Download Patients undergoing minor interventional procedures such as biopsy

Patients undergoing minor
interventional procedures
such as biopsy, drain
insertion and aspiration
Best practice guidance for nursing staff
Patients undergoing minor interventional procedures
Acknowledgements
With thanks to contributors from the RCN Imaging Nurses Forum.
Contributing authors:
Maggie Williams, Lead Nurse, Radiology, Queen Elizabeth Hospital, Gateshead
Brenda Munro, Sister, Radiology Department, Princess Elizabeth Hospital, Guernsey
Grace Johnston, Practice Educator, Radiology and Medical Specialties, NHS
Grampian
Mina Karamshi, Specialist Sister, Royal Free Hampstead NHS Trust
Caroline Rushton, Nuclear Medicine Nurse, Royal Devon and Exeter NHS
Foundation Trust
This publication is due for review in July 2016. To provide feedback on
its contents or on your experience of using the publication, please email
[email protected]
RCN Legal Disclaimer
This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers
are advised that practices may vary in each country and outside the UK.
The information in this publication has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort
has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the
circumstances in which it may be used. Accordingly, to the extent permitted by law, the RCN shall not be liable to any person or entity
with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this
information and guidance.
Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN
© 2014 Royal College of Nursing. All rights reserved. Other than as permitted by law no part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise,
without prior permission of the Publishers or a licence permitting restricted copying issued by the Copyright Licensing Agency, Saffron
House, 6-10 Kirby Street, London EC1N 8TS. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade
in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers.
2
Royal colleGe of nursing
Contents
Introduction4
1. Pre-procedure
5
2. Peri-procedure
7
3. Post-procedure
9
4. References and further reading
10
5. Glossary
11
3
Patients undergoing minor interventional procedures
Introduction
This guidance has been developed by the Royal College of Nursing (RCN) Imaging
Nurses Forum to support radiology nurses (nurses registered with the NMC in
accordance with NMC 2010 guidance) in providing a clinically effective and safe
environment when assisting and monitoring patients during minor interventional
procedures such as biopsy, drain insertion and aspiration.
Patients undergoing such procedures will be admitted either as a day case or will be
an inpatient, but the standard preparation process will be the same in all cases.
This best practice guidance is divided into three parts and follows the
patient’s journey:
• pre-procedure
• peri-procedure
• post-procedure.
This guidance has been produced to facilitate consistency throughout radiology
departments nationally. It can be used in conjunction with other best practice
guidance for imaging nurses. This guidance can also be a useful source of reference
for support workers and other health care professionals.
Return to contents
4
Royal colleGe of nursing
1 Pre-procedure
Patient pre-assessment may be carried out by a registered radiology nurse in the
form of a telephone call, or a face-to-face appointment. All information obtained
should be documented in the patient’s notes. Patients should also be given written
and verbal information about their procedure.
Action
Pre-assessment
Reason for action
Obtain patient history as per local guidelines
for each procedure.
Gain information about the patient to assess
the patient’s suitability for the proposed
procedure.
Assists the patient to understand the
procedure and to make an informed decision
about proceeding.
To reduce the risk of regurgitation and
inhalation of stomach contents if sedation is
administered.
Explain the procedure to the patient and give
written information.
Give the patient a date and time for the
procedure and explain that they should
refrain from eating food for six hours
pre-procedure and drinking fluids for two
hours pre-procedure, or as per local policy.
Give advice as per local guidelines with regard
to medications that need to be stopped prior
to procedure and hydration prior to
procedure.
For females of child-bearing age pregnancy
status should be obtained.
The patient should arrange for someone to
take them home and stay with them
overnight, post-procedure, unless they are to
remain in hospital overnight.
Written consent can be obtained by medical
staff or a designated professional with sound
knowledge of the procedure.
Minimises the risk of complications such as
bleeding, contrast induced nephrotoxicity/
nephropathy and metformin induced lactic
acidosis.
Avoids exposing the foetus to ionising
radiation.
To ensure immediate attention should
post-procedure complications occur.
Establishes that the patient has full
understanding of what is involved, the
potential benefits and risks, and wishes to
proceed.
