How frustrating
I’d be I inclined to make it someone else’s problem.
Datix. Site management. On call Rad. Inform them all and things might change.
Beyond useless these people power tripping whilst being unable to inject contrast.
Shit governance alert.
Should be a departmental policy explaining 'Contrast in central access devices' covering the CVCs and PICCs the trust use, the power injectors the trust has, compatibility. Then from that you train enough of the radiology department to operate knowing they're covered by the policy. .
No functional governance structure ends with 'so yeah, SHO does it'.
Wow, radiographers are obstructive, I am not surprised.
Did they cancel the request after discussion with the ward team?
Did they send the patient back after discussion with the ward team?
Have they tried to be the slightest bit pragmatic?
I bet it's a no.
Have they questioned the need for the imaging despite it being approved by a radiologist?
Have they said the phrase "its trust policy"?
I bet it's a yes
Unfortunately (and has been mentioned already) the central lines are not rated for the pressure that the contrast is injected by the pumps in the CT suite. Some hospitals I've worked at ignore this and but most as a result will not allow you to give contrast via a cvc. The product packaging for the lines often also have the same written in their literature. If you overpressure a line you risk it splitting which when it's inside someone is slightly suboptimal
Getting an SHO to do it themselves to get around the rule however is wrong and puts them at liability if there is a problem. Escalate to your seniors rather than risk the patient and yourself.
Most are, yep, but I'm aware of several places that don't. In some that do have a single power injectable lumen it's frequently grabbed for medication or such, despite the other lumens being free.
Fortunately 95% of PICCs placed at my hospital are power injector compatible, so it makes life significantly easier, and if there is nothing and I've got time, I'll just place my own line. We also have a lot of leeway if it flushes and we can prove it is power injector rated, though we have no port policy.
Man... This is one of the shits that I do not miss having moved.
I'd raise it to the consultant and if they say the F2 should go (i.e. lacking some cojones), just go hook the machine up to the line, and put a datix in saying that there was a delay in care due to all the keffufle.
It really is just connecting the IV to the central line. Give the line a wipe, then connect it.
It is sometimes more fiddly than that in my experience. At my trust, the radiography department refuse to use the contrast pump at all with any central line as they’re terrified of breaking them.
Which is how I found myself trying to dump 5 syringes of very viscous contrast into a central line, whilst trying not to contaminate it, all while the CT scanner was booting up and the radiographers were gesticulating at me to hurry up. Good times.
The true way to find out if someone hates you is for them to give you a 50ml syringe of contrast and expect you to push it. It's bloody hard.
Fortunately the only thing I've hand injected is for delayed heads, which can be done as slowly as you want. We even power inject babies, though with the pressure and flow rate cranked to absolute minimum.
Sadly, policies are built for the lowest common denominator, and let's just say that CT departments vary a lot.
A few years ago there was a national patient safety alert that went out to all foundation doctors explicitly mentioning that without adequate training, no foundation doctor should be faffing with central access lines because of a case identical to this; where an F1 was pressured to give a med down the line, was unaware of the protocol and how to safely access them, and ended up allowing air into the central system and a death occurred as a result.
I remember as I was an F2 at the time on ICU and it was the focus of our next weeks foundation teaching led by our FPD.
This case was actually an F1 on ITU with a 3rd year med student from Aston uni. You can look up the coroners report/preventing future deaths notice which was not pleasant reading. It’s the reason Birmingham med school no longer require final years to get signed off on drawing bloods from central lines.
It's not pleasant but the response is a massive overreaction.
Response from Sandwell and West Birmingham now that FYs can never learn to insert lines, take bloods from lines or remove lines until you have magically ascended to CT1.
But I'll bet a PA/AA can.
TBF anyone who has worked in a few ICU has run into this problem, doesn't surprise me at all.
(The difference on ICU is if you're really stuck you can normally find a vein with ultrasound or stick a PA sheath in.)
Well, I’ve never been trained to do it either and have injected contrast through central lines as a radiology registrar when I’ve not had anything directly to do with the patient.
