CHHS18/055

Canberra Hospital and Health ServicesClinical Guideline MRI Preparation and Procedure (Neonates/infants)Contents

Contents....................................................................................................................................1

Guideline Statement.................................................................................................................2

Background........................................................................................................................... 2

Key Objective........................................................................................................................ 2

Alerts.....................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – MRI Preparation & Procedure................................................................................2

Section 2 – Equipment..............................................................................................................3

Non-ventilated Infant............................................................................................................3

Ventilated Infant...................................................................................................................3

Section 3 – Preparations...........................................................................................................3

Non-Ventilated Infants..........................................................................................................3

Infants receiving respiratory support (ventilated /CPAP.......................................................4

Section 4 – On return to Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU). 5

Implementation........................................................................................................................ 5

Related Policies, Procedures, Guidelines and Legislation.........................................................5

References................................................................................................................................ 5

Search Terms............................................................................................................................ 6

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Guideline Statement

BackgroundMagnetic 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 Procedure

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Scope

This 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 Midwives Student Nurses and Midwives working under supervision

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Section 1 – MRI Preparation & Procedure

Nursing 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.

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Section 2 – Equipment

Non-ventilated Infant Alcohol based hand-rub (ABHR) Oxygen, tubing and suction unit with catheters Laerdal 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 ventilator Giraffe open care centre or isolette Syringe pumps for all infusions 20ml syringes Anaesthetic MRI circuit (in MRI box in Unit equipment room) IV extension sets x 2 for each infusion Yellow ear muffs

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Section 3 – Preparations

Non-Ventilated Infants Ensure the MO has sent the request to MRI Admit the infant if not an inpatient. Outpatients should ideally be admitted to the

Paediatric Day Stay Unit Ensure the infant has 2 ID labels insitu Remove 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 scanned Replace zinc oxide tape with Micropore® if necessary The Nurse/Midwife is to remove all metal from their person if they are going into the

MRI room with the infant e.g. scissors, jewellery Check sedation order (chloral hydrate before feed) with another RN/M and administer

to the infant a minimum of ½ 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 procedure

Ensure 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 available

Check portable oxygen, suction and self-inflating bag prior to transport to ensure correct working order

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Wards-person are sent by MRI staff, if they do not arrive on time, page them via switch Ensure the medical notes, observation chart and medication chart accompany the infant

to MRI.

Infants receiving respiratory support (ventilated /CPAP Ensure 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 MRI Ensure 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 shuttle Ensure infant has 2 ID labels insitu Administer IV sedation if ordered by MO Draw 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 scanned Replace zinc oxide tape with Micropore® if necessary Replace metal IV board with a plastic or cloth board Monitor infant (heart rate, oxygen saturation) during transport as required Parents may accompany their infant during transfer, however they must wait in the

waiting room during the procedure Attach infant to MRI compatible ventilator for transport to MRI Check and take MRI anaesthetic circuit and retrieval bag to MRI Equipment 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 ventilator For 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 MRI Attach infant to MRI oxygen saturation monitor and ensure it is working properly prior

to commencement of procedure Swaddle infant in warm blanket and supportive bean bag mattress. MRI staff will

withdraw air until the infant is snuggly surrounded by the mattress Ventilated 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 NICU Document in progress notes that the procedure has been performed

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Section 4 – On return to Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU)

The registered nurse will:

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monitor oxygen saturation hourly for 4 hours following procedure as the infant has been sedated

Inform parents of infant’s return to SCN Document in progress notes that the procedure has been performed When the infant is fully awake, feed the infant The Neonatologist on service is responsible for notifying parents of results of

investigation.

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Implementation

Staff will be informed of the new procedure via email and in-service education.

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Related Policies, Procedures, Guidelines and Legislation

Policies Consent and Treatment

Procedures Healthcare Associated Infections Clinical Procedure Patient Identification and Procedure Matching Policy Neonatal Neurology Clinical Procedure

Legislation Health Records (Privacy and Access) Act 1997 Work Health and Safety Act 2011

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References

1. Purdy, I. & Wiley, B. (2003). “Magnetic Resonance Imaging and the Neonate”. Neonatal Network 22 (1) 9-18

2. Saunders 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.

3. 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.

4. Stokowshi, LA, Ensuring Safety for Infants Undergoing Magnetic Resonance Imaging. 2005;5(1):14-27.

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Search Terms

MRI, Magnetic resonance imaging, Neonate, Newborn, Infant

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Disclaimer: 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 Amended Section Amended Divisional Approval Final Approval13/12/2017 Complete Review ED WY&C CHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS13/080 Department of Neonatology MRi procedure

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register