Download Nuclear Medicine Section

Kingdom of Saudi Arabia
Ministry of Health
King Fahad Medical City
‫اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮب اﻟﺴﻌﻮدﯾﺔ‬
‫وزاره اﻟﺼﺤﺔ‬
‫ﻣﺪﯾﻨﮫ اﻟﻤﻠﻚ ﻓﮭﺪ اﻟﻄﺒﯿﺔ‬
Nuclear Medicine Section
Medical Imaging Administration
Tel No.: 288 9999 ext 1047/1048
Fax No.: 288 9999 ext 1046
Leaflet E:
INSTRUCTIONS TO EMU NURSING STAFF ON
SEIZURE (ICTAL & POST ICTAL) BRAIN PERFUSION SPECT STUDY
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Study is scheduled by the neurologist of EMU in conjunction with supervising nuclear medicine
(NM) physician and coordinated through both Nuclear Medicine Section and the Epilepsy
Monitoring Unit (EMU).
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Female patients should not be pregnant. If the patient is breast-feeding, the patient should stop
breast-feeding for 24 hr after injection of radiopharmaceutical and discard the milk.
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A list of patient's present medications, neurological & neuropsychiatry history, and CT and MRI
scans findings, renal function, allergy to food, dyes & preservatives should be made available to the
NM physicians before the study is scheduled. Need to determine if any of patient's medications
should be withheld for the test.
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Patient is admitted in EMU for seizures monitoring. Caffeine products like tea, coffee and colas,
alcohol and other drugs such as benzodiazepines that may affect brain flow should be withheld for
24 hrs before the test. Otherwise, patient may eat and drink as usual. The patient should be well
hydrated.
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Cerebral Perfusion SPECT study will be done between 8.30 am and 3 pm.
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NM technologist has to identify the patient. Verify NM physician's order. Explain the procedure to
patient and relatives, and to nursing staff. Explain and instruct patient to remain motionless during
imaging. It is critical that the patient be able to lie still for the duration of the scan. Excessive motion
and improper positioning can render an examination uninterruptible. If the patient is agitated or
confused, having a family member present may be helpful If this may be a problem, the NM
physician should be informed so that modifications to scan acquisition may be contemplated, such as
doing a series of shorter scans, rather than a long one. All these should be preferably done before
injection of radiopharmaceutical.
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An i.v catheter line is inserted in the patient's hand or arm and flushed with heparinised saline in
advance by EMU nurse, so that the patient does not experience pain from the needle puncture at the
time of radiopharmaceutical injection ( as it can influence cerebral blood flow ).
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Patient is monitored in a quiet room with subdued dim lighting. Little soft or no speaking, no noise
from within or outside, or interacting with staff from 15 min before to 15 min after injection of
radiopharmaceutical is necessary. This is to limit extraneous brain activity that could influence brain
flow. No sitters or roommates should be present until the injection is complete.
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Patient should not be sedated prior to injection of radiopharmaceutical unless necessary. Sedation, if
necessary to facilitate SPECT imaging, should only be given 15 after radiopharmaceutical
administration.
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NM technologist takes to the EMU an adult dose 30 mCi of Tc-99m-ECD (neurolite)in a syringe
with leaded syringe shield, labeled as to content (30), in a lead box carrying case and places it in a
secured area. The activity remaining in the syringe at 1, 2, 3, 4, 5, 6 hr should be provided and
explained to the EMU nurses. Dose for children is adjusted according to weight. If the patient is not
injected, the syringe dose must be topped up by the NM technologist to a full dose of 30 mCi (1110
MBq) or to a dose appropriate for a child, every 2-3hrs. If the dose is not used within 6 hrs of
reconstitution it shall be considered expired and discarded as radioactive waste by the NM
technologist.Tc-99m-ECD is stable up to 6 hr post reconstitution.
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When the EMU nurse notes the onset of seizure activity, the full dose of Tc-99m-ECD is to be
immediately injected intravenously through existing i.v line as a slow bolus push followed with a 10
ml heparinised saline flush. This injection is to be performed only by an EMU nurse trained to give
Tc-99m-ECD injection and in radiation protection. Gloves must be worn. The empty syringe should
be placed back into the leaded carrying box, and disposed by NM technologist.
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The EMU nurse injecting the patient will record the exact time of injection. Time should be recorded
in terms of both the clock time as well as the time in seconds between onset of seizure activity and
the bolus injection. This time in seconds should be as accurate as possible and can be obtained by
review of the video record.
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The patient should be well hydrated and encouraged to drink plenty of fluids (adults 500 ml of water
taken after injection of Tc99m-ECD) and void frequently with 2 hours interval for at least 6 hours
post-injection. This will decrease radiation exposure to the bladder wall.
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Once the patient is stable, the EMU staff will contact NM unit and arrange a time for the image
acquisition. The NM reception staff should give a time earliest as possible. The image acquisition
should begin within 2 hrs of injection. EEG leads should be removed in the EMU, empty bowel and
bladder, change diapers (if applicable) and paediatric urine collector inserted for child who has no
bladder control, before sending the patient down to NM for imaging.
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The neurologist prescribes sedation with intravenous Lorazepam or equivalent, if necessary to
facilitate SPECT imaging. It should be given only 15 min after injection of Tc-99m-ECD via existing
intravenous line by EMU nurse in the imaging room and not in the EMU (as the patient needs to be
moved to the imaging table).
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An EMU nurse will accompany the patient to NM unit and return the patient to the EMU afterwards.
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If the patient had no baseline Interictal study, this should be booked in conjunction with the EMU
neurologist and the supervising NM physician.
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