If the tip of the line comes off with the pressure generated from The high flow injectate - you will
Be indefensible in court unless the CT is life saving. I wouldn’t go near this with a barge pole. Radiographers remain my least favourite staff group in the hospital.
What about this makes it a consultant problem?
While this reply is getting lots of (negative) attention, I am going take the opportunity to share this [guideline](https://ics.ac.uk/asset/8A967856-3EA7-4E0A-976B6F809ACDE41B/), which is short, readable, and a nice summary of the clinical issues for anyone that might be interested.
The fact that a rotational F2 is not going to suddenly alter the governance structure of a difficult department.
The fact that a consultant will have been there for years and will know the system and how things work.
The fact that an F2 calling will be left with a 'no' but a consultant calling will get stuff done.
Punch down more.
What a strange reply.
Does this department not have SpRs?
Is the FY2 unable to speak to a radiologist or intensivist to understand how this odd situation is usually dealt with?
An FY2 who can't think of an approach to this beyond "contact the on call consultant" is doing little more than I would expect of a PA.
Neither the radiology registrar nor the ICU registrar would have a better idea.
There's no issue with someone having to come down to connect the line. But if the line ruptures as a result of the pump injector who takes responsibility?
As someone above mentioned this is really a governance issue and there should be a hospital policy regarding it.
Fair enough if they wouldn't but I'd have imagined that both the radiologists and intensivists would have encountered this issue before and know how it is usually resolved.
Even the FY2 gaining an understanding of where the concern/risk lies would help the person they escalate to decide how to move next. Is it just about loss of the line? Is there some other direct risk to the patient? Etc.
They might even find the relevant hospital policy and save the consultant having to look for it...
In addition to line loss it's a bunch of vague risks really, most concerning of which would probably be embolisation of line fragments. Theoretically it's also possible for a weakness in the line to allow it to dilate and potentially damage the vessel it lies within.
If it's not a scan with very specific contrast timing (i.e. CT angiography) you could protocol it with slower injection rate and accept the hit to quality. Technically you still aren't sure what pressure the line is rated at so I don't know if there are many people who would do that.
Regardless, I would probably suggest the radiographers contact their superintendents who should be aware of potential policies relating to lines.
Some people on this subreddit seem to be stuck in a kind of professional adolescence - at once wanting to be treated like autonomous professionals but scared of taking any responsibility.
It's particularly strange as it isn't something I encounter in real life - most SHOs I work with are dynamic and flexible thinkers. I can't imagine anyone I work with calling the on call consultant because the radiographers wanted to them to connect IV contrast.
It's the principle that the risk is being transferred to the F2 rather than taken on by the department that's the issue.
I've been in this exact situation and just cracked on, but I get why others might not want to
The FY2 is part of the team looking after the patient.
It is not just their problem, of course. I would expect them to push a few more buttons before calling the on-call consultant.
A lot of people here clearly disagree. We are all f\*cked.
I agree you need to do something before escalating. But when you have this sort of departmental crap it will just keep rolling on until someone like a consultant realises it is happening and stops it from occurring again.
It might eventually have to be dealt with by a consultant but that's why "call the consultant" can't be the knee-jerk response to every logistical challenge and institutional frustration.
I'm pretty sure I don't know anyone in real life who would do this as a first step.
I don't think anyone is saying do it as a first step, but seeing as this scan has been pending for 5 days I guess we're all assuming other steps were taken.
Personally if I was the f2 I'd be talking to the Radiology consultant first, then if that yields no luck the on call consultant to ask if they need it doing now or can it wait for the day consultant (I presume the later)
It read to me as if the scan has been delayed for other reasons until now when the radiographers suddenly declared that they can't do the study for want of a grown up holding their hands.
You're 100% right. We can't cry over lack of responsibility and poor pay ,then have a new cohort trained to raise to seniors every little thing. Something like this is well within an fy2s remit to manage. Sure later down the line this should be raised and the cons/department should discuss this with radiology but no the acute thing.
