MRI Preparation and Procedure (Neonates and infants)



Canberra Hospital and Health ServicesClinical Guideline MRI Preparation and Procedure (Neonates/infants)Contents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc506454940 \h 1Guideline Statement PAGEREF _Toc506454941 \h 2Background PAGEREF _Toc506454942 \h 2Key Objective PAGEREF _Toc506454943 \h 2Alerts PAGEREF _Toc506454944 \h 2Scope PAGEREF _Toc506454945 \h 2Section 1 – MRI Preparation & Procedure PAGEREF _Toc506454946 \h 2Section 2 – Equipment PAGEREF _Toc506454947 \h 3Non-ventilated Infant PAGEREF _Toc506454948 \h 3Ventilated Infant PAGEREF _Toc506454949 \h 3Section 3 – Preparations PAGEREF _Toc506454950 \h 3Non-Ventilated Infants PAGEREF _Toc506454951 \h 3Infants receiving respiratory support (ventilated /CPAP PAGEREF _Toc506454952 \h 4Section 4 – On return to Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU) PAGEREF _Toc506454953 \h 5Implementation PAGEREF _Toc506454954 \h 5Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc506454955 \h 5References PAGEREF _Toc506454956 \h 5Search Terms PAGEREF _Toc506454957 \h 6Guideline StatementBackgroundMagnetic Resonance Imaging (MRI) is an investigative procedure that permits safe and painless scans of the human body, providing information related to structural changes and abnormalities.. Indications for MRI include Hypoxic Ischemic Encephalopathy (HIE) Grade 2 or 3, seizures, or to assess structural brain defects. Term neonates/infants require MRI for Grad 3 or 4 Intra-ventricular Haemorrhage or Periventricular Leukomalacia on ultrasound scan.Infants require special preparation for this procedure.Key ObjectiveThis guideline outlines the preparation for and transportation of infants to MRI.Alerts Ventilated infants must have a Neonatal Registrar/Fellow or Consultant present during transport and procedure.All staff in attendance at MRI must have completed MRI safety training.Also refer to Neonatal Neurology ProcedureBack to Table of ContentsScopeThis document pertains to all infants who are patients in the Department of Neonatology and who require an MRI. This document applies to the following Canberra Hospital Health Services (CHHS) staff working within their scope of practice:Medical Officers (MO)Registered Nurses and MidwivesStudent Nurses and Midwives working under supervisionBack to Table of ContentsSection 1 – MRI Preparation & ProcedureNursing and medical staff will ensure that parents have been informed that the infant is to have an MRI and that the pre-MRI checklist has been completed by the nursing staff. A consent form is to be signed by the parents if the MRI is performed under anaesthetic. Ensure the MO has completed the MRI request form and obtained consent.Back to Table of ContentsSection 2 – EquipmentNon-ventilated InfantAlcohol based hand-rub (ABHR)Oxygen, tubing and suction unit with cathetersLaerdal bag and mask (ensure mask is correct size)Additional oral sedation and the infants medication chart Supportive bean bag mattress (kept in MRI) Oxygen saturation monitor (if required for transport)Low flow oxygen meter and long piece of green tubing (if required) Ventilated Infant In addition to above:Shuttle with MRI compatible ventilatorGiraffe open care centre or isoletteSyringe pumps for all infusions20ml syringesAnaesthetic MRI circuit (in MRI box in Unit equipment room)IV extension sets x 2 for each infusionYellow ear muffsBack to Table of ContentsSection 3 – Preparations Non-Ventilated InfantsEnsure the MO has sent the request to MRIAdmit the infant if not an inpatient. Outpatients should ideally be admitted to the Paediatric Day Stay UnitEnsure the infant has 2 ID labels insituRemove the infant’s clothing if it has any metal parts e.g. zips, press studs Replace the metal IV board with a plastic or cloth board Zinc oxide tapes do not need to be replaced unless they are in the area to be scannedReplace zinc oxide tape with Micropore? if necessaryThe Nurse/Midwife is to remove all metal from their person if they are going into the MRI room with the infant e.g. scissors, jewelleryCheck sedation order (chloral hydrate before feed) with another RN/M and administer to the infant a minimum of ? hour prior to the procedure (wait for notification by MRI staff)Ensure the infant is fed prior to the sedation and provide top up feed if required to ensure that the infant is settled and quiet during procedureEnsure there is an additional order in place for further sedation