Measure and record blood pressure, pulse,
To identify the patient’s normal range and
respiration rate and oxygen saturation levels. establish a baseline.
Obtain blood samples and screening swabs as To ensure it is safe to administer IV contrast,
per local policy and ensure any abnormal
to identify pathogenic organisms and to
results are acted on.
reduce the risk of bleeding.
5 Return to contents
Patients undergoing minor interventional procedures
Action
On the day of the procedure
Reason for action
Patients who are taking anticoagulants may
need a blood test to check coagulation status.
Refer to local guidance.
Check the patient has undergone relevant
investigations; for example ultrasound scan,
blood tests, lung function test, ECG.
Written consent from the patient will be
obtained (or confirmed) by the clinician
performing the procedure, or a designated
professional with sound knowledge of the
procedure.
Insert an intravenous cannula, if local policy
requires it.
Ensure the patient is wearing an identification
bracelet with the correct information.
Ensure all required equipment is available, as
per WHO/RCR* check list.
* See glossary on page 11.
Minimises the risk of haemorrhage.
To ensure all relevant information is available
to the operator/radiologist.
Establishes that the patient has full
understanding of what is involved, the
potential benefits and risks, and wishes to
proceed.
Allows immediate administration of sedation,
or emergency drugs and intravenous fluids.
To ensure correct patient identification and
prevent possible problems/errors.
Promote patient safety and reduce delays to
procedure.
Return to contents
6
Royal colleGe of nursing
2 Peri-procedure
Where analgesia or sedation is given, the nursing team should include a registered
nurse who possesses advanced resuscitation skills; their role will be to monitor the
patient. A registered radiology nurse or HCA (with suitable NVQ3 qualification) will
assist the radiologist.
Action
Reason for action
Receive the patient from the ward and
complete the accompanying checklist.
To ensure up-to-date accurate information is
available and to ensure the patient still wishes
to proceed.
Reassures the patient and reduces any anxiety.
Explain the procedure and equipment to the
patient.
Reassure the patient and answer any
questions.
Ensure a WHO/RCR safety checklist
handover occurs before the procedure
commences.
Written consent should be obtained, if not
previously done.
To provide emotional support to the patient.
To reduce potential risks to patient safety.
Establishes that the patient has full
understanding of what is involved, the
benefits and risks, and wishes to proceed.
Assist with positioning the patient, ensuring
To maintain the patient’s dignity, and body
that they are covered by the gown or blanket. temperature.
Connect the patient to a monitor and record To provide a baseline for comparison during,
blood pressure, oxygen saturation, respiration and post-procedure. Allows early
rate and pulse rate, at locally agreed intervals. identification of complications, ensuring
prompt action should they arise.
Assist in the preparation of a sterile field with Reduces risk of infection, and ensures smooth
all the equipment needed for the radiologist, running of the procedure.
using aseptic technique.
At the end of the procedure provide a sharps Reduces the risk to patients and staff by
bin for the clinician, check disposal of sharps following national guidance and local policies
and document on WHO/RCR* checklist.
on infection control, clinical risk, and health
Ensure clinical waste is disposed of according and safety.
to local policy.
* See glossary on page 11.
7 Return to contents
Patients undergoing minor interventional procedures
Action
Reason for action
Ensure that the patient’s care pathway/plan is Ensures complete documentation for easy
completed and signed. The radiologist should access and future reference, and ensures
prescribe any post-procedure medication.
appropriate treatments are carried out in the
follow-up period.
The nurse/HCA gives a complete handover to Enables effective follow-up by documenting
the recovery nurse or ward nurse. This should care needs, and possible complications.
include details of the procedure, postprocedure care and possible complications.
Complete WHO/RCR• safety checklist sign
out and scan onto the radiology department’s
computer system.
* See glossary on page 11.
Return to contents
8
Royal colleGe of nursing
3 Post-procedure
Post-procedure instructions should be documented in the patient’s notes, and
followed, to reduce the risk of complications occurring.
Action
Reason for action
Nurse the patient appropriately on a bed/
chair, depending on the procedure and local
policy.
For patient safety during their recovery
period.