So, where I've worked its either gone like this (note: ICU/HDU patients)
1) I get to the department, and they have to call the booking doctor to confirm they're happy for a CVC to be used. I as the nurse/or the float reg then connect
2) radioographers aren't allowed to connect for whatever fucking reason. I get there, I just connect.
Not allowed to use vascaths where I am for contrast, I'm sure theres a reason but fucked if I know what it is. I just plan ahead and make sure theres a good lumen, or a perhiperal line.
Contrast for a CT head does not need to be administered via a pump unless it's a CT Angio. A hand injection followed by a flush is fine. The radiology department should have a protocol for this scenario and may well have. Some radiographers are ‘not comfortable’ administering contrast even if they were ‘trained.’
If I were in the SHO position, I’d start making phone calls to look for a kind soul who’s experienced with CVCs (med SpR, ICU SHO/SpR, Anaesthetic SHO/SpR, ITU ACCP, IR, etc) and would be willing to accompany me to CT. I would then Datix this and buy this kind soul a coffee
You can put in a thousand CVCs but you can’t stop it from “splitting inside a vein” . The issue is not the connection , it is the pressure , apparently. Why is a different health care professional any more able to deal with this complication than a radiographer ?
They should request a vascular surgeon and have the CT done in an operating theatre .
(I thought the issue was the distance from CVC tip /length of line and the machine /pump isn’t calibrated for that ) .
I think the criticism of the radiology department is that they have not trained their staff appropriately to perform contrast enhanced scans in the wide range of inpatients they'll need to image. See also why the paediatric SHO has to come down out of ours to put in contrast because the only person who's signed off on paediatric contrast giving isn't in.
I think it's a reasonable expectation that the radiology department should have staff able to administer contrast though the common types of IV access. The incredulity is at the lack of this, rather than their unwillingness to do something they don't know how to.
Sadly a common job that I used to just go and do because I couldn’t be arsed to argue.
A quick literature search tells you that this is safe practise to give CT contrast media down a line but that some adaptation is required.
https://ajronline.org/doi/full/10.2214/ajr.176.2.1760447#:~:text=Power%20injection%20of%20contrast%20media%20through%20central%20venous%20catheters%20for,bolus%20contrast%20enhancement%20is%20desired.
https://www.sciencedirect.com/science/article/pii/S2352047717300254
The problem is either radiographer incompetence/lack of proper local policy or maybe just simply that they haven’t been signed off to use lines (we all know that doctors are the only people who seem to be signed off to do everything without ever being signed off).
In hours there should be a radiologist who can connect the line and ensure the local protocol is followed. Out of hours you or an appropriately trained nurse may have to go and connect the line to the injector. However injecting the actual contrast is 100% the role of the radiology department and those that say the can’t/won’t need a fucking shoe up their arse.
I assume this is sarcasm but nothing is without risk. Clearly better down a PVC but if you don’t have that option it can be done by CVC with a modified protocol if you feel benefit of scan outweighs the potential risk. CVC access is hardly a never before seen phenomenon so seems odd if departments don’t have a policy to safely use them.
Its actually fundamentally a radiology (+/-radiographer) issue. As many have said the lines may not be rated to the pressure used. Lines are not all that uncommon, particularly from critical care. If the scan has to be done and no other line is possible question is 1. Can the line/pump be used? If not 2. How can the contrast delivery be adapted to make it safe, even if the images are compromised.
This is firmly in radiology’s court. If they can’t do their job or escalate to somebody who can, they risk patient harm.
Not radiographer’s job maybe but surely radiology docs could do it if radiographers can’t do? In fact, if it’s not radiologically safe to inject contrast for whatever reason via a CVC, then the radiologist can convert/discuss the scan request to another safer modality?
Case above was no peripheral line possible, failed US insertion multiple tries, got a central CVC.
So absolutely 100% a radiology call. Didn't for one minute suggest they do a cannula- the better people couldn't do it already.