in the event the infant becomes wakeful and that a further small amount of feed is availableCheck portable oxygen, suction and self-inflating bag prior to transport to ensure correct working orderWards-person are sent by MRI staff, if they do not arrive on time, page them via switchEnsure the medical notes, observation chart and medication chart accompany the infant to MRI.Infants receiving respiratory support (ventilated /CPAPEnsure that the parents are informed about the MRI, have signed the consent form and have the information sheet: ‘the MRI information sheet for parents’Ensure the MO has sent request to MRIEnsure the infant is placed on a Giraffe open care centre or isolette prior to procedure to ensure that the infant can be transported via the shuttleEnsure infant has 2 ID labels insituAdminister IV sedation if ordered by MODraw all IV infusions into 20ml syringes and prime 2 extension tubes (2metres of tubing)Zinc oxide tapes do not need to be replaced unless they are in the area to be scannedReplace zinc oxide tape with Micropore? if necessaryReplace metal IV board with a plastic or cloth boardMonitor infant (heart rate, oxygen saturation) during transport as requiredParents may accompany their infant during transfer, however they must wait in the waiting room during the procedureAttach infant to MRI compatible ventilator for transport to MRI Check and take MRI anaesthetic circuit and retrieval bag to MRIEquipment from NICU is not permitted inside the MRI room except a low-flow oxygen-meter, infusion pumps in the MRI compatible cabinet and the MRI compatible ventilatorFor infants receiving bubble CPAP, remove metal fasteners that hold the snorkel in place and replace with cloth tapes (trachy tape) and replace toggle with Micropore?Ensure the medical notes, observation chart and medication chart accompany the infant to MRIAttach infant to MRI oxygen saturation monitor and ensure it is working properly prior to commencement of procedureSwaddle infant in warm blanket and supportive bean bag mattress. MRI staff will withdraw air until the infant is snuggly surrounded by the mattressVentilated infants are ventilated with the MRI compatible ventilator during the procedure Observe vital signs throughout procedure and if there are any concerns assess the infant and continue if appropriate, otherwise terminate the procedure and attend to infant Following the procedure, page wards-person for return transport to NICUDocument in progress notes that the procedure has been performedBack to Table of Contents Section 4 – On return to Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU)The registered nurse will: monitor oxygen saturation hourly for 4 hours following procedure as the infant has been sedatedInform parents of infant’s return to SCNDocument in progress notes that the procedure has been performedWhen the infant is fully awake, feed the infant The Neonatologist on service is responsible for notifying parents of results of investigation.Back to Table of ContentsImplementation Staff will be informed of the new procedure via email and in-service education.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesConsent and TreatmentProceduresHealthcare Associated Infections Clinical ProcedurePatient Identification and Procedure Matching PolicyNeonatal Neurology Clinical ProcedureLegislationHealth Records (Privacy and Access) Act 1997Work Health and Safety Act 2011Back to Table of ContentsReferencesPurdy, I. & Wiley, B. (2003). “Magnetic Resonance Imaging and the Neonate”. Neonatal Network 22 (1) 9-18Saunders DE, Thompson C, Gunny R, Jones R, Cox T, & Khean Chong W. Magnetic Resonance Imaging protocols for paediatric Neuroradiology. Padiatric Radiology. 2007 Aug; 37(8): 789-797.Smyser, CD, Hiroyuki Kidokoro, MD & Inder TE. MRI of the Brain at Term equivalent age in extremely Premature Neonates-to Scan or Not to Scan?. Journal of Paediatrics and Child Health. 2012 Sept; 48(9): 794-800.Stokowshi, LA, Ensuring Safety for Infants Undergoing Magnetic Resonance Imaging. 2005;5(1):14-27.Back to Table of ContentsSearch Terms MRI, Magnetic resonance imaging, Neonate, Newborn, InfantBack to Table of ContentsDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 13/12/2017Complete ReviewED WY&CCHHS Policy CommitteeThis document supersedes the following: Document NumberDocument NameCHHS13/080Department of Neonatology MRi procedure ................
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