critical care patient transfers to general mri 2019...(single infusion line) and one pump for each...

Authors: Michelle Carey, Isabel Gonzalez and Tim Lowes ²Date: 20/10/2019 ²Revision Due: 20/10/2022

This guideline has been developed for the benefit of those working in Critical Care at The James Cook University Hospital. While every effort has been made to check the accuracy of the contents, the use of this guideline is subject to professional judgement and no responsibility or liability will be accepted for any cost or damage arising from its use.

2019 © South Tees Hospitals NHS FT

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Critical Care Patient Transfers to General MRI

AIM: Checklist and Suggested Sequence for Safe Critical Care Patient Transfers to General MRI

EQUIPMENT AND STAFFING

� 3 Persons with MRI experience, e.g., 2 x Doctors and 1 x ICU Nurse or 1 Doctor, 1 Anaesthetic Nurse or ODP,

1 ICU nurse. If patient requires a log-roll and scan is out of hours you may need more personnel � A trolley for additional kit to be transported and a drip stand for infusion pumps in MRI control room

� MRI compatible ventilator ParaPACä with 5 m oxygen tubing (kept in ICU2 cupboard near B6)

� MRI compatible ventilator ParaPACä ventilator tubing and standard catheter mount � HME Filter with capnography port for MRI capnograph connection

� Infusion Pumps: 2 for each infusion running, i.e., 1 in progress on ICU and for the transfer to radiology

(single infusion line) and one pump for each infusion loaded with syringe with infusion lines x3. Infusions

should be rationalised (no more than 3), only essential infusions, e.g., vasoactive drug and propofol +/-

opioid. Consider bolus of opiates and paralysing agents. Take enough chargers. � Infusion Drugs: minimum 2 of each drug, 1 in progress attached to single infusion line, 1 loaded into

spare infusion pump attached to infusion lines x3 and spare one. Note that MRI takes much longer time

than CT scan, 90 minutes or even longer. Ensure you have adequate amounts of each drug.

� Infusion lines x3 connected to each other for each infusion to be located in MRI control room. Ensure

they are plain infusion lines and avoid those with anti-syphon valves as the pump cannot overcome the

pressure of three infusion lines joined together. Ensure that distal line has correct drug label. � Oxygen cylinders minimum 2 CD size

� Monitoring: arterial line, ECG, SpO2, ETCO2 and NIBP. No need for CVP monitor and cable.

� Arterial line transducer with an added extension as MRI monitor cable is very short � MRI compatible ECG dots (x3) and standard spare ECG dots (x5) to recommence monitoring after MRI

� Spare obturators and sterets to maintain sterility when connecting / disconnecting infusions

� Additional drugs: neuromuscular blocking agents, opioids, benzodiazepines, vasopressors and

emergency drugs as required.

� Saline flushes and spare syringes and needles � Transfer bag and emergency drugs

� If patient has chest drain(s) in situ, take several plastic clamps

� Anaesthetic Chart or Intrahospital Transfer Chart

COMPLETE THE MRI SAFETY QUESTIONNAIRE

Ensure the patient does not have any contraindications for MRI scanning and weight the benefits vs. the risks of transferring a critical care patient to the MRI scan room.




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SUGGESTED SEQUENCE

In ICU

Þ Empty all drainage bags, e.g., catheter, bile bag, drains

Þ Connect patient to MRI Ventilator (ParaPAC®) with oxygen pipe attached to wall

For how to set ParaPACä, see below

Þ Ensure catheter mount and HME filter with capnography port inserted into circuit.

Þ Use ICU capnography as usual for transfer to and from MRI.

Þ Ensure patient is adequately ventilated

Þ Ensure infusions running on short line attached to patient venous access

Þ Spare pumps with infusions attached to 3 infusion lines checked and fully purged (not attached to

patient). Ensure that distal line has correct drug label. Consider separate drip stand to carry these

pumps to MRI control room and don’t forget chargers

Þ All required additional drugs drawn up into labelled syringes, including saline flushes.

Þ Add arterial line extension set into arterial line transducer

Þ Monitoring transferred to bed and oxygen in safe place

Þ Final MRI check – Check you have all kit in list above

Þ Patient haemodynamically stable and adequately ventilated

Þ Arrange porters and connect to ventilator to oxygen cylinder when ready to leave unit

Þ Transfer to MRI area




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In MRI Suite Do not proceed into MRI scanning room until final safety check complete

Þ MRI table in the corridor nearest the scan room, ICU bed at ‘wall’ side

Þ Stop in MRI corridor

Þ Remove any personal ferromagnetic material: bleeps/lanyards/money/phone and place in MRI

control room

Þ All staff to have completed MRI checklist

Þ Apply ear plugs to patient if possible

Þ Slide +/- logroll if required patient across onto MRI table

Þ Take pumps with infusion lines x3 to MRI control room and plug them to electricity. Switch

pumps on and purge lines to see drug delivery via the pumps in the control room. Place lines

through hole in wall, leaving pumps in control room. Take end lines to the patient in the

corridor, clean with sterets and swap with current infusions, confirm drug label on end infusion

line, start the infusion at the same rate.