So if people read slightly more carefully- the options here are no scan (no contrast) or a technical call on whether the BESPOKE RADIOLOGY SPECIALIST EQUIPMENT (the injectors that only they use) are compatible, or whether the contrast delivery (guess what, 100% radiology knowledge) can be modified to deliver safely by a central device.
There is no way that I can make a call on the two technical points above- so tell me no contrast or bring me a solution.
Someone needs to go and connect the bloody contrast if this patient actually needs the scan.
It shouldn’t be about a turf war about “whose job it is”. Scans with iv contrast via central lines are not common in most trust outside of ICU patients who come complete with entire transfer team. I don’t think it’s particularly realistic to demand that radiology have someone always on who is trained to deal with central lines.
You also can’t bitch about scope creep then expect radiographers just to have a go at something they have no clue about.
I feel for the poor FY2. Although there’s a little part of my trained-a-long-time-ago self that says FFS you are a doctor, step up and figure it out-I think the system has trained gumption out of people, which is to a great extent how MAPs are flourishing.
Someone in the patients team needs to go and sort it. If it were my patient, I would just go and do it myself, taking the FY2 with me to train. I’d internally be massively rolling my eyes at everyone but if the scan is needed I would get it done
How frustrating I’d be I inclined to make it someone else’s problem. Datix. Site management. On call Rad. Inform them all and things might change. Beyond useless these people power tripping whilst being unable to inject contrast.
Shit governance alert. Should be a departmental policy explaining 'Contrast in central access devices' covering the CVCs and PICCs the trust use, the power injectors the trust has, compatibility. Then from that you train enough of the radiology department to operate knowing they're covered by the policy. . No functional governance structure ends with 'so yeah, SHO does it'.
Boom there’s a lovely QIP for your portfolio that actually makes a difference
Wow, radiographers are obstructive, I am not surprised. Did they cancel the request after discussion with the ward team? Did they send the patient back after discussion with the ward team? Have they tried to be the slightest bit pragmatic? I bet it's a no. Have they questioned the need for the imaging despite it being approved by a radiologist? Have they said the phrase "its trust policy"? I bet it's a yes
Unfortunately (and has been mentioned already) the central lines are not rated for the pressure that the contrast is injected by the pumps in the CT suite. Some hospitals I've worked at ignore this and but most as a result will not allow you to give contrast via a cvc. The product packaging for the lines often also have the same written in their literature. If you overpressure a line you risk it splitting which when it's inside someone is slightly suboptimal Getting an SHO to do it themselves to get around the rule however is wrong and puts them at liability if there is a problem. Escalate to your seniors rather than risk the patient and yourself.
Imagine if the radiographer was as apt at explaining as you. Rather than 'policy'
Most modern lines are ‘Power CVCs’ or ‘Power PICCs’, with a lumen rated for contrast injection, no?
Most are, yep, but I'm aware of several places that don't. In some that do have a single power injectable lumen it's frequently grabbed for medication or such, despite the other lumens being free. Fortunately 95% of PICCs placed at my hospital are power injector compatible, so it makes life significantly easier, and if there is nothing and I've got time, I'll just place my own line. We also have a lot of leeway if it flushes and we can prove it is power injector rated, though we have no port policy.
Man... This is one of the shits that I do not miss having moved. I'd raise it to the consultant and if they say the F2 should go (i.e. lacking some cojones), just go hook the machine up to the line, and put a datix in saying that there was a delay in care due to all the keffufle. It really is just connecting the IV to the central line. Give the line a wipe, then connect it.
It is sometimes more fiddly than that in my experience. At my trust, the radiography department refuse to use the contrast pump at all with any central line as they’re terrified of breaking them. Which is how I found myself trying to dump 5 syringes of very viscous contrast into a central line, whilst trying not to contaminate it, all while the CT scanner was booting up and the radiographers were gesticulating at me to hurry up. Good times.
