1. PATIENT CARE Eduardo D Campuzano BS,RT (R,MR,CT)
Images property of Siemens Medical.

2. ETHICAL & LEGAL PRINCIPLES
PATIENT CARE
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.
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.

3. ETHICAL & LEGAL PRINCIPLES
PATIENT CARE
ETHICAL & LEGAL PRINCIPLES
LEGAL ASPECTS OF RADIOLOGY
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.

4. ETHICAL & LEGAL ASPECTS
PATIENT CARE
ETHICAL & LEGAL ASPECTS
REQUEST FORM
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

5. ETHICAL & LEGAL PRINCIPLES
PATIENT CARE
ETHICAL & LEGAL PRINCIPLES
INFORMED CONSENT (WRITTEN OR VERBAL)
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)

6. PATIENT CARE
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.

7. ETHICAL & LEGAL PRINCIPLES
PATIENT CARE
ETHICAL & LEGAL PRINCIPLES
CONFIDENTIALITY(HIPAA)
HIPAA- Means Health Insurance Portability and Accountability Act
Health care provider must provide for the privacy and security of patient information in any forms (verbal, written, or electronic).

8. ETHICAL & LEGAL PRINCIPLES
PATIENT CARE
ETHICAL & LEGAL PRINCIPLES
PROFESSIONAL LIABILITY
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.

9. ETHICAL & LEGAL PRINCIPLES
PATIENT CARE
ETHICAL & LEGAL PRINCIPLES
PATIENT IDENTIFICATION
The Technologist has the responsibility for proper patient identification.
Wrist band
Questioning patient (Name & date of birth)

10. INTERPERSONAL COMMUNICATION
PATIENT CARE
INTERPERSONAL COMMUNICATION
COMMUNICATION WITH PATIENT
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.

11. INTERPERSONAL COMMUNICATION
PATIENT CARE
INTERPERSONAL COMMUNICATION
EQUIPMENT
All MRI Equipment Inside the MRI Suite must be MR Safe
IV’S- Check frequently, maintain solution bottle/bag 18-20” 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 ).

12. PATIENT CARE INFECTION CONTROL TERMINOLOGY
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.

13. PATIENT CARE 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.
Alcohol Based is approved by Joint Commission
Patient Prepping- Betadine destroy microorganism, Alcohol prevents the growth of microorganism.

14. PATIENT CARE
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.

15. PATIENT CARE PATIENT MONITORING VITAL SIGNS Blood Pressure Temperature
Systolic range- Represents the pressure created during contraction of the left ventricle ( Normal)
Diastolic range- Represent the pressure within the vascular system with the heart at rest (60-80 Normal)
Temperature
Oral 98.6, Rectal 99.6, Axillary 97.6
Respiration
Adults per minutes, Children per minutes
Pulse
Normal Range beats/minute for adults, for infants/children.

16. INDICATIONS & CONTRAINDICATIONS
PATIENT CARE
CONTRAST MEDIA
INDICATIONS & CONTRAINDICATIONS
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 life-threatening reaction (5% Rule)

17. Pre-Meds for allergy are anti-histamine(Benadryl) and Steroids(Medrol)
CONTRAST AGENTS
Idiosyncratic Reactions
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)

18. Use for those at risk of reactions
PREMEDICATION
Use for those at risk of reactions
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).
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

19. CONTRAST AGENTS PATIENT PREPARATION SIGNED INFORMED CONSENT
Allergies
Pregnancy
Kidney Functions
SELECTION OF VEINS
Anticubital Veins (Best)
TYPE & SIZE OF NEEDLE
18/20 Angiocatheter Gauge for MRA ,Perfusion, Dynamic Studies

20. SAFETY CONSIDERATIONS
CONTRAST AGENTS
SAFETY CONSIDERATIONS
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

21. CONTRAST AGENTS VENIPUNCTURE 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.

22. INTRAVENOUS INJECTION
PATIENT CARE
CONTRAST MEDIA
INTRAVENOUS INJECTION
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.

23. CONTRAST AGENTS
Is used to improve the sensitivity and specificity of clinical diagnoses.
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.

24. PATIENT CARE CONTRAST MEDIA ADVERSE REACTIONS Assessment of Patient :
How do they look,sound(voice),breathing ?
If needed , stop exam immediately and remove patient from Zone 4
Call for Help
Code or Radiologist/MD (Follow your Hospital Policy)
Vital Signs: Get Baseline
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

25. PATIENT CARE CONTRAST MEDIA ADVERSE REACTIONS
Mild Reaction- Nausea and vomiting, Hives, Itching, Sneezing.
Monitor and comfort patient (Document reaction).
Moderate Reaction- Excessive hives, tachycardia, excessive vomiting.
Call for medical assistance, monitor & comfort patient (Document reaction)
Severe Reaction (Anaphylactic)- Very low blood pressure, cardiac or respiratory arrest, convulsion, cyanosis.
Call for immediate assistance, prepare for CPR, prepare for antihistamine (EPINEPHRINE).

