#19 Interventional Radiology for Nurses

Dr. Amrit Hansra, interventional radiologist, gives an overview of imaging modalities as well as key nursing takeaways for common IR procedures such as G-tubes, biliary drains, and nephrostomy tubes.

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Objectives

  1. Listeners will be able to describe the differences between the various modes of medical imaging, including their advantages, limitations and indications
  2. Listeners will be able to explain the the differences between PEG tubes and G-tubes, including how each are inserted as well as important difference in nursing management
  3. Listeners will be able to identify tunneled v. non-tunneled catheters and where to apply pressure after catheter removal.
  4. Listeners will be able to describe what biliary drains are, when they are indicated, and how nurses can effectively manage them

Radiology 101

X-ray

  • Creates a 2-D image
  • Useful for imaging bones, air
  • Pros: widely available, can sometimes be performed at bedside
  • Cons: not a detailed image, radiation risk

Ultrasound

  • Using echoes of ultrasound pulses to delineate objects of different density in the body
  • Useful for quickly imaging internal organs and blood vessels
  • Pros: No radiation, can be performed quickly at bedside. Because they show images in real-time, the viewer is able to see movement of the internal organs, no radiation
  • Cons: not a detailed image

Computed Tomography (CT)

  • Creates a 3-D image
  • Useful for imaging soft tissue, organs, bones, and blood vessels
  • Indicated for an assessment of internal bleeding, fractures, and tumors
  • Pros: Creates a detailed image, relatively fast
  • Cons: Radiation risk, cannot be performed at bedside

Magnetic Resonance Imaging (MRI)

  • Creates very detailed 3-D images of body structures
  • Indicated for an assessment of the brain (esp. CVAs), joints, blood vessels
  • Pros: Creates a very detailed image, no radiation
  • Cons: Requires the patient to lie flat for a long period of time, claustrophobia
  • Contraindicated for patients with implanted metal devices

Positron Emission Tomography (PET)

  • Indicated for diagnosis and staging of malignancies, some infection/inflammatory processes
  • The patient receives a radioactive “tracer” containing glucose that “lights up” highly active (often malignant) cells
  • Important nursing note: do not administer insulin prior to a PET scan

G-tubes v. PEG Tubes

Vancouver Coastal Health

G-tube

Inserted by an interventional radiologist under fluoroscopy

Internal retention device: Balloon

PEG Tube

Inserted by a gastroenterologist using endoscopy

Internal retention device: Bumper

Important nursing takeaways
  • If a gastrostomy tube is pulled out, immediately insert a foley catheter into the stoma to maintain the tract (no need to inflate the balloon)
  • Educate patients and caregivers about which ports to use in a gastrostomy tube (i.e. don’t touch the balloon port!)

Biliary Drains

There are two types of biliary drains: external and internal-external

Important Nursing Takeaway

When flushing an external biliary drain, the NS may not flow back out into the external drain but that’s OK! The NS has drained into the patient’d duodenum, which is a good thing.

#18 Critical Care Transport

Patients require transportation for many reasons: to an increased level of care, a decreased level of care, a procedure, or for imaging. Katherine Stradling, BSN, RN, CCRN, TCRN discusses the science of transport, what it’s like in the ambulance, and what bedside nurses can do to facilitate safe transport.

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#17 What Happens During Dialysis?

Dialysis isn’t simply hooking up a patients to a machine for 3-4 hours. Veteran dialysis nurse, Jameisha Rogers RN, talks us through what happens during dialysis starting from reviewing orders to decannulation.

Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00) or here for detailed instructions.

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#16 VTE Prophylaxis Demystified

Venous thromboembolism (VTE) prophylaxis is a core marker of healthcare excellence. Dr. Walter Cheng, hospitalist, explains that almost every hospitalized patient is at an increased risk for developing a deep vein thrombosis (DVT) or pulmonary embolism (PE) and that nurses play a crucial role in preventing, assessing for, and educating our patients about VTE. 

Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00) or here for detailed instructions.

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#15 The Nurses Role in Early Mobility

Today, ICU patients seem to become sicker and more sedated. Sedation medications, such as Propofol, have become more accessible and can be hung up and left on a drip all day. Heidi Engel, PT, DPT argues that less sedation and more mobilization should be thought of as important as taking medications. In this episode, we discuss how nurses can play a crucial role in mobilizing our patients both in the ICU and on the floor.

Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00) or here for detailed instructions.

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#14 Pregnant and Lactating Patients in Non-Obstetric Departments

Pregnant and breastfeeding patients aren’t always hospitalized for obstetric reasons and can be placed throughout the hospital. Dr. Michelle Solone, OBGYN talks to us about how we can assess these patients, what to look out for, and how nurses can promote pumping and breast feeding during a hospitalization.

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#10 The COVID Episode: What Do We Know Now?

We’re a year into the pandemic and, as a nurse, I’m curious: what have we learned are the best practices for treating COVID in the hospital? I sat down with a returning guest, Dr. Cyrus Shariat, an intensivist, and asked him about COVID pathophysiology, management of respiratory failure, medications, and risk of thromboembolism. 

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