Þ Stop and disconnect short line infusions, maintain sterility and cap off for use at end of scan.

Turn pumps off to preserve battery life.

Þ Connect MRI SpO2 (wireless) and capnograph to HME

Þ Remove all ICU ECG dots and the ICU ETCO2 Drager monitoring. Disconnect arterial transducer

and rest of monitoring from ICU monitor.

Þ Switch off the monitor to preserve battery for transfer back to ICU.

Þ Final patient and bed sweep for MRI incompatible material

Þ Staff member in MRI ready to connect to wall O2 supply

Þ Disconnect oxygen from oxygen cylinder and move into MRI room leaving oxygen cylinder in

the corridor. The MRI compatible ventilator (ParaPACä) can go into the MRI room with the

patient and rest at the foot end of the MRI table.

Þ Connect oxygen to MRI room wall O2 supply behind anaesthetic machine

Þ Connect ECG and arterial line monitoring. Consider also to connect NIBP cuff.

Þ Once on table and positioned proceed to final haemodynamic and respiratory monitoring

sweep

Þ Ask MRI staff to confirm final position of MRI bed within scanner and perform a test run into MRI

scanner

Þ Monitor to face control room window

Þ Commence MRI.

Þ Remember to record in Anaesthetic Chart or Intrahospital Transfer Chart




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Please note that this document does not address the transfer of critical care patients to MRI for a GA under the anaesthetic team. It does not address the use of the anaesthetic machine available in the general MRI suite.

Whilst patient in MRI

Þ Record observations in Anaesthetic Chart or Intrahospital Transfer Chart

Þ Sort monitoring ready for reattachment at the end of the scan

Þ Ensure adequate amounts of drugs in the original syringe drivers for transfer back to ICU

Þ Check oxygen cylinder to ensure adequate supply for transfer back to ICU

Following MRI

Þ Reverse sequence of entrance

Þ Staff member in MRI corridor with oxygen cylinder and monitoring ready

Þ Slide patient down MRI table to release from head rest

Þ Disconnect arterial line monitoring and ECG

Þ Disconnect from wall oxygen supply

Þ Carefully wheel MRI table out of MRI room to corridor

Þ Connect to oxygen cylinder in corridor

Þ Re-attach ECG, arterial line transducer, SpO2 and inline ETCO2 Drager monitor

Þ Remove MRI monitoring, pulse oximeter and ETCO2

Þ Reattach short line infusions pumps in corridor and start running

Þ Stop infusion line x3 infusions when appropriate. Disconnect from patient and cap off. Disconnect the

infusion line sets between the first and second line and cap off, that is, leaving one giving set and

discard the unattached extra infusion lines pulling the remaining lines back through to control room

Þ Slide +/- logroll if required patient across to ICU bed

Þ Remove ear plugs

Þ Ensure MRI monitoring is returned to original position and left clean and tidy for next case

Þ Ensure ECG monitoring box is returned to MRI staff to place on charge

Þ Return to ICU,

Þ Complete Anaesthetic Chart or Intrahospital Transfer Chart




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ParaPACä MRI Compatible Transport Ventilator*

• CMV/DEMAND feature • Ventilation powered by gas • Adjustable pressure relief with audible alarm • Air mix facility - selection of 100% or 45% O2 • Dual controls to select tidal volume and frequency • CPAP and integrated PEEP function

• Integrated alarm system: - High pressure,

- Low pressure (disconnect)

- Low battery

- Low supply gas

• Suitable for ventilation during CPR and emergency transportation of patients down to 5kg body weight.

*Full ParaPAC 310 instructions available on website (see equipment in critical care)

• The paraPAC plus model 310 has been determined to be MR–Conditional: There is no projectile risk or change in ventilator performance within an open bore shielded magnet with a static magnetic field of 3–Tesla or less with spatial gradient magnetic field of 430–Gauss/cm or less.

• MR image quality may be compromised if the area of interest is closer than 30cm to the position of the ventilator.

• When in use in MRI environment, check the pressure manometer to confirm unchanged ventilation. Also, test the high-pressure relief/alarm system by temporary circuit disconnection and occlusion of the ventilator outlet connector, both whenever the system is taken into MRI environment, and every time the patient is positioned within the magnetic field.




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Document Details

Title Critical Care Patient Transfers to General MRI

Main points the document covers Checklist and suggested sequence for the safe transfer of critical care patient to MRI suite

Who is the document aimed at? All critical care staff that could be involved with the transfer of patients for MRI

Author Michelle Carey, Tim Lowes, Isabel Gonzalez

Approval process

Approved by Critical Care Directorate and Critical Care Guidelines Group

Effective from October 2019

Category Critical Care Services JCUH

Sub Category Miscellaneous

Review date October 2022

Document Links

Required by CQC Mandatory

Required by NHSLA Mandatory

Other Pending approval by CSSG

Amendments History

No Date Amendment

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critical care patient transfers to general mri 2019...(single infusion line) and one pump for each...

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