Transcript Nursing

Through the SPECTacle of
a Neurology Nurse
Natalie Cormier, BSN, RN
Carlos Orellana, RN
Felice Espinosa, MBA, BSN, RN
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Objectives
• Describe SPECT Scan and its purpose.
• Describe the role of a SPECT Nurse including
safe administration of Neurolyte.
• Describe the characteristics of an EMU.
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Introduction
What is SPECT?
SPECT (Single Photon Emission Computed Tomography)
imaging is a nuclear medicine study. It utilizes a
radiopharmaceutical to create images of actual brain
function by identifying blood flow patterns throughout
the brain.
Stewart, C. (2010). Single Photon Emission Computed Tomography (SPECT scan) basic level. Mayfield Clinic
and Spine Institute. Retrieved from http://www.mayfieldclinic.com/PDF/PE-SPECT.pdf
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Introduction
• Brain perfusion SPECT is most commonly performed to aid in
identification of epileptogenic focus in patients with medically
refractory epilepsy (usually partial complex seizures) in whom
surgical treatment is being considered.
– It shows “hotspot”
• In comparison to X-rays that display the internal structures of your
body in 2-D image format, SPECT Scan generates 3-D images that
display the actual working of the organs.
– For example, a SPECT scan can display the movement of blood to your
heart or areas inside your brain that may be more or less active.
SPECT Scan. (2012). Mayo Foundation for Medical Education and Research (MFMER). Retrieved
from http://www.mayoclinic.com/health/spect-scan/MY00233/DSECTION=risks
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Introduction
• The radioisotopes typically used in a SPECT scan to identify blood
flow are:
–
–
–
–
–
iodine-123,
technetium-99m,
xenon-133,
thallium-201,
fluorine-18
• These radioactive forms of natural elements are safe and will pass
safely through your body. The most commonly used isotope at Texas
Children’s Hospital is technetium.
• During a seizure, blood flow is highest at the point in the brain where
the seizure starts.
Stewart, C. (2010). Single Photon Emission Computed Tomography (SPECT scan) basic level. Mayfield
Clinic and Spine Institute. Retrieved from http://www.mayfieldclinic.com/PDF/PE-SPECT.pdf
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RISKS
Risks Involved:
• Pain, swelling or bleeding at the specific spot on your arm where the
needle was inserted.
• Although rare, allergic reaction may occur from the radioactive tracer.
Radiation Risks:
• During a SPECT scan, the least possible amount of radiation is used.
• Radiation levels during SPECT scans are similar to what you may be
exposed to over a period of one year in your surroundings.
SPECT Scan. (2012). Mayo Foundation for Medical Education and Research (MFMER). Retrieved
from http://www.mayoclinic.com/health/spect-scan/MY00233/DSECTION=risks
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SPECT Imaging
SPECT Scan Brain Images (2012). Retrieved from http://www.colin-studholme.net/research/ipag/
mrspect3.html.
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• Looks at blood flow
and activity patterns
• Nuclear Medicine
study that uses
radioisotopes to look
at living brain tissue
• More readily
available and costeffective compared
to high resolution
SPECT scans
PET Scan
• Shows what the
brain actually
physically looks like
SPECT Scan
MRI & CAT Scans
Indication for SPECT scan
• Injected tracer
stays in your
blood stream
rather than being
absorbed by
surrounding
tissues
• The images are
limited to areas
where the blood
flows
Stewart, C. (2010). Single Photon Emission Computed Tomography (SPECT scan) basic level. Mayfield
Clinic and Spine Institute. Retrieved from http://www.mayfieldclinic.com/PDF/PE-SPECT.pdf
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System Setup
NS FLUSH
TRANSDUCER
BASE PLATE
RADIOIOSOTOPENEUROLYTE
SYRINGE with lead syringe
cover
3-WAY STOPCOCK
TUBING
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Procedure
A peripheral IV is placed in a preferred site at
the time of admission for the nurse to inject the
radioactive tracer on the day of the SPECT scan
The SPECT nurse and Child Life explain in
developmentally appropriate ways about the
SPECT scan prior to administration of the
tracer.
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Baseline vs. Initiation of New Set
February 7, 2011 –
July 18, 2011
SPECT
Injections
Radioisotope
Spills
Old set up
(Baseline)
13
1
New set up
(Initiation)
6
0
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Reinforcement of New Set up
August 1, 2011 –
August 30, 2012
SPECT
Injections
New set
up
18
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Radioisotope
Spills
0
Preparation for SPECT Procedure
•
Our Radioactive Material Sign
is placed on the patient’s door
prior to the scan so that others
will be aware of the test in
progress.
•
This also prevents any
interruptions while the scan is in
progress (i.e., the patient only
seizes when she wakes up from a
nap)
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SPECT Procedure
•
Nuclear Medicine calls the
RN when the tracer is ready
• Nurse goes to Nuclear
Medicine to pick up the lead box
(above) with the tracer in a lead
lining, RN Injection Protocol
chart, and patient sticker
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What to expect during a SPECT Scan?
Usually, patient is made NPO if being sedated prior to SPECT Scan.
SPECT Scan involves a two-step procedure:
1. Injection of radioisotope through the IV
2. Scanning of the brain
Ictal SPECT
• Radioactive material is administered during the seizure
Interictal SPECT
• Radioactive material is administered NOT during the seizure
Pediatric Epilepsy Surgery Program. (2012). Single Proton Emission Computed Tomography (SPECT).