Observe wound site for signs of bleeding. Ask To promote patient comfort and early
the patient to report any pain. Monitor and
detection of post-procedural complications.
record the patient observations including
oxygen saturation level, pulse, blood pressure
and respiration rate at locally agreed intervals
for signs of potential complications. For
drainage procedures monitor wound site,
fluid type and volume.
Inform the medical staff promptly of any
change in the patient’s condition such as,
pain, signs of distress, haemoptysis or
changes in the patient’s skin colour.
To ensure prompt medical attention.
Have prescribed analgesia available.
To ensure the patient will be comfortable and
as pain free as possible.
Give full explanation to the patient of when
results will be available and details of
follow-up appointments.
To ensure the patient is aware of when their
results and any future treatment will be
discussed.
Once the patient is ready for discharge
remind the patient of any potential
complications, wound care, and who to
contact if they have any medical problems
post-procedure. Give written discharge
instructions.
To ensure the patient will be reassured and
informed. Written instructions will ensure
the patient has an accurate record of
post-procedure care and contact details for
follow-up or emergency care.
9 Return to contents
Patients undergoing minor interventional procedures
4 References and further reading
Board of the Faculty of Clinical Radiology, Royal College of Radiologists, and the
Royal College of Nursing (2014) Guidelines for nursing care in interventional
radiology: the roles of the registered nurse and nursing support, London: RCR.
Board of the Faculty of Clinical Radiology, Royal College of Radiologists (2003) Safe
sedation, analgesia and anaesthesia within the radiology department, London: RCR.
Available from: www.rcr.ac.uk (accessed 19 February 2014).
British Society of Gastroenterology (2004) Guidelines on the use of liver biopsy in
clinical practice [on-line publication]. Available from: www.bsg.org.uk (accessed 19
February 2014).
Dougherty L and Lister S (editors) (2004) The Royal Marsden Hospital manual of
clinical nursing procedures (sixth edition), Oxford: Blackwell.
Francis IS and Watkinson AF (2000) Interventional radiology explained, London:
ReMedica.
Jones S and Taylor EJ (2006) Imaging for nurses, Oxford: Blackwell Publishing Ltd.
Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K,
Richardson C and Sawicka E (2003) Guidelines for radiologically guided lung biopsy,
Thorax, 58, November, pp.920-936. Available from: thorax.bmj.com (accessed 19
February 2014).
Nursing and Midwifery Council (2010) Joining the register [on-line webpage].
Available from: www.nmc-uk.org (accessed 19 February 2014).
Patel IJ, Davidson JC, Nikolic B, Salazar GM, Shwartzberg MS, Walker G. and Saad
WA (2012) Concensus guidelines for periprocedural management of coagulation
status and hemostasis risk in percutaneous image-guided interventions, Journal of
Vascular Radiology, 23, pp.727-736.
Royal College of Nursing (2005) The management of pressure ulcers in primary and
secondary care: a clinical practice guideline, London: RCN. Available at:
www.rcn.org.uk/clinicalguidelines (accessed 3 March 2014).
Royal College of Radiologists (2010) Standards for intravascular contrast agent
administration to adult patients (second edition), London: RCR.
Return to contents 10
Royal colleGe of nursing
Royal College of Radiologists (2012) Standards for patient consent particular to
radiology departments, London: RCR.
Royal College of Radiologists (2013) Guidance for fellows in implementing surgical
safety checklists for radiological interventional procedures, London: RCR.
5 Glossary
HCA Health care assistant
NMC Nursing and Midwifery Council
RCR Royal College of Radiologists
WHO World Health Organization
11 Return to contents
The RCN represents nurses and nursing, promotes
excellence in practice and shapes health policies
July 2014
Review date: July 2016
RCN Online
www.rcn.org.uk
RCN Direct
www.rcn.org.uk/direct
0345 772 6100
Published by the Royal College of Nursing
20 Cavendish Square
London
W1G 0RN
020 7409 3333
www.facebook.com/royalcollegeofnursing
www.twitter.com/thercn
www.youtube.com/rcnonline
Publication code: 004 593
ISBN: 978-1-910066-51-5