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Echocardiography Contrast Ordering by Sonographers - Adult - Inpatient/Ambulatory [57]

Echocardiography Contrast Ordering by Sonographers - Adult - Inpatient/Ambulatory [57] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 57

Delegation Protocol Title:
Echocardiography Contrast Ordering by Sonographers – Adult – Inpatient/Ambulatory

Delegation Protocol Applies To:
Echo Vascular Lab

Target Patient Population:
Adult inpatient and ambulatory patients with an order to receive an echocardiogram

Delegation Protocol Champion:
Peter Rahko, MD – Department of Medicine – Cardiology, Medical Director of Echo Lab

Delegation Protocol Reviewers:
Nancy Bell, RN, RCDS, RVT – Program Manager – Echo/Vascular Lab
Mary Chivington – MBA, RDCS, RCCS, RVT - Echo/Vascular Lab Manager
Brenda Herron, BSN, RN

Responsible Department:
Echo/Vascular Lab

Purpose Statement:
To delegate authority from providers to cardiac sonographers to place orders for
echocardiography contrast agents and placing IV lines when needed to enhance the
diagnostic quality of the echocardiogram.

Who May Carry Out This Delegation Protocol:
Sonographers performing echocardiography procedure who are registered diagnostic cardiac
sonographers (RDCS or RCS) through American Registry of Diagnostic Medical Sonographers (ARDMS) or
Cardiovascular Credentialing International (CCI).

Training will be led by senior staff with considerable experience and demonstrated ability to carry out
the delegated acts (as confirmed by the delegating providers). Training will consist mostly of one-on-one
instruction with the new staff who must also demonstrate ability before they serve as delegates.

Guidelines for Implementation:
1. The protocol will be implemented when a patient has an order for an echocardiogram from a
UWHealth Provider.
2. Contraindications – Perflutren microsphere (DEFINITY, OPTISON) contrast agent will not be
administered to any patients with
known hypersensitivity or known reaction to perflutren microspheres (DEFINITY, OPTISON).
3. Step by Step Instructions
3.1. Sonographer reviews clinical reason/indication for exam.
3.2. Sonographer completes preliminary study, if unable to visualize, if unable to visualize
completes the remainder of this protocol.
3.3. Sonographer screens the patient to determine their risk for reaction to contrast agents. If the
patient is determined to be at high risk, the provider MUST be consulted and this protocol
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org



cannot be implemented.
3.4. If the patient is not high risk, the sonographer determines the contrast agent needed for the
study as indicated below.
3.4.1. Perflutren microsphere (DEFINITY, OPTISON) will be used for the following indications:
• Enhanced assessment of left ventricle function with Left Ventricular Opacification (LVO)
and Endocardial Border Definition (EBD)
• To facilitate the identification and assessment of intracardiac masses, such as tumors and
thrombi
• To improve the visualization of the right ventricle and great vessels and enhance Doppler
signals
3.4.2. Agitated saline will be used for the following indications:
• Assess for the presence of an atrial septal defect (ASD)
• Assess for the presence of an arteriovenous malformation (AVM)
• Assess for the presence of a patent foramen ovale (PFO)
• Diagnosis of stroke (CVA) or transient ischemic attack (TIA)
• Pre liver transplant work ups to evaluate for hepatic fistula
• Assess for potential embolic source as requested by provider
3.5. Sonographer enters the orders for perflutren/agitated saline and, if needed, insertion of an IV
line.
3.5.1. In areas using Health Link for order entry the sonographer will enter the order in Health
Link using order set: IP - ECHO – Supplemental. The orders will be signed with as order mode
of “Protocol/Policy, Without Cosign”.
3.5.2. In areas not using Health Link for order entry the sonographer will write the order on
paper, indicate “Per protocol” and date, time and sign the orders. The order form will then
be submitted for scanning into Health Link.

Order Mode: Protocol/Policy, Without Cosign

References:
1. Definity [package insert]. N. Billerica, MA: Lantheus Medical Imaging; 2017.
2. Optison [package insert]. Marlborough, MA: GE Healthcare Inc; 2016.
3. Scope of Practice for the Diagnostic Ultrasound Professional. American Society of
Echocardiography. http://www.asecho.org/i4a/pages/index.cfm?pageid=3550.
Accessed February 8, 2017.

Collateral Documents/Tools:
1. UWHC Nursing Policy #10.24 Administration of Echocardiography Contrast Agents. Effective June 27,
2016.
2. IP - ECHO – Supplemental Order Set [4137]

Approved By:
UW Health Ambulatory Protocol Committee: January 2012, *March 2014; *March 2017
UWHC P&T Committee: February 2012, *July 2014; *April 2017
UWHC Medical Board: March 2012, *July 2014; *April 2017
UW Health Chief Medical Officer: April 2012, *July 2014; *April 2017

Effective Date: April 2017

Scheduled for Review: April 2020
*Expedited Review Process
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org