26. PATIENT MONITORING MEDICATIONS:
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.

27. PATIENT MONITORING MEDICATIONS:
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.

28. PATIENT MONITORING Cardiac Arrest Seizure Stroke Shock
CPR should be started on any patient demonstrating cardiac failure
Seizure
Can cause a patient to demonstrate convulsive moments or period of unconsciousness
Stroke
Lack of blood flow to the brain. Could result in inability to speak, facial numbness,limb paralysis.
Shock
Can result due to blood loss(trauma) or massive vasodilation can occur due to allergy to iodine contrast

29. LOCAL ADVERSE REACTIONS
PATIENT CARE
CONTRAST MEDIA
LOCAL ADVERSE REACTIONS
Extravasations- Escape contrast media into the interstitial tissues at the site of injection
Symptoms-Pain, swelling and redness. Care by applying warm/cold compress and elevating the effecting extremity.

30. EXTRAVASATION
Most common experience is pain, swelling or tightness/burning at the site
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
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.

31. EXTRAVASATION TREATMENTS Elevation of affected extremity
Keeping the extremity above the level of the Heart, decrease capillary pressure and promotes reabsorption of extravasated fluids.
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.
Surgical Consultation
For severe extravasation.
Progressive swelling or pain
Altered tissue perfusion,blistered,and/or ulcer skin
Increase Patient Risk
Patient who cannot communicate (Elderly/Pediatrics)
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.

32. Pregnancy Test is required for Child Bearing age female patients
Need to be medically necessary and approved by ordering physician and OB-GYN
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

33. PATIENT CARE 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.
Symptoms-Swelling ,tighness,and redness of the skin. Patient must contact Referring physician if seen are seem.

34. CONSCIOUS SEDATION
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

35. JOINT COMMISSION
Joint Commission (JC) – Accredits and certifies more than 20,500 health care organizations and programs in the United States.
Every Three Years
Improve Patient Safety
Improve Health Care Quality

36. JOINT COMMISSION MRI SAFETY
MRI Safety Officer- Every department needs an MRI Safety Officer.
Recommended a dedicated MRI Safety Committee
Yearly In-Service/Training for entire Hospital Staff
Dedicated In-Service for MRI Technologist
Meet Yearly with local Fire Department & Police Department
MRI Zones must be label throughout the department
Restrict access to Zone III, Only MR Personnel Level 2 Zone IV
5 Gauss Line ,must be marked/visible on the room/floor.

37. JOINT COMMISSION MRI SAFETY(Cont…)
MRI Safety Officer- Every department needs an MRI Safety Officer.
Patient Identifiers(Two) ,name and date of birth or MR#
MRI Screening forms to anyone entering the MRI Suite
Have two different MRI Personnel review the forms
All Equipment must be mark for MRI Safety within the department.
Stickers with MR Safe or UnSafe
Fire Estiguisher,Wheelchairs,Stretchers,IV Pole,Vital Sign Machine
Hand Held Magnet (Exclusion Criteria Equipment)

38. JOINT COMMISSION INFECTION CONTROL
Hand Washing- Needs to be followed per guidelines below.
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)

39. JOINT COMMISSION INFECTION CONTROL
Infection Control Policy - Dedicated policy for MRI Department.
Cleaning Pads and Coils after each use
Have PPE ready in every room.
Cleaning MRI Safety Equipment routinely(even if not used)
MR Vital Signs, Anesthesia Machine,etc
Using correct cleaning solution for infection control
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
MRSA can grow in old/tear pads

40. Hospital Policies & Procedures
JOINT COMMISSION
Hospital Policies & Procedures
Policies – Everyone should know where to locate Hospital and Departmental specific policies.
Chemical Spills & Material Safety Data Sheet (MSDS)
Code Red(FIRE)
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.
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)

41. Hospital Policies & Procedures
JOINT COMMISSION
Hospital Policies & Procedures
Policies – Everyone should know where to locate Hospital and Departmental specific policy.
Emergencies or Code Blue/Cardiac Arrest
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
Nothing under sinks

42. JOINT COMMISSION MEDICINE
MEDICINES – All medicines need to be store and locked.
Do monthly checks for expired medication
Check biopsy supplies monthly for expiration
Keep a log
All medications should be label ,including contrast
Power Injector, label syringes with contrast and saline
Label needs to include medicine,dose,time,date,and initials

43. JOINT COMMISSION PRIVACY
HIPPA – Privacy must be maintained by all Hospital Personnel
Employees should only have access to information needed.
No cameras in Private Patient areas
Changing rooms, Bathrooms
Patient Chart should have a cover/folder(No papers).
All computers Screen must be close when not in used.
Always log off medical records,PACS,RIS.
All CPU must have a privacy protector screen.