Harris Stephen, Crowley James R, Warden Nancy
Vascular Wellness Management Solutions, Cary, NC, United States.
Department of Molecular Imaging, Carilion Clinic, Roanoke, VA, United States.
Front Nucl Med. 2023 Oct 13;3:1244660. doi: 10.3389/fnume.2023.1244660. eCollection 2023.
The nuclear medicine community has stated that they are using best practices to gain venous access and administer radiopharmaceuticals, and therefore do not contribute to extravasations. We tested this hypothesis qualitatively and quantitatively by evaluating four different perspectives of current radiopharmaceutical administration practices: (1) clinical observations of nuclear medicine technologists on the job, (2) quality improvement (QI) projects, (3) a high-level survey of current practices in 10 acute care hospitals, (4) intravenous (IV) access site data for 29,343 procedures. These four areas were compared to the gold standard of pharmaceutical administration techniques.
From clinical observations of radiopharmaceutical administrations in adult populations, technologists extensively used 24-gauge peripheral intravenous catheters (PIVCs) and butterfly needles. They also performed direct puncture (straight stick). Technologists predominantly chose veins in areas of flexion (hand, wrist, and antecubital fossa), rather than forearm vessels for IV access placement; in many circumstances, antecubital fossa vessels are chosen first, often without prior assessment for other suitable vessels. For selecting the injection vein, technologists sometimes used infrared vein finders but primarily performed blind sticks. Review of QI projects suggested that smaller gauge needles were contributing factors to extravasations. Additionally, the review of surveys from 10 hospitals revealed an absence of formalized protocols, training, knowledge, and skills necessary to ensure the safety/patency of IV devices prior to the administration of radiopharmaceuticals. Finally, findings from a review of IV access data for 29,343 procedures supported the observations described above.
We expect that nuclear medicine technologists have the best intentions when providing patient care, but many do not follow venous access best practices; they lack formal protocols, have not received the latest comprehensive training, and do not use the best placement tools and monitoring equipment. Thus, the presumption that most nuclear medicine technologists use best practices may not be accurate. In order to improve radiopharmaceutical administration and patient care, the nuclear medicine community should update technical standards to address the most recent peripheral IV access and administration best practices, provide technologists with vascular visualization tools and the proper training, develop and require annual vascular access competency, and provide active monitoring with center and patient-specific data to create ongoing feedback.
核医学领域宣称他们采用最佳实践来获得静脉通路并给予放射性药物，因此不会导致外渗。我们通过评估当前放射性药物给药实践的四个不同视角，对这一假设进行了定性和定量测试：（1）核医学技术人员的在职临床观察；（2）质量改进（QI）项目；（3）对10家急症医院当前实践的高级别调查；（4）29343例操作的静脉（IV）通路部位数据。将这四个方面与药物给药技术的金标准进行了比较。
从对成人放射性药物给药的临床观察来看，技术人员广泛使用24号外周静脉留置针（PIVC）和蝶形针。他们也进行直接穿刺（直刺）。技术人员主要选择屈曲部位（手、腕和肘前窝）的静脉，而非前臂血管进行静脉通路置管；在许多情况下，首先选择肘前窝血管，通常没有事先评估其他合适的血管。对于选择注射静脉，技术人员有时使用红外静脉探测器，但主要是盲目穿刺。对QI项目的审查表明，较小规格的针头是导致外渗的因素。此外，对10家医院调查的审查显示，在给予放射性药物之前，缺乏确保静脉装置安全/通畅所需的正式方案、培训、知识和技能。最后，对29343例操作的静脉通路数据审查的结果支持了上述观察。
我们期望核医学技术人员在提供患者护理时抱有最良好的意图，但许多人并未遵循静脉通路最佳实践；他们缺乏正式方案，未接受最新的全面培训，也未使用最佳的置管工具和监测设备。因此，认为大多数核医学技术人员采用最佳实践的假设可能并不准确。为了改善放射性药物给药和患者护理，核医学领域应更新技术标准，以涵盖最新的外周静脉通路和给药最佳实践，为技术人员提供血管可视化工具和适当培训，制定并要求每年进行血管通路能力评估，并利用中心和患者特定数据进行主动监测，以产生持续反馈。