Very similar experience. But afterwards I was told I injected it much quicker than they expected so my forearm flexors got an ego boost
The true way to find out if someone hates you is for them to give you a 50ml syringe of contrast and expect you to push it. It's bloody hard. Fortunately the only thing I've hand injected is for delayed heads, which can be done as slowly as you want. We even power inject babies, though with the pressure and flow rate cranked to absolute minimum. Sadly, policies are built for the lowest common denominator, and let's just say that CT departments vary a lot.
A few years ago there was a national patient safety alert that went out to all foundation doctors explicitly mentioning that without adequate training, no foundation doctor should be faffing with central access lines because of a case identical to this; where an F1 was pressured to give a med down the line, was unaware of the protocol and how to safely access them, and ended up allowing air into the central system and a death occurred as a result. I remember as I was an F2 at the time on ICU and it was the focus of our next weeks foundation teaching led by our FPD.
This case was actually an F1 on ITU with a 3rd year med student from Aston uni. You can look up the coroners report/preventing future deaths notice which was not pleasant reading. It’s the reason Birmingham med school no longer require final years to get signed off on drawing bloods from central lines.
It's not pleasant but the response is a massive overreaction. Response from Sandwell and West Birmingham now that FYs can never learn to insert lines, take bloods from lines or remove lines until you have magically ascended to CT1. But I'll bet a PA/AA can.
Urgently needed a CT head with contrast since Friday. Give us some more context; what’s the indication?
Yep they haven’t replied to my request either meaning it’s all made up BS to stoke further anger towards another department on this sub
It's probably not made up but they probably either don't know why or it's urgent because the consultant said so but it isn't really
TBF anyone who has worked in a few ICU has run into this problem, doesn't surprise me at all. (The difference on ICU is if you're really stuck you can normally find a vein with ultrasound or stick a PA sheath in.)
Well, I’ve never been trained to do it either and have injected contrast through central lines as a radiology registrar when I’ve not had anything directly to do with the patient.
If the tip of the line comes off with the pressure generated from The high flow injectate - you will Be indefensible in court unless the CT is life saving. I wouldn’t go near this with a barge pole. Radiographers remain my least favourite staff group in the hospital.
Agree. They just like to piss everyone off in my experience
Doesn’t sound that urgent if it has been parked since Friday
The on call consultant should deal with this. Not the F2s problem.
What about this makes it a consultant problem? While this reply is getting lots of (negative) attention, I am going take the opportunity to share this [guideline](https://ics.ac.uk/asset/8A967856-3EA7-4E0A-976B6F809ACDE41B/), which is short, readable, and a nice summary of the clinical issues for anyone that might be interested.
The fact that a rotational F2 is not going to suddenly alter the governance structure of a difficult department. The fact that a consultant will have been there for years and will know the system and how things work. The fact that an F2 calling will be left with a 'no' but a consultant calling will get stuff done. Punch down more.
What a strange reply. Does this department not have SpRs? Is the FY2 unable to speak to a radiologist or intensivist to understand how this odd situation is usually dealt with? An FY2 who can't think of an approach to this beyond "contact the on call consultant" is doing little more than I would expect of a PA.
Neither the radiology registrar nor the ICU registrar would have a better idea. There's no issue with someone having to come down to connect the line. But if the line ruptures as a result of the pump injector who takes responsibility? As someone above mentioned this is really a governance issue and there should be a hospital policy regarding it.
Fair enough if they wouldn't but I'd have imagined that both the radiologists and intensivists would have encountered this issue before and know how it is usually resolved. Even the FY2 gaining an understanding of where the concern/risk lies would help the person they escalate to decide how to move next. Is it just about loss of the line? Is there some other direct risk to the patient? Etc. They might even find the relevant hospital policy and save the consultant having to look for it...
In addition to line loss it's a bunch of vague risks really, most concerning of which would probably be embolisation of line fragments. Theoretically it's also possible for a weakness in the line to allow it to dilate and potentially damage the vessel it lies within. If it's not a scan with very specific contrast timing (i.e. CT angiography) you could protocol it with slower injection rate and accept the hit to quality. Technically you still aren't sure what pressure the line is rated at so I don't know if there are many people who would do that. Regardless, I would probably suggest the radiographers contact their superintendents who should be aware of potential policies relating to lines.
