The Interventional Radiology Department (IRD) at Tampa General Hospital, Tampa, FL, has increased the number of interventional procedures performed tremendously over the past 5 years.
Our IR Department performs a variety of invasive procedure from simple cases such as a central venous access insertion like peripherally inserted central catheter (PICC) lines, to more complicated procedures requiring the skills of the neurointerventional radiologist, from cerebral angiograms with embolization of tumor or aneurysm coiling, to stroke intervention and the insertion of transjugular intrahepatic portal systemic shunts (TIPs), to name just a few.
These types of procedures performed in the IRD, which are among many others, not only provide cost-effective alternatives to traditional surgery, but also make my role as a nurse challenging and more personally meaningful each day.
Gaining Access
The techniques performed in the IRD allow the physician to gain access to many organ systems in the body with a tiny puncture either in the groin, arm or any other direct site of body part.
For example, an individual who has a history of variceal bleeding or ascites as a consequence of a portal hypertension, the physician can use the TIPS procedure to provide a nonsurgical decompression shunt as a temporary treatment solution for a liver transplant candidate.
Most all procedures performed in the IRD are done with the patient under conscious sedation or general anesthesia, depending on the severity and complexity of the case, and the patient’s status.
In each procedure room there is a team of two radiology technologists, a registered nurse and a radiologist. We are responsible for following the recommended guideline of the hospital’s policy for the safety of our patients.
Nurse Roles & Responsibilities
My roles and responsibilities regarding each procedure impact each patient’s physical and emotional dimensions. My working experiences in IRD are quite unique because it not only includes intra-procedurals care, but involves pre-and post procedural care, as well.
When I care for a patient during each procedure, I have to be more concerned with each individual’s characteristics. Most of our patients and their families are depending on me to assist with their unique care situations. My practices must be proficient in order to provide the patient with a sense of security while they are under my care.
Synergy Model
I use the Synergy Model of nursing practice to deliver the care for all of my patients.
This model of nursing practice includes the following nursing roles which are crucial to the success of any procedure:
- advocacy in the role of an educator;
- clinical judgment in the role of an administrator; and
- clinical inquiry in the role of a protector.
Pre-Procedure
Before any procedure will take place, patient education and preparation helps greatly in the outcome.
I usually start each case by going over the patient’s chart, medical history, home medication, lab results, doctor’s orders, consent form and NPO status. I talk to each patient before bringing the patient into the procedure room.
As with any procedure, when the fear of the unknown occurs, concern about the outcome leads to increased anxiety. I use many techniques to help prepare a patient. I start by letting the patient meet with the physician and go over all options possible, and then after the patient agrees, I will go over what will take place during and after the procedure.
By preparing the patient step-by-step, anxiety can be reduced and emotional stress lessened.
Intra-Procedure
I perform an initial assessment of the patient by monitoring the patient’s blood pressure, respiration, heart rate, rhythm, and oxygen saturation.
This initial assessment is the most important information for the procedure.
By knowing the patient’s status, the management of the patient’s airway during administration of drugs can be easier. From start to finish the patient’s vital signs are monitored throughout the procedure and his level of comfort is noted.
I use music therapy along with giving patients sedation medication to help them cope with the anxiety and to distract them from pain or other unpleasantness associated with the procedure. And remember that every patient finds it helpful to go over the pre-procedure and post-procedure instructions in their own language whenever possible.
By preparing the patient and keeping him informed about what is happening is reassuring and increases patient satisfaction.
Post-Procedure
After the procedure is completed, the surgical site needs to be cleaned and covered. In some instances, additional time is needed to compress at the puncture site to prevent bleeding or hematoma.
Patients are always thankful for when the proper technique is performed and they have been protected from developing complications.
Putting Patients First
By educating patients and their families about their procedures it helps them to become more active participants in decision making, while a better understanding of each complex procedure lessens their anxiety levels.
By helping patients to be involved with their own care pre- and post-procedure, it provides them with better a better understanding of what is happening to them, which invariably translates into greater patient satisfaction.
Puntipa Lily Phuphanich is a registered nurse working in the Interventional Radiology Department at Tampa General Hospital, Tampa, FL.
