St. Louis Children’s Hospital

New Technology Arrived in May
By Christi Geraci, BSN, RN, CNOR;
Julie Ruether, RN, CPAN, CPN;
Elisa Sykora, RN

Ten-year-old Brittany has been diagnosed with a brain tumor and is scheduled for an intraoperative magnetic resonance imaging (IMRI) craniotomy. What is IMRI? Where is the procedure done? How is care provided for her?

IMRI utilizes a powerful magnetic force coupled with radio frequency to produce an image of the brain. Neurosurgeons are able to see the brain anatomy in real time, which lowers the need for repeat surgeries by allowing for visualization of residual tumor. It can also enhance the accuracy of the resection of brain tissue.

Pediatric neurosurgery performed in an IMRI suite provides a challenge to all members of the health care team. In the operating room the team must remember that the magnet is always on, so safety is of utmost importance. No one may enter the IMRI suite without viewing a safety video and completing a safety checklist. Only a limited number of staff are allowed badge access to the suite, and all other staff must check in at a control desk. The patient must also be carefully screened for any implants, piercings or tattoos.

Multi-disciplinary teams from Barnes-Jewish Hospital and St. Louis Children’s Hospital were convened over a year ago to address the challenges of caring for SLCH patients in the IMRI suite at Barnes-Jewish Hospital (BJH). A Failure Mode and Effects Analysis was used to determine areas of concern. This exercise led to numerous work groups addressing all components of care from the admission of these patients through discharge.

Front line staff from Same Day Surgery (SDS), Operating Room (OR), Post Anesthesia Care Unit (PACU), and the Pediatric ICU were involved in decision-making and development of care for patients. In addition, multiple walk-throughs were done to identify and solve potential problems prior to scheduling the first patient.

Brittany was seen prior to the day of surgery for an anesthesia evaluation in Same Day Surgery. On the morning of surgery, she arrived one hour before surgery for staff to obtain consent, mark her operative site, and complete her pre-operative and MRI checklists. Brittany and her family were then transported by the SDS nurse and BJH personnel to BJH. There, the SLCH and BJH OR nurses, BJH IMRI technician, and pediatric anesthesiologist completed the preoperative process. When Brittany was taken to the IMRI suite, her family in the waiting room was updated on the progress of surgery by the OR nurse. Intra-operatively, nursing care was provided by two SLCH nurses and one BJH nurse.

This collaboration continued through the intra-operative and post-operative periods. Following surgery, Brittany was transported to a pediatric PACU bay where PACU nurses from both SLCH and BJH provide care. Her family saw her prior to discharge from the PACU. Next, Brittany was transported to the SLCH PICU by the pediatric anesthesiologist, SLCH and BJH PACU nurses, neurosurgery resident, and BJH transporter. After a 24-hour PICU stay, she was transferred to an inpatient unit.

The first St. Louis Children’s Hospital pediatric neurosurgery IMRI procedure was done on May 28, 2008. To date, six patients have undergone procedures in the IMRI suite using this new collaborative effort among Barnes-Jewish Hospital, St. Louis Children’s Hospital and Washington University.

For more information, contact Geraci at cmg9766@bjc.org, Ruether at juliamr@bjc.org, or Sykora at eliseas@bjc.org