Safety Zones? What Safety Zones?

We all probably know the 2001 horrifying story of the 6-year-old in New York who was killed when a nurse brought an oxygen tank into the MRI suite and the magnet pulled it into the bore by way of the child’s skull.  But do you know about the patient who was injured from a nurse’s scissors that flew out of her pocket into the patient’s head when the nurse stepped into the MRI suite?  Or the 2014 case of the 79-year-old in New York who was allowed to walk into the MRI room with a walker?  The walker was snatched away by the magnet and the patient fell and hit his head.  The injury led to a stroke and he died just weeks later.

Have you heard about the 17-year-old in California in 2014 with EKG leads still attached who had an abdominal MRI and suffered second-degree burns where the leads touched her skin?  A nurse claims she walked by the MRI window and saw smoke coming from the bore.  In 2015, a 13-year-old boy in France lost his thumb after burns from his finger monitoring device during an abdominal MRI.  He was under anesthesia during the exam, but was awakened by the excruciating pain.  Or in 2014, the two hospital workers in India who were pulled into the magnet while taking in a four-foot-tall metal oxygen tank along with a patient?  At least the patient wheelchair was MRI safe.  The oxygen tank pinned them both to the MRI bore for over 4 hours while they waited for someone to turn the magnet off.  One suffered a broken elbow from the tank and the other one a ruptured bladder.

One in five Americans has at least one tattoo. Did you know the ink in a patient’s tattoos can cause burns during an MRI?  There can be pain and discomfort during and after the exam, and in severe cases first and second degree burns on and around the site of the tattoo.  Did you know an innocent piece of metal in a welder’s eye can be dislodged and blind the patient or in rare cases even kill them?  And aneurysm clips can be unclipped and cause a bleed?  And how do we explain that the term jewelry means anywhere on your body, not just the ears or fingers?  There are many cases of projectiles and burning from belly button rings in poorly screened patients.  These types of MRI incidents are reported frequently in hospitals around the world.

Magnetic Resonance Imaging (MRI) has become an almost essential part of the Imaging department today.  Using a strong magnetic field, radio waves, and field gradients, what it can demonstrate is extraordinary.  Without getting into the technology of the modality, hydrogen atoms are used to generate a radio frequency signal that is then recorded after the magnetic field picks up the signals inside of our bodies.  Those hydrogen atoms are abundant in our water and fat content, so we are the perfect medium.  Using these wonderful capabilities of MRI, we can have medical diagnoses and disease staging without the harm of ionizing radiation.  But there are still drawbacks.

Because of the use of a magnetic field, certain contraindications make some patients not able to be scanned.  Some of these contraindications include cochlear implants, cardiac pacemakers, and metallic implants.  And then there are those items inside that may not be medical, such as shrapnel, bullets, piercings, etc.  So, patients must be screened before being placed in the MRI suite and all employees who are around the MRI suite must be screened before entering.  This means not just technologists, but any employee who may need to have access for one reason or another.  Because if metal is taken into the range of these powerful magnets, the metal will be drawn out and head straight to the gantry.  And if the metal doesn’t come loose, it can create a burn when in contact with skin.  Ouch!

A submission from Melinda Walker, MHA, RT(R) (MR), Supervisor of Outpatient Diagnostic Center & MRI, Baptist Health Lexington, demonstrates a way to ensure all employees are screened appropriately.  There are different levels of zones in the MRI suite, and we need to know about all of them.  Check out the link to The Joint Commission too.

mrisafetyzones

Managing MRI and providing education on MRI safety for staff that have access to the MRI area can be a challenge especially when you hope that the information will be retained. During routine rounding it was regularly found that barely any of the staff retained detailed knowledge of the MRI safety zones. Here is an easy solution that can be worn with their name badge that was created to help our staff be successful. http://www.jointcommission.org/assets/1/18/SEA_38.PDF

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