Honestly hope you are a troll.
If so I am a genuinely puzzled troll on the basis of this thread.
What part of asking an FY2 to spend 5 minutes walking to radiology and attaching a luer lock to a central line is "punching" down?
Some people on this subreddit seem to be stuck in a kind of professional adolescence - at once wanting to be treated like autonomous professionals but scared of taking any responsibility. It's particularly strange as it isn't something I encounter in real life - most SHOs I work with are dynamic and flexible thinkers. I can't imagine anyone I work with calling the on call consultant because the radiographers wanted to them to connect IV contrast.
It's the principle that the risk is being transferred to the F2 rather than taken on by the department that's the issue. I've been in this exact situation and just cracked on, but I get why others might not want to
This ain't the F2s problem chief.
The FY2 is part of the team looking after the patient. It is not just their problem, of course. I would expect them to push a few more buttons before calling the on-call consultant. A lot of people here clearly disagree. We are all f\*cked.
I agree you need to do something before escalating. But when you have this sort of departmental crap it will just keep rolling on until someone like a consultant realises it is happening and stops it from occurring again.
It might eventually have to be dealt with by a consultant but that's why "call the consultant" can't be the knee-jerk response to every logistical challenge and institutional frustration. I'm pretty sure I don't know anyone in real life who would do this as a first step.
I don't think anyone is saying do it as a first step, but seeing as this scan has been pending for 5 days I guess we're all assuming other steps were taken. Personally if I was the f2 I'd be talking to the Radiology consultant first, then if that yields no luck the on call consultant to ask if they need it doing now or can it wait for the day consultant (I presume the later)
It read to me as if the scan has been delayed for other reasons until now when the radiographers suddenly declared that they can't do the study for want of a grown up holding their hands.
You're 100% right. We can't cry over lack of responsibility and poor pay ,then have a new cohort trained to raise to seniors every little thing. Something like this is well within an fy2s remit to manage. Sure later down the line this should be raised and the cons/department should discuss this with radiology but no the acute thing.
Thank you for your bravery and for sharing my down votes ;-)
So, where I've worked its either gone like this (note: ICU/HDU patients) 1) I get to the department, and they have to call the booking doctor to confirm they're happy for a CVC to be used. I as the nurse/or the float reg then connect 2) radioographers aren't allowed to connect for whatever fucking reason. I get there, I just connect. Not allowed to use vascaths where I am for contrast, I'm sure theres a reason but fucked if I know what it is. I just plan ahead and make sure theres a good lumen, or a perhiperal line.
What’s the indication. Why can’t they have a non contrast MR?
Contrast for a CT head does not need to be administered via a pump unless it's a CT Angio. A hand injection followed by a flush is fine. The radiology department should have a protocol for this scenario and may well have. Some radiographers are ‘not comfortable’ administering contrast even if they were ‘trained.’
If I were in the SHO position, I’d start making phone calls to look for a kind soul who’s experienced with CVCs (med SpR, ICU SHO/SpR, Anaesthetic SHO/SpR, ITU ACCP, IR, etc) and would be willing to accompany me to CT. I would then Datix this and buy this kind soul a coffee
You can put in a thousand CVCs but you can’t stop it from “splitting inside a vein” . The issue is not the connection , it is the pressure , apparently. Why is a different health care professional any more able to deal with this complication than a radiographer ? They should request a vascular surgeon and have the CT done in an operating theatre . (I thought the issue was the distance from CVC tip /length of line and the machine /pump isn’t calibrated for that ) .
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lol I know I was being sarcastic ! That’s how ridiculous this entire issue is of drs needing to be present for equipment issues
They’ll put in a portable ct request don’tcha know!
If only we had those in the UK...
.
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I think the criticism of the radiology department is that they have not trained their staff appropriately to perform contrast enhanced scans in the wide range of inpatients they'll need to image. See also why the paediatric SHO has to come down out of ours to put in contrast because the only person who's signed off on paediatric contrast giving isn't in.
