Download Pregnancy testing prior to diagnostic and interventional imaging

Pregnancy testing prior to diagnostic
and interventional imaging
RCN best practice for imaging nurses and health care assistants
Acknowledgements
With thanks to contributors from the RCN Imaging Nurses Forum.
Contributing authors:
Caroline Rushton, Nuclear Medicine Nurse, Royal Devon and Exeter NHS Foundation Trust
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
Maggie Williams, Lead Nurse, Radiology, Queen Elizabeth Hospital, Gateshead
This publication is due for review in November 2016. To provide feedback on its content 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 booklet 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, 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 website information and guidance.
Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN
© 2014 Royal College of Nursing. All rights reserved. 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, 90 Tottenham Court Road, London W1T 4LP. 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.
ROYAL COLLEGE OF NURSING
Introduction
The RCN Imaging Nurses Forum Committee promotes best practice in imaging, and has
produced this guidance to provide direction on current best practice concerning pregnancy
testing of women before they undergo any diagnostic and interventional imaging of any
modality. The guidance is intended for an imaging nursing audience. You should read this
document alongside the referenced further information.
The Health Protection Agency’s advice (2009) concerning in utero exposure to ionising
radiation is: “to prevent unnecessary exposure to the fetus” when medical diagnostic
procedures involving ionising radiation are indicated during pregnancy.
Therefore, before undertaking a diagnostic or interventional imaging procedure, it is essential
that health practitioners ask any female of reproductive age who presents for an examination
involving exposure of the pelvic area or the administration of radioisotopes whether she may
be pregnant.
A female of reproductive age is generally defined as being between 12 and 55 years of age,
although local trust policy and guidance may differ.
Testing for pregnancy
●
Where possible diagnostic or interventional imaging should be scheduled within 28 days
of the onset of the woman’s last menstrual period.
●
When a high-dose procedure is proposed (for example, a pelvic CT, fluoroscopic
examination of abdomen and pelvis, or contrast studies of abdomen and pelvis), local
policy may require the imaging procedure to be completed within ten days of the onset of
the woman’s menstrual period. If the woman cannot exclude the possibility of pregnancy,
then she should be asked if her menstrual period is overdue.
NOTE: Where pregnancy has been confirmed or cannot be excluded practitioners should seek
confirmation from the medical team who have authorised the investigation about whether
the benefits of carrying out the investigation outweigh the risks.
●
If the woman’s menstrual period is not overdue (within 28 days of the onset of the last
menstrual period) then a urine or serum test for pregnancy may be performed prior to the
interventional or diagnostic imaging.
PREGNANCY TESTING PRIOR TO DIAGNOSTIC AND INTERVENTIONAL IMAGING
●
Should the woman’s menstrual period be overdue and pregnancy is a possibility, a urine
or blood test for pregnancy must be carried out, in confidence. If possible, the imaging
procedure should be postponed until after the onset of the woman’s next menstrual
period.
●
Some women may use long acting reversible contraception (LARC). Such women are
considered to be of non-reproductive capacity if they have received injections, or
implanted devices under the care of a clinician. Each contraceptive treatment, device or
implant has specific advice and practitioners should consult the manufacturers’ guidance
and/or the clinician responsible for the LARC.
●
When a child is questioned about the dates of their menstrual period, it may be the case
that issues of child protection arise. In this case practitioners should consult their local
policy. In addition, guidance on these issues is available from the Royal College of
Paediatrics and Child Health (see further reading).
If you would like to know more about pregnancy testing before interventional or diagnostic
imaging, or if you would like to contact the RCN Imaging Nurses Forum call RCN Direct on
0345 772 6100 or visit the forum web pages at:
www.rcn.org.uk/development/nursing_communities/rcn_forums/imaging
ROYAL COLLEGE OF NURSING
References and further reading
British Institute of Radiology (2009) Pregnancy and work in diagnostic imaging
department (2nd Edition), London: British Institute of Radiology.
(ISBN 978-0-905749-67-9).
Great Ormond Street Hospital for Children NHS Foundation Trust (2014) Pregnancy
testing before treatment. Available at: www.gosh.nhs.uk/medical-information/proceduresand-treatments/routine-pregnancy-testing-before-treatment (Accessed 19 November
2014).
Health Protection Agency, Royal College of Radiologists and College of Radiographers
(2009) Protection of pregnant patients during diagnostic medical exposures to ionising
radiation. Available at:
www.ipem.ac.uk/Portals/0/Images/Protection%20of%20pregnant%20patients.pdf
(Accessed 19 November 2014).
National Patient Safety Agency (2010) Rapid Response Report: Checking pregnancy before
surgery. Available at:
www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=73883&type=full&servicet
ype=Attachment (Accessed 19 November 2014).
Royal College of Paediatrics and Child Health (2014) Child Protection Companion (2nd
edition). This and a range of child protection publications available at:
www.rcpch.ac.uk/child-health/standards-care/child-protection/publications/childprotection-publications (Accessed 19 November 2014).
The RCN represents nurses and nursing, promotes excellence in
practice and shapes health policies
November 2014
Review date: November 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 004 678
ISBN 978-1-910066-96-6