A Great Start 

Dec 02
2009

By Sandy Keefe, MSN, RN

Mike Breitweiser, BSN, RN, charge nurse in the cath lab at the Merrillville, IN, campus of The Methodist Hospitals, enjoys the precise teamwork within the neurointerventional radiology suite that saves lives when minutes count.

"We work with a great group of professional people to deliver the best care we can," he said. "One of the most exciting things about my job is seeing patients come in after a devastating neurological event and then leave the lab in better functional status to go on with their lives." These devastating events can include patients presenting with strokes, aneurysms and spinal injuries.

Methodist neurointerventional radiologist Mayumi Oka, MD, depends on teamwork. "When I'm doing procedures, I cannot always see the patient, or assess him right away," she said. "To have a nurse I can trust and who can properly assess a neuro patient is a great advantage to me in my practice."

Assessment of patients can lead to delivering a clot-busting drug directly to the blockage found in a patient with stroke, or inserting coils into an aneurysm to avoid rupture rupture and clotting. Nurses play a large role in the treatment of patients within the neurointerventional radiology specialty.

Breitweiser started out as a neurology nurse and progressed through neurology stepdown and neuro ICU before joining colleagues in neurointerventional radiology nursing. His passion for neuro nursing, as well as his nursing assessment abilities and critical-thinking skills, have served him well in his present role.

"When the chance came to specialize in this area, I put my hand up and said yes," he laughed. "It's brought me back to where I started my nursing career."

A Solid Knowledge Base

Kathy Coughlin, RN, CNRN, an interventional radiology nurse at St. Mary's of Michigan Medical Center in Saginaw, started her career as a staff nurse on the hospital's neuro progressive care unit. "After doing that for awhile, I was looking for a change," she said. "I still loved neuroscience nursing, so when a friend told me about the open position in interventional radiology, I checked it out and I've been here ever since."

As a certified neuroscience nurse, Coughlin brought a solid knowledge and skill base that served her well in neurointerventional cases. "I still needed to learn how things worked in the interventional radiology area, so I was assigned to a preceptor who worked with me until I was comfortable," she said. "I also learned patient care is my first priority. We may help gather the equipment for a procedure, but our main job as interventional radiology nurses is to care for the patient. We monitor vital signs throughout the procedure, and explain what's going on. We can't sedate our neuro patients completely, because the doctor needs to have the patient follow commands as he removes the clot or repairs the aneurysm. We sedate them just enough to take the edge off, and then nurses work closely with the patient to help him get through the procedure."

Breitweiser starts his day as charge nurse by coordinating schedules and staff, making sure patients are available for the radiologist to assess before they're taken into the lab, and overseeing care in the lab itself and during the recovery phase. "In a typical case, the nursing role is focused on conscious sedation and monitoring of the patient, as well as documentation of the case," he said.

Cutting-Edge Procedures

St. Mary's has been certified by the Joint Commission as a primary stroke center, with a well-earned reputation for reversing some of the ravages of acute ischemic strokes. "When a stroke patient is coming via EMS or is transferred from another hospital, we'll hear an overhead page for the stroke team," said Coughlin. "One of us will go to the ED to see if the patient may be coming to us for a procedure, so we'll be ready when the patient is. When there's a stroke alert issued, the patient with the stroke is our first priority."

Coughlin is an integral part of a team that delivers cutting-edge procedures such as aneurysm coiling, placement of intra-carotid stents, clot retrievals and stroke interventions with injection of tissue plasminogen activator (tPA) right into the arteries in the brain. "We also treat vasospasms by injecting papaverine or verapamil into the vessel that is spasming," she said.

Patient Education

Susan Jaeger, MSN, CNP, neuroscience nurse practitioner at the Cleveland Clinic in Ohio, focuses on care management and prevention for stroke patients after the neurointerventional procedure. "I see them for a follow-up appointment 30 days after their stroke and talk with them about what happened," she said. "I do health teaching around risk-factor reduction to prevent complications or future strokes. Many patients with ischemic stroke have undergone neurointerventional procedures such as intra-arterial tPA to dissolve the clot causing an ischemic stroke, a thrombectomy to remove a clot from a blood vessel in the brain, or stenting when needed for instability. A patient with hemorrhagic stroke may have had aneurysm coiling to occlude the weakened portion of the blood vessel."

Jaeger educates patients about their neurointerventional procedures and links the procedures to functional outcomes. "I tell them they're very lucky to have access to those interventions, because we know time lost is brain lost," she said. She may draw a picture or print one out from the hospital intranet to show exactly how a specific procedure saved brain tissue. "When I explain to them how the neurointerventional procedure restores circulation and prevents loss of function, they understand," she said.

Functional Improvement 

Jaeger is impressed with the functional improvements in stroke patients following neurointerventional procedures. "It's amazing to see the changes in their stroke scale scores from the time they're brought to the ED until they're discharged from the hospital," she said. "And when I see them in person a month later, there's even more improvement. We know patients with strokes experience their fastest recovery in the first 6 months, but the brain does continue to heal for a year or even more."

Coughlin also appreciates the changes, which can be quite marked. "It's so nice to see the clot on the radiology screen and then watch the interventional radiologist open the vessel," she said. "Sometimes we'll see changes in the patient's function right away, maybe he'll wiggle the fingers on his affected hand, but sometimes the improvements don't come until after the patient has left our area."

While functional improvements are impressive, it's the nurse/patient relationship that keeps Coughlin in her specialty. "The part of my job I like the most is the direct patient care," she said. "As an interventional radiology nurse, I make a difference in the patient's experience during the procedure."

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