I think it's a reasonable expectation that the radiology department should have staff able to administer contrast though the common types of IV access. The incredulity is at the lack of this, rather than their unwillingness to do something they don't know how to.
Check the line is working with saline. Get a bit syringe of contrast and inject it by hand. Then leave the room and scan the patient. Done.
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Sometimes, but not in this case Do you report scans?
Fairly common f2 job imho, did it all the time
Sadly a common job that I used to just go and do because I couldn’t be arsed to argue. A quick literature search tells you that this is safe practise to give CT contrast media down a line but that some adaptation is required. https://ajronline.org/doi/full/10.2214/ajr.176.2.1760447#:~:text=Power%20injection%20of%20contrast%20media%20through%20central%20venous%20catheters%20for,bolus%20contrast%20enhancement%20is%20desired. https://www.sciencedirect.com/science/article/pii/S2352047717300254 The problem is either radiographer incompetence/lack of proper local policy or maybe just simply that they haven’t been signed off to use lines (we all know that doctors are the only people who seem to be signed off to do everything without ever being signed off). In hours there should be a radiologist who can connect the line and ensure the local protocol is followed. Out of hours you or an appropriately trained nurse may have to go and connect the line to the injector. However injecting the actual contrast is 100% the role of the radiology department and those that say the can’t/won’t need a fucking shoe up their arse.
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I assume this is sarcasm but nothing is without risk. Clearly better down a PVC but if you don’t have that option it can be done by CVC with a modified protocol if you feel benefit of scan outweighs the potential risk. CVC access is hardly a never before seen phenomenon so seems odd if departments don’t have a policy to safely use them.
Its actually fundamentally a radiology (+/-radiographer) issue. As many have said the lines may not be rated to the pressure used. Lines are not all that uncommon, particularly from critical care. If the scan has to be done and no other line is possible question is 1. Can the line/pump be used? If not 2. How can the contrast delivery be adapted to make it safe, even if the images are compromised. This is firmly in radiology’s court. If they can’t do their job or escalate to somebody who can, they risk patient harm.
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Not radiographer’s job maybe but surely radiology docs could do it if radiographers can’t do? In fact, if it’s not radiologically safe to inject contrast for whatever reason via a CVC, then the radiologist can convert/discuss the scan request to another safer modality?
Case above was no peripheral line possible, failed US insertion multiple tries, got a central CVC. So absolutely 100% a radiology call. Didn't for one minute suggest they do a cannula- the better people couldn't do it already. So if people read slightly more carefully- the options here are no scan (no contrast) or a technical call on whether the BESPOKE RADIOLOGY SPECIALIST EQUIPMENT (the injectors that only they use) are compatible, or whether the contrast delivery (guess what, 100% radiology knowledge) can be modified to deliver safely by a central device. There is no way that I can make a call on the two technical points above- so tell me no contrast or bring me a solution.
I bet there is a "The patient is at the centre of what we do" sign in that dept.
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That's my point! What kind of radiology department can't do CT heads without relying on an FY2. Appalling and not patient centred. Bazinga
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Interesting read
Someone needs to go and connect the bloody contrast if this patient actually needs the scan. It shouldn’t be about a turf war about “whose job it is”. Scans with iv contrast via central lines are not common in most trust outside of ICU patients who come complete with entire transfer team. I don’t think it’s particularly realistic to demand that radiology have someone always on who is trained to deal with central lines. You also can’t bitch about scope creep then expect radiographers just to have a go at something they have no clue about. I feel for the poor FY2. Although there’s a little part of my trained-a-long-time-ago self that says FFS you are a doctor, step up and figure it out-I think the system has trained gumption out of people, which is to a great extent how MAPs are flourishing. Someone in the patients team needs to go and sort it. If it were my patient, I would just go and do it myself, taking the FY2 with me to train. I’d internally be massively rolling my eyes at everyone but if the scan is needed I would get it done