Safety the ultimate goal Patient advocate Responsible = responsive Correct medication history and administration Be aware of specific facility guidelines May be responsible for obtaining, maintaining, or giving meds Meds necessary to perform studies Contrast IV or PO Anesthetics Anti-anxieties Sedation (moderate/conscious/anesthesia) Need a basic knowledge of these meds Actions, outcomes (expected and unexpected) 1
Emergencies in the radiology department Examples: allergic reactions angina asthma attacks diabetic emergencies cardiac arrest RTs may be responsible for giving and charting meds Know what drugs are needed, where they are kept, and how to administer Know your state laws and facilities policies Intravenous Medications RTs are responsible for assuring the safety of the patient Should check site for signs of patency Not necessarily responsible for the medication infusion If a patient needs a med while in your care check with MD Some basic knowledge is key Written Order must come from a LIP NP, APN, PA, or MD Verbal Order not legal in many states except in emergencies During emergencies rules bend slightly May take a verbal order verify by stating back, show med vial if able Once emergency is ended get written order and document med, dose, route, rate, and time Have physician sign before leaving the department 2
Drugs = Medications Prescribed vs. OTC vs. recreational Generic vs trade proprietary vs commercial typically less expensive must have order to substitute Unsure? Know how to look it up Internet, PDR, drug insert Pharmacokinetics Mechanism, action, and excretion Based on chemical composition Affects the way individuals respond to medications Vary greatly depending on age, weight, physical condition, immune status other drugs, history of substance abuse Absorption, Distribution, Metabolism, Excretion Absorption Moves the drug from the site of administration to central circulation Routes: Oral (PO), sublingual (SL), buccal, nasal, rectal use mucosal lining of the GI and respiratory tract Transdermal, topical absorbed through the skin Intramuscular (IM), subcutaneous (SQ), intra-dermal (ID) use blood vessels in the muscle and skin Intravenous (IV), intra-arterial (IA), intrathecal direct absorption into the circulating blood 3
Distribution How medication travels from bloodstream to target site Depends on conditions of circulation (cardiac output = HR x BP) Action more rapid when target is blood filled organs Metabolism Breaks down medication for excretion Typically occurs in the liver Excretion Eliminates waste products from metabolism Kidneys, intestines, lungs, breast milk, and other exocrine glands Good hydration prevents toxic build up of waste products Drug Reactions Therapeutic effect desired purpose of medication Side effect predictable action/effect other than desired Toxic effect poisonous, potentially lethal more common in elderly, renal and liver impairment (antidote) Idiosyncratic effect unusual reaction Allergic reaction hive, itching, respiratory issues (slight or severe) Synergistic effect combined drugs that produce undesired effects HTN and diuretic meds that cause syncope and hypotension Iatrogenic medication error 4
Right s of Medication Administration Right Patient Right Medication Right Dose Right Time Right Route Right Documentation Right Reason Right Drug/Drug interaction Right education REMEMBER: The patient always has the right to refuse! Always!!! Confirm the order, Check the expiration date, Check for allergies Drug Reactions Any drug has the potential for an allergic reaction Monitor patients especially when giving CNS depressants Know where emergency equipment is located and how to use Know your facilities protocols and policies Know how to look up medications (Intranet, PDR, drug insert) HOCA have greater risk of reaction d/t ionic concentration Routes of Administration Enteral oral (most common), rectal, ngt/peg can be capsules, pills, tablets, liquids, granules, chewables should be given whole not crushed or cut (ER/XL) absorbed into bloodstream from stomach or small intestine Inhalation liquid meds or pills that are vaporized using O2 or air reusable inhalers = rescue inhalers nebulizers hand held or masks radioactive gasses for nuclear med studies Sublingual/buccal route under the tongue or inside the cheek considered topical not oral/enteral immediate absorption via the mucous membranes 5
Topical - applied to the surface of the skin May have local or systemic affect Also called transdermal Absorbed through the skin into the bloodstream NTG, Nicoderm, Scopalamine Parenteral - Injected directly into the body Used for faster onset or when NPO or n/v Bypass the GI tract Rapid absorption and onset Routes: ID intra-dermal, SQ subcutaneous, IM intramuscular, IV intravenous Intrathecal, Epidural, Intra-arterial Syringes Barrel the long cylinder that holds the medication typically marked in CCs or MLs Plunger pushed inward to expel the medication Needle different lengths (inches) bores (gauges) diameter of the opening Most are disposable may be metal on some OR/sterile trays metal are reusable and can be autoclaved Starting an IV veins most often used anterior forearm, posterior hand, wrist, anticubital (AC) when selecting a site look for those largest and most superficial AC is typically the access of choice larger bore means faster flow may be impeded by movement may become sclerotic with frequent use ask the patient where they prefer 6
Special Considerations never start IV on same side as peripheral dialysis access or mastectomy children, obese, and frail patients are more difficult after 2 failed attempts let someone else try (utilize IV/PICC team if available) may use power port or power PICC for contrast cleanse the port each time you access per facility policy generally withdrawal to get blood return before you inject hand hygiene before and after procedure always wear gloves Precautions needle sticks continue to be a common job related injury use standard/universal precautions on all patients wear gloves when may be in contact with blood do not recap needles dispose of all sharps and contaminated waste appropriately use needless system whenever possible follow all facility policies read all medication labels at least 3 times label any syringes that are not used immediately check the patients identity check for allergies monitor for side effects 7
IV fluids may be free flowing or on a pump may contain medication that requires a specific rate cardiac and renal patients do not tolerate large amount of fluids free flow use roller clamp to control the rate the higher the bag the faster the flow pumps should be set to dose mode or ml/hr monitor site for infiltration monitor patient for signs of adverse reaction or allergy Extravasation/Infiltration when IV fluids or meds leak into tissue can be painful and dangerous may cause swelling, heat, sloughing of tissue stop the infusion and notify MD remove the needle and apply ice (20-60 mins 3 x daily) document IR (incident report) chart carefully Discontinue IV gather dressing, tape, bandaid/bandage hand hygiene explain procedure to patient clamp the drip loosen the tape/dressing remove the catheter while applying pressure check the catheter to make sure it is intact apply dressing 8
References Adler, A. & Carlton, R. (2012). Introduction to radiologic sciences and patient care (5th Ed.). St. Louis: Mo.: Elsevier Saunders. 9