THE RADIOLOGY DEPARTMENT is one place where RNs can reap important professional rewards. It’s not an easy job – advances in medical technology and higher levels of care for an increasingly sicker patient population are literally changing the face of imaging departments.
But that also means radiology nurses are in greater demand than ever. Hospital patients undergoing special interventional procedures in medical imaging departments need a positive atmosphere and a thorough explanation of the procedure – and much of that falls to radiology RNs. If patients are well-informed, they’re likely to need less sedation and also to have less anxiety and fewer postprocedural complications.
Indeed, the radiology RN is a key player in peripheral angiography and works in concert with the technologist and the radiologist or cardiologist to ensure positive outcomes.
Not for the Faint of Heart
Radiology RNs must possess strong critical care skills, exhibit sound judgment, and be willing to serve as patient advocates. They don’t have the same “assignment” during their shift as happens in floor nursing. They go from one patient to another throughout the day, assessing and monitoring, documenting, providing education, and intervening in crises. Besides providing the standard of care and improving quality of care, radiology nurses also have considerable influence over decisions made in their departments.
Nurses identify potential problems that sometimes result in delay or cancellation of a procedure. They can also question the necessity of already established procedures and collaborate with radiologists and other physicians to ensure successful outcomes. Radiology nurses usually work alone or together with another RN, but must be able to think and act on their own.
They must also be physically fit and prepared for the demands placed on them throughout the day – for example, radiology nurses spend most of their time walking, standing, or wearing 10-pound lead aprons for certain procedures.
Radiology nursing is patient-focused. RNs may only spend a few moments each day with a patient, yet must maintain excellence in care throughout the imaging department. On some days, they may have only one or two procedures scheduled, but the sheer unpredictability of their shift may result in assessing many more patients, starting IVs, running a Code Blue, or just helping out wherever they’re needed.
Radiology nurses’ people skills must be in tip-top shape, too, to educate patients and their families and meet special needs. RNs also serve as liaisons between departments to alleviate conflicts of interest and increased tension and ensure patient safety.
Radiology encompasses many diagnostic imaging procedures, including ultrasound, nuclear medicine, computed tomography, magnetic resonance, and x-ray. Nurses must be ready to go from one modality to the other at any time. They’re always learning something new and interesting, and their day is rarely boring.
Common interventional technologies used in the radiology department also include myelograms, arteriograms, and venograms.
Staying on Point
Radiology nurses must comply with the philosophy and objectives of their medical imaging department. They should also be fully versed in the department’s policies and procedures and should participate in staff meetings and continuing education.
Patients undergoing invasive procedures need a complete preprocedure physical and psychological assessment. Documentation of patient care occurs throughout patients’ stay.
Much is riding on radiology nurses’ competence. They must always think ahead to maintain patient safety, identify potential problems, and anticipate patients’ needs. A radiology nurse is an integral part of the radiology team who works to provide the most effective – and efficient – patient care.
Special Procedures, Special Concerns
Jeannette M. Hill, RN, MS, CRN, CCRN, CEN, CPAN
When a hospital’s radiology department gets a request for a special procedure, many issues must be addressed. Following are some representative concerns:
Consent. All procedures require an informed consent. The department must explain the risks and benefits of the planned procedure, and if the patient is unable to sign, it falls to the next of kin or someone with power of attorney. Phone consent requires two witnesses.
Allergies. If the patient is allergic to Iodine, premedication with steroids and antihistamines (for example, prednisone and diphenhydramine) is required before administering iodine dye. If patients have had iodine dye since an allergic reaction, nurses should ask them how they were pretreated. They’re wise to also ask about allergy to shellfish, since these sea creatures contain small amounts of iodine.
Lab work. Radiology nurses want to know how easily bleeding can be stopped following a procedure, so coagulation studies – prothrombin time, partial thromboplastin time – are requested for most patients. If results are abnormal, the procedure may be postponed or the patient may require fresh frozen plasma before the procedure. Depending on the count, platelets may be needed.
Kidney function studies (BUN, creatinine) are also needed to determine renal function. Kidneys metabolize iodinized dyes, so if the renal function is abnormal, less dye or a different type may be used.
Glucophage. A frequently used diabetic medication, glucophage can alter renal function acutely and has also been associated with lactic acidosis. Glucophage is withheld on the day of the procedure and until the BUN and creatinine results have returned to normal. Results usually are reevaluated 48 hours after the procedure.
Precautions. Here are some important considerations for radiology department scheduling:
Is the patient on a ventilator?
Does the patient need to travel with a nurse and monitor?
Is the patient confused or combative?
Is the patient able to move, stand unassisted, or walk around?
Is the patient restrained?
Transportation. All patients for angiogram, biopsy, and fluid drainage should arrive in their beds or on stretchers.
Chart and stamper plate. These must be sent with each patient. Radiology needs the chart for patient information and the plate to stamp the patient’s name on hospital papers.
PICC lines. Radiologists may prefer using iodine dye to outline venous access on peripherally inserted central catheter, or PICC, lines. A peripheral IV should be arranged antecubital or below on the preferred arm for a PICC line. It’s wise to request PICC lines before all venous access sites are used. PICC lines come in single and double lumens. After a PICC line is removed, it’s common for the vein to develop spasms. This makes reinsertion difficult at best – sometimes even impossible. Be careful not to discontinue a PICC line one day and request another one the next.
Groin shaving. The shaving area should be fairly big. Too little means reshaving – or the prospect of pain when tape is removed.
Access/entry. Usually, the access or entry site for an angiogram is on the groin, opposite the affected side. If the patient requires procedures for both legs, both groins will be accessed, crossing over to the opposite side. The procedures may be performed on different days due to catheter placement and the amount of dye required.
Report. After the procedure, report will include the procedure performed, the access site, how the puncture site was closed, meds given during the procedure, vital signs (including those required postprocedurally), ambulation status, discharge time, and anything else pertinent to the case.
Jeannette M. Hill, RN, MS, CRN, CCRN, CEN, CPAN, works in the Radiology Special Procedures Department at Morton Plant Mease Health Care’s Dunedin and Countryside campuses in Florida.
For additional insight into a demanding yet rewarding career, contact the American Radiological Nurses Association online at www.rsna.org and click on “Related Societies.”