Abstracts

Many medical centers with epilepsy monitoring units (EMU), are performing ictal brain scintigraphy (SPECT). In order to produce accurate SPECT images, the injection of radiopharmaceutical (tracer) must occur during the seizure. After the onset of a seizure, the preferred maximum amount of time allowed for injecting the isotope is 90 seconds with less than 30 seconds being optimal. The medical personnel in closest proximity to the patient during seizure onset is the registered nurse (RN). Injection of the radioactive tracer by the RN may be the best way to ensure an optimally timed ictal injection. State radiation regulatory agencies are often reluctant to grant permission to perform these injections to allied health personnel outside of the Nuclear Medicine department. We will describe our RN safety education program and competency assessment program at Mayo Clinic Arizona (MCA). The Arizona Radiation Regulatory Agency (ARRA) controls the use of all radiopharmaceuticals. MCA has a broad scope radioactive material license from the ARRA. ARRA granted approval to deliver the injection of radiopharmaceuticals for this procedure, provided that an education module and competency assessment were developed for the RNs at MCA working in the EMU. Certified Nuclear Medicine Technologists (CNMTs) and the Radiation Safety Officer (RSO) provided initial education (January 2003) for these RNs. Advisory opinions posted by the Arizona State Board of Nursing had previously established that RNs were able to inject IV contrast medium for diagnostic studies such as computed tomography. A total of 15 RNs were present for the initial training which involved viewing a radiation safety video, reading and verbalizing understanding of the unit specific ictal radiopharmaceutical injection policy. A performance criteria sheet was completed as each RN demonstrated the correct performance of these injections. The initial class was approximately one hour. All 26 EMU RNs completed the same education requirements described above. All RNs (100%) met the competency requirement. This competency is reinforced and revalidated during annual unit based education, which is mandatory for all RNs. During annual competencies RNs are not required to view the radiation video again, however, they are required to demonstrate understanding of the policy as well as correct performance of the injection and handling of the radioactive material. Despite regulatory deterrents to the procedure, EMU RNs play an important role in the injection of ictal SPECT scan patients at MCA. Through a dedicated radiation safety education and competency assessment, EMU RNs can aquire the knowledge and skills necessary for the safe and rapid injection of the radiopharmaceutical during a seizure event.