Through the SPECTacle of a Neurology Nurse

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Through the SPECTacle of a Neurology Nurse

• Natalie Cormier, BSN, RN
• Carlos Orellana, RN
• Felice Espinosa, MBA, BSN, RN

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Objectives

• Describe SPECT Scan and its purpose.
• Describe the role of a SPECT Nurse including safe
  administration of Neurolyte.
• Describe the characteristics of an EMU.

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Introduction

• What is SPECT?
• SPECT (Single Photon Emission Computed
  Tomography) imaging is a nuclear medicine study.
  It utilizes a radiopharmaceutical to create
  images of actual brain function by identifying
  blood flow patterns throughout the brain.
• Stewart, C. (2010). Single Photon Emission
  Computed Tomography (SPECT scan) basic level.
  Mayfield Clinic and Spine Institute. Retrieved
  from http//www.mayfieldclinic.com/PDF/PE-SPECT.pd
  f

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Introduction

• Brain perfusion SPECT is most commonly performed
  to aid in identification of epileptogenic focus
  in patients with medically refractory epilepsy
  (usually partial complex seizures) in whom
  surgical treatment is being considered.
• It shows hotspot
• In comparison to X-rays that display the internal
  structures of your body in 2-D image format,
  SPECT Scan generates 3-D images that display the
  actual working of the organs.
• For example, a SPECT scan can display the
  movement of blood to your heart or areas inside
  your brain that may be more or less active.
• SPECT Scan. (2012). Mayo Foundation for Medical
  Education and Research (MFMER). Retrieved from
  http//www.mayoclinic.com/health/spect-scan/MY0023
  3/DSECTIONrisks

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Introduction

• The radioisotopes typically used in a SPECT scan
  to identify blood flow are
• iodine-123,
• technetium-99m,
• xenon-133,
• thallium-201,
• fluorine-18
• These radioactive forms of natural elements are
  safe and will pass safely through your body. The
  most commonly used isotope at Texas Childrens
  Hospital is technetium.
• During a seizure, blood flow is highest at the
  point in the brain where the seizure starts.
• Stewart, C. (2010). Single Photon Emission
  Computed Tomography (SPECT scan) basic level.
  Mayfield Clinic and Spine Institute. Retrieved
  from http//www.mayfieldclinic.com/PDF/PE-SPECT.pd
  f

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RISKS

• Risks Involved
• Pain, swelling or bleeding at the specific spot
  on your arm where the needle was inserted.
• Although rare, allergic reaction may occur from
  the radioactive tracer.
• Radiation Risks
• During a SPECT scan, the least possible amount of
  radiation is used.
• Radiation levels during SPECT scans are similar
  to what you may be exposed to over a period of
  one year in your surroundings.
• SPECT Scan. (2012). Mayo Foundation for Medical
  Education and Research (MFMER). Retrieved from
  http//www.mayoclinic.com/health/spect-scan/MY0023
  3/DSECTIONrisks

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SPECT Imaging

SPECT Scan Brain Images (2012). Retrieved from
http//www.colin-studholme.net/research/ipag/
mrspect3.html.
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Indication for SPECT scan
Stewart, C. (2010). Single Photon Emission
Computed Tomography (SPECT scan) basic level.
Mayfield Clinic and Spine Institute.
Retrieved from http//www.mayfieldclinic.com/PDF/P
E-SPECT.pdf
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System Setup
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Procedure

• A peripheral IV is placed in a preferred site at
  the time of admission for the nurse to inject the
  radioactive tracer on the day of the SPECT scan
• The SPECT nurse and Child Life explain in
  developmentally appropriate ways about the SPECT
  scan prior to administration of the tracer.

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Baseline vs. Initiation of New Set
February 7, 2011 July 18, 2011
SPECT Radioisotope Injections Spills
Old set up (Baseline) 13 1
New set up (Initiation) 6 0
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Reinforcement of New Set up
August 1, 2011 August 30, 2012
SPECT Radioisotope Injections Spills
New set up 18 0
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Preparation for SPECT Procedure

• Our Radioactive Material Sign is placed on the
  patients door prior to the scan so that others
  will be aware of the test in progress.
• This also prevents any interruptions while the
  scan is in progress (i.e., the patient only
  seizes when she wakes up from a nap)

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SPECT Procedure

• Nuclear Medicine calls the RN when the tracer
  is ready
• Nurse goes to Nuclear Medicine to pick up the
  lead box (above) with the tracer in a lead
  lining, RN Injection Protocol chart, and patient
  sticker

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What to expect during a SPECT Scan?

