|
It has become textbook fodder: In 2001, a 6-year-old boy named Michael underwent routine magnetic resonance imaging following successful removal of a brain tumor. When piped-in oxygen failed, an oxygen tank was brought in. What happened next was pure disaster.
The MRI's 10-ton magnet - 30,000 times more powerful than Earth's magnetic field, according to one ABC News report, sucked the ferrous canister across the room and into the machine's bore, crushing Michael's head. That is where his life ended.
"The tank found the strongest part of the magnetic field - the center of the bore," explained AnnaMarie Bair, MR, RT (R), MRI supervisor for PinnacleHealth, Harrisburg, Pa. "Tragically, that child was in the center, too."
The blame for the tragedy fell on a lack of proper MRI suite design, training, and procedures. Seven years and 389 MRI-related "events" later, the Joint Commission issued a Sentinel Event Alert enumerating dangers in the MRI environment and prescribing risk-reduction steps such as improved MRI facility layout, equipment, screening, and staff training.
Not only patients at risk
Think it is only patients in need of safeguarding? Think again. Respiratory therapists need to pay strict attention to this safety alert, or they, too, could find themselves in the path of destruction.
"Always make sure you are safe, as well as your patients," Bair said. "You, too, are going into that magnetic field. Some people don't understand the magnet is always on, never turned off. It's on whether a scan is under way or not."
Lee Sheaffer, RRT, education coordinator of respiratory care services at Pinnacle, said thorough screening is the first line of defense.
"During our orientation process for the therapists, we have them fill out a screening sheet with 10 crucial questions," Sheaffer said. They ask if the RT:
• has a pacemaker or cardiac defibrillator
• has aneurism clips
• has heart valve replacements
• has surgical implants
• has had surgery in the last six months (in case of staples, new joints, etc.)
• has had eye injuries involving metal fragments
• is pregnant
• has done metal grinding, welding, sheet metal work
• has been a machinist or metal hobbyist
• has shrapnel wounds.
Even the tiniest metal fragment in the eye could cause permanent eye damage if moved by the magnet's extreme pull.
It is mandatory that people entering the area have nothing on their person that could become a projectile. "Check everything," Bair cautioned. "You may wear a necklace that is safe one day, and one the next day that isn't. Gold is OK, but other metals may not be. Earrings have to be checked. Objects such as bobby pins, stethoscopes, cell phones must be removed. A pen or a set of keys flying through the ro om could cause harm to a patient or staff."
Sheaffer also advises RTs to leave their bank or credit cards elsewhere - the magnet will erase the cards.
One key is understanding
Anyone who comes to the MRI suite must know the basics of MRI safety, and RTs at PinnacleHealth are required to complete an online MRI safety education course. They learn about the types of equipment that are MRI compatible. Oxygen is piped into the MRI rooms, and they use non-ferrous oxygen tanks. But they choose not to use an MRI-compatible ventilator.
"Our respiratory department realized most vents are 'MRI-conditional' and can't go beyond a certain point in the room," Bair said. "One model could go near the table, but since patients would be on the middle of the bore, you'd need 15 feet of tubing to reach them."
As an alternative, PinnacleHealth's RTs devised their own system. "We use a resuscitation bag with a six-foot extension to the expiratory valve and just bag the patient during the MRI procedure," Sheaffer said. "We use tubing with a non-rebreathable valve, and an MRI-compliant PEEP valve to keep their lungs expanded and help with ventilation."
Patients also are on a pulse oximeter connected to an MRI-safe monitor. "The RTs think this system works best," Bair said. "So for now, that's our protocol."
Zoned for safety
Mark Kendrick, vice president of Consolidated Medical Services Inc., Hunt Valley, Md., has a unique understanding of safety in the MRI suite. He leads his company's design-build process, utilizing first-hand knowledge of health care facilities' management and clinical operations. Being married to an MRI tech does not hurt, either.
"The Joint Commission has developed recommendations for MRI safety zones," Kendrick said, "and they are required when designing a facility's MRI project."
The safety zones, which must be set apart by a barrier such as a wall or door, work like this:
Zone 1: A public zone where patients initially present. Patients can still have ferrous oxygen tanks.
Zone 2: Here patients are handed off to an MRI technologist to be screened for implants or possessions that are not safe. "A leg with an orthopedic implant, for example, could get sucked to the wall of the machine, causing it to twist or break," Kendrick warned. If patients are using non-compatible ventilators, oxygen, wheelchairs, or gurneys, Zone 2 staff would switch to compatible equipment.
Zone 3: At this final checkpoint ". patients should pass through a metal detector before going into a scan. It's very important," Kendrick said.
He is also quick to point out that physical safety zones are only truly effective when care providers maintain intellectual zones as well.
"Clinicians have to understand the progression, process, and procedures," Kendrick noted. "Exactly where are those MRI-safe oxygen tanks located? If a patient crashes, does the respiratory team know precisely where the compatible equipment is stored? Providers must address safety issues in both the physical and intellectual sense. The 'zones' go well beyond the MRI environment."
Contact Valerie Neff Newitt at vnewitt@advanceweb.com.
|