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Guidelines for Administration of Invasive & Noninvasive Respiratory Support in Nuclear Medicine Procedures (2.09)

Guidelines for Administration of Invasive & Noninvasive Respiratory Support in Nuclear Medicine Procedures (2.09) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Mechanical Ventilation

2.09





2.09 Guidelines for Administration of Invasive & Noninvasive Respiratory Support in
Nuclear Medicine Procedures
Category: UWHC Patient Care Policy
Effective Date: January 1, 2016
Version: Revision
Section: Mechanical Ventilation

I. PURPOSE
Aerosolized radio-tagged media (Tc 99m DTPA) is delivered via positive pressure ventilation or
BiPAP/CPAP support to assess ventilation distribution within the lung. V/Q scans are done to image
lung ventilation versus perfusion. Respiratory Therapy (RT) provides mechanical ventilation or
continuous CPAP support during the test. Ventilator or CPAP parameter changes assure ventilation is
adequate and the V/Q scan is optimized.

II. POLICY
A. All patients are assessed by the RT to determine if appropriate indications for therapy are present.
B. V/Q scans will be performed in accordance with a provider’s order.
C. Pneupac Transport ventilators cannot be used during the V/Q procedure.
D. NMT will provide a full face resuscitation mask for non-intubated patients. Nasal masks should
not be used for this procedure.
E. The NMT will discard the resuscitation mask.
F. V/Q scans must be done only with a shielded nebulizer system dedicated to this procedure.


IV. EQUIPMENT
A. The Nuclear Medicine Technologist (NMT) will provide the following equipment:
1. Shielded, disposable nebulizer
2. Disposable resuscitation mask for non-invasive mechanical ventilation and CPAP
3. Extra high pressure extension tubing (stored in E1/392)
B. Noninvasive BiPAP/CPAP system
C. Critical care ventilator or Hamilton transport ventilator


V. PROCEDURE
A. NMT responsibility: (Content is provided to delineate practitioner responsibilities for this test.)
1. Stores, prepares, assures correct dosage and administers radio-tagged media to patients
according to written protocol.
2. Assures minimal exposure to patients and health care workers from radiation.
3. The aerosol generator is a single patient use item; discarded by the NMT after use
employing appropriate techniques for disposing of nuclear biohazardous material.
4. Once the media is instilled into the nebulizer, the shield must be immediately closed and
not reopened to avoid radiation exposure. The nebulizer gas connection must be secure
prior to closing shield. The nebulizer must also be seated into the oxygen inlet carefully
to avoid breakage and resultant leakage of media.
5. Sets nebulizer gas flow at 8 lpm and communicates this flow to the RT. Nebulization can
take from 5 to 10 minutes.
6. Assures the proper disposal of nuclear media and contaminated disposable items.
7. Stores all contaminated reprocessed equipment to allow the decay of nuclear material
prior to sending the equipment to reprocessing.






B. RT responsibility:
1. Use extra high-pressure tubing (stored room E1/392 in the Nuclear Medicine area) if the
ventilator air/oxygen high-pressure tubing is not long enough to reach the needed
ventilator placement. Return the tubing to the storage area when done.
2. Attach the ventilator wye or BiPAP or CPAP tubing with exhalation valve to the aerosol
manifold on the top of the lead canister shield
3. The BiPAP/CPAP circuit will be shortened by the NMT. (See related link).
4. Adjust patient ventilation parameters as tolerated by the patient and as needed to improve
imaging.
a. Adjust set ventilator tidal volume to compensate for the additional nebulizer gas
using peak pressure as the reference. Retaining a slightly larger delivered tidal
volume could be desirable to negate system mechanical dead space and/or
improve aerosol distribution.
b. Other options available to improve distribution and deposition of the diagnostic
aerosol (to be used as needed) include:
1. Using the lowest respiratory rate tolerated.
2. Using the lowest flowrate (i.e.: longest inspiratory time) tolerated.
3. Using the longest pause time tolerated.
4. Bypassing (and turning off) the heated humidifier for the duration of the
media aerosolization.
5. Return all modified ventilator or CPAP settings to baseline after the
aerosol delivery is completed and perform a complete ventilator check.


VI. REFERENCES

A. CADEMA Nuclear Medicine Aerosol System illustration.
B. UWHC Nuclear Medicine Department P&P: Ventilation Lung Scan-Aerosol.



Approved by Director and Medical Director of Respiratory Care:

A copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].