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Radiology Nurses Keep Pace with Interventional Technology

Monday August 27, 2001
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Jane Smith*, a 38-year-old patient lying on a gurney in the radiology department of a local hospital is anxiously awaiting an innovative procedure called a uterine fibroid embolization, a relatively new alternative to a hysterectomy or myomectomy. The radiologist tells her the procedure is a minimally invasive method of blocking the arterial blood supply to her fibroids, thereby shrinking them and reducing her bleeding and pelvic pain. She hears his words "minimally invasive," but somehow the words don't seem to calm her fears.
In walks Mary Brown, RN, who is assigned to be with Jane throughout the procedure. Brown sees the familiar look of anxiety in the patient's face. She introduces herself and tries to place her patient at ease. She checks her identification and the signed consent form. She reviews the patient's current medications, medical history, lab work and allergy history. Brown, an experienced radiology nurse, looks for any potential problems that might affect the procedure or choice of sedation. Confirming that the chart is in order, Brown tells the patient what to expect during the procedure, and that she will be giving her some medication to relax. She starts her IV. Shortly thereafter, the radiologist arrives and the procedure gets underway.
Although Brown is a fictional character in the above scenario, the described events are similar to the experiences occurring in the average workday of today's interventional radiology (IR) nurse. A significant part of the nurse's role is reducing patients' worries by teaching and supporting patients undergoing procedures. Strong critical care skills, the ability to act quickly in an emergency, and flexibility are some of the many attributes needed to perform well as a radiology nurse.
Role of the Radiology Nurse
Jill Coffey-Roberts, RN, a radiology nurse at Sinai Hospital in Baltimore, MD, says the pace can be hectic. "We have three nurses in the department who cover procedures in IR, CAT scan, ultrasound, MRI, nuclear medicine and the main radiology department," she says. Coffey-Roberts is a 25-year nursing veteran and has worked in Sinai's radiology department for five years. She says her cardiac care and ED background prepared her for this role.
Marty Goppert, RN, BSN, MSN, a radiology nurse at George Washington University Hospital (GWUH) for the past 11 years, says, "Assisting the radiologist with special procedures, primarily interventional neuroradiology and vascular procedures, such as vascular and cerebral arteriograms, is the nurses' main focus. We also cover for emergencies that occur in another area of the department, or if a patient has nursing needs. We give chemotherapy to patients with brain, throat, and tongue cancer. We assist with the administration of tissue plasminogen activator (t-PA) therapy to dissolve blood clots in stroke patients."
Goppert, a former ICU head nurse, adds, "The nurse's responsibility is to monitor the patient during the procedure. The radiologist focuses on the diagnostic procedures. The nurse's job is to look at the patient's needs and ask, 'What can I do for him to make him comfortable and place him in a pain-free comfort zone.' We have a one-on-one relationship with the patient during the procedure. It's our responsibility to give them reassurances and lower their anxiety."
Patient Advocates
According to Colleen Sasso, RN, BSN, CRN, president of the American Radiological Nurses Association (ARNA) and a radiology charge nurse at the Veterans Affairs Medical Center, San Francisco, CA, "The primary role of the radiology nurse is as a patient advocate and all that it entails. To be true patient advocates, we must faithfully utilize the nursing process in all our encounters with patients, families and even with members of the healthcare team with whom we work. Though the focus may change in our different work environments based on economic decisions, our focus must remain constant to provide optimal and safe care for our patients and their families."
Conscious Sedation: Benefits and Risks
One of the more challenging responsibilities of the interventional radiology nurse is conscious sedation. The nurse, under the supervision and direction of a physician, gives sedation and analgesics during the procedure, to place the patient in a mildly depressed state of awareness. Conscious sedation is fast becoming one of the most preferred methods for anxiety and pain relief during therapeutic and diagnostic procedures.
Goppert says, "While receiving conscious sedation, a patient is able to maintain a patent airway, maintain their vital signs within normal limits, and respond to verbal and physical stimuli. Versed is the most common drug given intravenously by the nurse to sedate. Fentanyl is usually given to control the pain. The medications are short acting. The effects last about 30 minutes to an hour. We are certified annually at GWUH in how to administer conscious sedation and also in ACLS."
But there are potential risks. Conscious sedation can progress to a deeper sedation causing airway obstruction and respiratory depression. The nurse needs to monitor the level of consciousness, vital signs, cardiac rate and rhythm, oxygen saturation levels and respiratory rate. Qualifications for RN administration of conscious sedation vary by state and institution. So to ensure that all radiology nurses are competent in giving conscious sedation, hospitals are requiring their nurses to be certified annually in administration of conscious sedation and in ACLS.
Advantages, Challenges, and Drawbacks
Goppert says, "The autonomy the job gives me is a definite advantage." According to Coffey-Roberts, the one-on-one relationship with the patient is a definite plus. However, she says, "We work with a lot of oncology patients and get very attached. When you lose a patient, you really feel the loss."
Coffey-Roberts maintains the biggest challenge for her is being able to coordinate the workday. For Goppert, it's using her critical care skills to quickly assess and address patient problems. Goppert says, "There are four nurses in our department to cover a 30-day on-call schedule. We are responsible for 24-hour coverage over a seven-day period. So we can work some long hours to cover emergencies that can be a drawback."
Educator Role
"Radiology nurses have a primary role in patient and family education both before and after the procedure," Goppert says. "Although the doctor explains the procedure, and obtains the consent, it's the nurses' responsibility to educate the patient and family on post-procedure care; for example, appropriate activity level, checking the needle puncture site for infection or bleeding, and what to do should bleeding occur. We advise them to apply pressure on the site should bleeding occur at home and to call 911."
According to Coffey-Roberts, Sinai initiated an "Ask a Nurse" program as a part of follow-up care and quality assurance. One of the nurses calls the patient after discharge to find out how he or she is doing after special procedures, such as biopsies, arteriograms, myelograms and chemoembolizations.
Keeping Pace with Advancing Technology
What does the future hold for an interventional radiology nurse? Sasso projects that there will be further expansion of technical procedures that will continue to require the expertise of qualified nurses to provide a safe environment for the patients. "As advocates, one of our primary roles is to educate our patients so we must keep informed in order to inform," she says. "The healthcare field requires continuous and diligent study to ensure that optimum care we strive for. More and more nurses are sitting for the certification exam in radiology (CRN) each year. It provides a way for nurses to establish themselves as experts in their field." Sasso suggests that nurses can also keep abreast of changes in the field by becoming a member in ARNA. She notes, "The organization provides an invaluable network with nurses across the country and internationally to exchange ideas, techniques and care models."

*Jane Smith is a composite of several patients.