Can Nurses Safely Perform Diagnostic Angiography?

Nurses, radiologic technologists, and radiographers have increasingly been performing tasks that were previously done exclusively by physicians. This month’s [HealthStream’s] Journal Alert asks whether nurses can safely perform diagnostic angiography. To study this, angiography was performed by a nurse in 68 patients. The nurse was trained for the procedure by a vascular radiologist. Subjects were referred for diagnostic angiography of the legs (31 patients), renal arteries (29 patients), or abdominal aorta (8 patients) and were excluded if they were obese, had poorly palpable femoral pulses, had a groin surgical scar, or had abnormal coagulation. All subjects gave consent for nurse angiography and all procedures were supervised by a radiologist experienced in angiographic procedures. Single-wall puncture of the femoral artery was routinely performed. Catheterization was followed by 4 F pigtail catheter insertion into the upper abdominal aorta for flush angiography. Following the procedure, the nurse removed the catheter and manually compressed the groin until hemostasis was achieved. Results: Successful angiography was achieved by the nurse (without radiologist intervention) in 85 percent of cases. The first forty patients had a success rate of 77.5 percent, while the final 28 patients had a success rate of 96 percent, which is equivalent to or better than trainee radiologists with similar experience levels. There were complications in eight patients - seven had a minor self-limiting groin hematoma and one had a severe groin hematoma six hours post-procedure. Thus, the severe complication rate was 1.5 percent. Implications: This study indicates that nurses can be trained to safely perform invasive diagnostic procedures like angiography. An experienced vascular radiologist should always be available, but allowing nurses to perform these tasks may help to alleviate staffing constraints and free physicians to perform more complex tasks. Source: Morgan M, Wallis L, Belli AM. Diagnostic Angiography Performed By Nurses. British Journal of Radiology 2001;74:648-650. HealthStream offers a monthly newsletter and various home study courses. To learn more, visit them on the web at www.healthstream.com

NULL