• Usually, patient is made NPO if being sedated
  prior to SPECT Scan.
• SPECT Scan involves a two-step procedure
• Injection of radioisotope through the IV
• Scanning of the brain
• Ictal SPECT
• Radioactive material is administered during the
  seizure
• Interictal SPECT
• Radioactive material is administered NOT during
  the seizure
• Pediatric Epilepsy Surgery Program. (2012).
  Single Proton Emission Computed Tomography
  (SPECT). Childrens Hospital of Pittsburg of
  UPMC. Retrieved from http//www.chp.edu/CHP/singl
  ephotonemissioncomputedtomography(spect)

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SPECT SCANs
Picture courtesy of Child Life at Texas Chidrens
Hospital (with Parent Permission)
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SPECT SCANs

Picture courtesy of Child Life at Texas Chidrens
Hospital (with Parent Permission)
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SPECT SCANs

Picture courtesy of Child Life at Texas Chidrens
Hospital (with Parent Permission)
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Nursing Implications - Training
Picture courtesy of Child Life at Texas Chidrens
Hospital (with Parent Permission)
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Nursing Implications - Procedure
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Nursing Implications - Education

• Inform the patient about radioactive hazard and
  the procedure utilizing Child Life and their
  preparation book.
• Address concerns and reassure the patient that
  the Radionuclide poses no radioactive hazard.

• Reinforce importance of remaining still
  throughout the procedure because movement
  produces unreliable result.
• There are no food, fluid, or medication
  restrictions unless by medical direction.

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After the SPECT Scan

• What you need to know after the test
• A few hours after the SPECT scan, most of the
  radioactive substance is
• flushed out by the body through the urine.
• Patient needs to increase fluid intake to aid
  in removing the radioactive
• substance.
• Whatever is left behind is broken down by your
  body in one or two
• days
• SPECT Scan. (2011). Mayo Foundation for Medical
  Education and Research (MFMER).
• Retrieved from http//www.mayoclinic.com/h
  ealth/spect-scan/MY00233/DSECTIONrisks

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Epilepsy Monitoring Unit (EMU)

• Texas Childrens Hospital EMU is considered level
  IV center among children's hospitals due to
  several factors, such as facilities, great cases,
  certain surgeries, EMG, SPECT Scans, etc.
• Goals
• Collaboration with key stakeholders regarding
  expansion
• TCH Executives - EMU and Nursing
  Leaders/Team - Project Coordinator
• Epileptologists - IS
• Vendor

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Epilepsy Monitoring Unit (EMU)

• Goals (cont)
• Expansion of the EMU to 12-beds with
  state-of-the-art monitoring capabilities
• Increase the volume of SPECTs, GRIDs, and
  possibly conduct a research study with bed
  expansions
• Streamline admission process to the EMU and start
  VEEG study within a reasonable time
• Maintain positive working relationship between
  EMU staff and nursing
• Implementation of a dedicated RN EMU Team

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The EMU Team - RNs

• Consists of 11 RNs from days and 8 RNs from
  nights, 6 of which are SPECT nurses
• Only team members will be assigned to EMU beds
• Training for the team includes
• In-class training by Nuclear Medicine
• Hands-on training to perform SPECT in
• Nuclear Medicine
• In-class in service in regards to identifying
• types of seizures by EMU Faculty
• (Epileptologists)
• Only a SPECT RN can administer isotope

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Collaboration Between Nursing and EMU Staff

• Nursing daily huddle in the EMU
• Weekly meeting
• Increase communication in regards to patient
  seizure activity between nursing and EMU techs
• Meet and greet with the new EMU staff
• Increase communication in regards to patient
  admission
• Utilize EMU admission algorithm (next slide)
• Green Belt Project

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EMU Admission Process
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Green Belt Project

• DEFINE
• Identify the problem in the EMU
• MEASURE
• Document the current process
• Quantify baseline metrics
• Identify quick wins
• ANALYZE
• Identify potential causes

• IMPROVE
• Identify, prioritize, and pilot best solution(s)
• CONTROL
• Implement controls to sustain success
• Train all necessary personnel
• Audit periodically to validate

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Green Belt Project Baseline Data
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EMU Whats in the horizon?

• Expansion to a 6-bed EMU is underway
• Expand to a 12-bed unit is the ultimate goal
• Continue the Green Belt project
• Maintain collaboration with EMU and
  Epileptologists
• Review other initiatives to deliver quality
  patient care
• Improve patient satisfaction
• Maintain Level IV EMU center

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References

• Mullen, J. (2012). EMU Admission Process
  Flowchart. Texas Childrens Hospital.
• Pediatric Epilepsy Surgery Program. (2012).
  Single Proton Emission Computed Tomography
  (SPECT). Childrens Hospital of Pittsburg of
  UPMC. Retrieved from http//www.chp.edu/CHP/singl
  ephotonemissioncomputedtomography(spect)
• Scanning Images (2011). Child Life Department.
  Texas Childrens Hospital .
• SPECT Scan. (2011). Mayo Foundation for Medical
  Education and Research (MFMER). Retrieved from
  http//www.mayoclinic.com/health/spect-scan/MY0023
  3/DSECTIONrisks
• SPECT Scan Brain Images (2012). Retrieved from
  http//www.colin-studholme.net/research/ipag/
  mrspect3.html.
• Stewart, C. (2010). Single Photon Emission
  Computed Tomography (SPECT scan) basic level.
  Mayfield Clinic and Spine Institute. Retrieved
  from http//www.mayfieldclinic.com/PDF/PE-SPECT.pd
  f
• Texas Childrens Hospital (2011-2012). Epilepsy
  Monitoring Unit.

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Questions???