of care in the imaging environment.
The Imaging Registered Nurse plans, coordinates, and delivers nursing care for patients across the life span who are going to receive sedation and analgesia while undergoing a radiological procedure. The purpose of sedation and analgesia is to relieve anxiety, discomfort or pain and diminish memory of the event and to facilitate the best results. Possessing clinical knowledge, sound judgment and critical thinking skills based on scientific principles the nurse plans and implements nursing care to address physical, psychological and spiritual responses of the patient undergoing a radiological procedure. The nurse is responsible for the patient outcomes resulting from the nursing care provided during the radiological procedure.
The imaging nurse uses evidence-based practice to provide quality nursing care for patients in the imaging setting. The nurse is knowledgeable in meeting the physical, psychological, cultural, and educational needs of patients.
Vertebroplasty is a percutaneous procedure performed to treat painful vertebral compression fractures.
The Safety in America group and The Joint Commission have set forth guidelines for the safe care of patients undergoing invasive procedures. The Joint Commission’s Universal Protocol for Preventing Wrong Site, Wrong procedure, Wrong Person Surgery™ was developed to ensure that these guidelines become a part of our culture and practice.
Moderate Sedation and Analgesia medications are frequently administered by Imaging Nurses. Moderate Sedation and Analgesia is defined as a drug‐induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.
The Joint Commission (JC) has identified that ineffective communication has been the root cause for sentinel events compromising safe patient care. To that end, National Patient Safety Goal (NPSG) 2E requires a “handoff” communication when care is transferred from one clinician to another.
Studies of contrast (iodinated and gadolinium-based) in pregnancy are limited. Effects of contrast on the human embryo or fetus are unknown. It must be assumed that all contrast media cross the blood-placenta barrier into the fetus. No data are available to assess the rate of clearance of contrast agents from the amniotic fluid. It is not possible to state with certainty whether contrast agents present a risk or pose no risk to the fetus. Patients of child-bearing potential should be screened for the possibility of pregnancy.
Extravasation of contrast medium can occur during hand or power injection. Iodinated contrast media are toxic to surrounding tissues, particularly skin. Some patients will experience stinging or burning, but other patients will have little to no immediate discomfort.
Metformin is an oral antihyperglycemic agent used to treat patients with type II diabetes mellitus. The most significant adverse effect of metformin therapy is the development of metformin-associated lactic acidosis in the susceptible patient. Although the incidence of metformin-associated lactic acidosis is rare, the mortality is high: 50% of patients with metformin-associated lactic acidosis die. Therefore, metformin and drugs containing metformin should be withheld temporarily for patients undergoing radiological studies using intravenous (IV) iodinated contrast.
Barium sulfate contrast media or aqueous contrast agents may be indicated in fluoroscopic or computed tomography applications. These agents can be given by mouth, feeding tube, or enema, as indicated for the appropriate study.
Renal failure due to contrast media has been reported to be the third most common cause of in-hospital renal failure, after hypotension and surgery. Transient renal effects are seen after intravascular contrast and may be due to renal hemodynamic changes or direct tubular toxicity of the contrast media. Patients with normal renal function are at extremely low risk for contrast-associated nephrotoxicity.
Medications used in the treatment of cancer are considered hazardous to healthcare workers. The term “hazardous” describes medications that need special handling because of health risks that may result from exposure. These risks are a result of the inherent toxicities of the medications.
Patient consent is required at various times in health care delivery. Radiology procedures requiring consent include but are not limited to: 1) invasive procedures such as a biopsy, drainage and/or placement of a drainage catheter, 2) angiograms or venograms, 3) vascular access catheter placement and 4) moderate sedation for a procedure.
AORN Position Statement on Criminalization of Human Errors in the Perioperative Setting
AORN Position Statement on Creating a Patient Safety Culture
APIC Position Paper on Safe Injection, Infusion and Medication Vial Practices in Healthcare
ANSR 2010 Consensus Document