Children’s Hospital of Pittsburg of UPMC. Retrieved from
http://www.chp.edu/CHP/single+photon+emission+computed+tomography+(spect)
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SPECT SCANs
Picture courtesy of Child Life at Texas Chidren’s Hospital (with Parent Permission)
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SPECT SCANs
Picture courtesy of Child Life at Texas Chidren’s Hospital (with Parent Permission)
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SPECT SCANs
Picture courtesy of Child Life at Texas Chidren’s Hospital (with Parent Permission)
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Nursing Implications - Training
Picture courtesy of Child Life at Texas Chidren’s Hospital (with Parent Permission)
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Nursing Implications - Procedure
Pre-Imaging
• Informed
Consent
• Allergies
• Preparation for
Imaging
• Vital Signs
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Imaging
• Nuclear
Medicine
technicians
• Diagnostic
Imaging RN
monitors and
recovers patient
with sedation
Post-Imaging
• Vital Signs
• Education
Nursing Implications - Education

Inform the patient about radioactive hazard
and the procedure utilizing Child Life and their
preparation book.
 Address concerns and reassure the patient that
the Radionuclide poses no radioactive hazard.
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
Reinforce importance of remaining still
throughout the procedure because movement
produces unreliable result.
 There are no food, fluid, or medication
restrictions unless by medical direction.
After the SPECT Scan
What you need to know after the test
• A few hours after the SPECT scan, most of the radioactive substance is
flushed out by the body through the urine.
• Patient needs to increase fluid intake to aid in removing the radioactive
substance.
• Whatever is left behind is broken down by your body in one or two
days
SPECT Scan. (2011). Mayo Foundation for Medical Education and Research (MFMER).
Retrieved from http://www.mayoclinic.com/health/spect-scan/MY00233/DSECTION=risks
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Epilepsy Monitoring Unit (EMU)
Texas Children’s Hospital EMU is considered level IV center among
children's’ hospitals due to several factors, such as facilities,
great cases, certain surgeries, EMG, SPECT Scans, etc.
Goals:
• Collaboration with key stakeholders regarding expansion
- TCH Executives
- EMU and Nursing
Leaders/Team
- Project Coordinator
- Epileptologists
- IS
- Vendor
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Epilepsy Monitoring Unit (EMU)
Goals (cont)
• Expansion of the EMU to 12-beds with state-of-the-art
monitoring capabilities
• Increase the volume of SPECTs, GRIDs, and possibly
conduct a research study with bed expansions
• Streamline admission process to the EMU and start
VEEG study within a reasonable time
• Maintain positive working relationship between EMU
staff and nursing
• Implementation of a dedicated RN EMU Team
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The EMU Team - RNs
• Consists of 11 RNs from days and 8 RNs from nights, 6 of which are SPECT
nurses
• Only team members will be assigned to EMU beds
• Training for the team includes:
– In-class training by Nuclear Medicine
– Hands-on training to perform SPECT in
Nuclear Medicine
– In-class in service in regards to identifying
types of seizures by EMU Faculty
(Epileptologists)
• Only a SPECT RN can administer isotope
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Collaboration Between Nursing and EMU
Staff
• Nursing daily huddle in the EMU
• Weekly meeting
• Increase communication in regards to patient seizure activity between
nursing and EMU techs
• Meet and greet with the new EMU staff
• Increase communication in regards to patient admission
– Utilize EMU admission algorithm (next slide)
– Green Belt Project
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EMU Admission Process
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Green Belt Project
•
DEFINE
o Identify the problem in the EMU
•
MEASURE
o Document the current process
o Quantify baseline metrics
o Identify quick wins
•
ANALYZE
o Identify potential causes
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•
IMPROVE
o Identify, prioritize, and pilot best
solution(s)
•
CONTROL
o Implement controls to sustain
success
o Train all necessary personnel
o Audit periodically to validate
Green Belt Project – Baseline Data
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EMU – What’s in the horizon?
• Expansion to a 6-bed EMU is underway
• Expand to a 12-bed unit is the ultimate goal
• Continue the Green Belt project
• Maintain collaboration with EMU and Epileptologists
• Review other initiatives to deliver quality patient care
• Improve patient satisfaction
• Maintain Level IV EMU center
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References
Mullen, J. (2012). EMU Admission Process Flowchart. Texas Children’s Hospital.
Pediatric Epilepsy Surgery Program. (2012). Single Proton Emission Computed Tomography
(SPECT). Children’s Hospital of Pittsburg of UPMC. Retrieved from
http://www.chp.edu/CHP/single+photon+emission+computed+tomography+(spect)
Scanning Images (2011). Child Life Department. Texas Children’s Hospital .
SPECT Scan. (2011). Mayo Foundation for Medical Education and Research (MFMER). Retrieved
from http://www.mayoclinic.com/health/spect-scan/MY00233/DSECTION=risks
SPECT Scan Brain Images (2012). Retrieved from http://www.colin-studholme.net/research/ipag/
mrspect3.html.
Stewart, C. (2010). Single Photon Emission Computed Tomography (SPECT scan) basic level.
Mayfield Clinic and Spine Institute. Retrieved from http://www.mayfieldclinic.com/PDF/PESPECT.pdf
Texas Children’s Hospital (2011-2012). Epilepsy Monitoring Unit.
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Questions???
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