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AVOIDING BURNS FROM ELECTRODES

AND CABLES DURING MRI

The FDA reported about an article in Nursing 2006describes second- and third-degree burns in patientsundergoing MRI exams while they were wearing elec-trocardiogram (ECG) electrodes and cables (Lange &Nguyen, 2006). Many of these burns were discoveredonly after the exam was over, and some were severeenough to require plastic surgery.

The problem is that the radiofrequency fields createdduring an MRI exam can heat ECG cables and elec-trodes, seriously burning the underlying skin. This haz-ard is likely to increase as the number of MRI examsgoes up and as more patients need ECG monitoringduring their MRI procedures.

The article recommends a number of ways to re-duce the risk of these kinds of burns. Here are someof them:

� Remove any electrodes and cables that are nolonger being actively used for monitoring. Searchthe patient for any electrodes and cables that mayhave been inadvertently left behind in clothing orsheets or on the patient.

� If the patient needs ECG monitoring during theMRI procedure, check beforehand with theMRI staff to be sure that the cables and electrodeshave been cleared for use in the MRI environ-ment. If still in doubt, check with the manufac-turer of these devices.

� Be sure that there is complete contact between theelectrode surface and the patient’s skin. If contactis poordfor example, if excess hair hasn’t beenremoved or there’s an air gap between the elec-trode and the skinda serious burn can occureven if you are using electrodes and cables thatare approved for MRI. Inadequate contact canalso occur if the gel layer on the electrode hasdried out, so avoid using electrodes that arepast their expiration date and inspect each elec-trode before using it.

� Avoid looping and crossing the cables becausethis can create excessive heat from resistance in

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the cable, which can burn the patient. Keep cablesoff the patient’s skin by placing padding, such asa blanket, between the cable and the skin.

� After completing the MRI study, examine the pa-tient for possible burns or reddening of the skinunder the electrodes. This is especially importantfor patients who can’t express themselves or thosewho have impaired sensation. If the patient hasa burn, administer appropriate treatment.

DELAYED ONSET OF HEPARIN-INDUCED

THROMBOCYTOPENIA

FDA is alerting health care professionals that the onsetof heparin-induced thrombocytopenia (HIT) can be de-layed in patients who had previously been treated withheparin sodium injection.

HIT results from an irreversible aggregation ofplatelets. About half the time, it can lead to develop-ment of venous and arterial thromboses, a conditioncalled heparin-induced thrombocytopenia and throm-bosis (HITT). HITT can result in serious thromboticcomplications including pulmonary embolism, stroke,myocardial infarction, skin necrosis, gangrene, andeven death.

New warnings in the drug label point out that HIT,with or without thrombosis, can occur up to severalweeks after heparin therapy is stopped. So patientswho present with thrombocytopenia or thrombosis af-ter they discontinue heparin should be evaluated forHIT and HITT. Heparin should not be administeredto these patients until their platelet count is checked,because giving heparin to these patients could causeserious or even fatal reactions.

DANGEROUS USE OF SALINE

FLUSH SYRINGES

The Institute for Safe Medication Practices (ISMP) re-cently alerted health professionals about the danger ofusing prefilled saline flush syringes to reconstitute med-ications. In this process the practitioner first discards

JUNE 2007nursing.org

Food and Drug Administration News JOURNAL OF RADIOLOGY NURSING

any unneeded saline from the syringe, then adds the re-maining saline in the syringe to a vial of medication.The practitioner mixes the contents of the vial anddraws it back into the syringe, ready to administer.

This could be an accident waiting to happen. A sy-ringe labeled ‘‘0.9% saline flush’’ now contains an ad-ditional drug, perhaps even a high-alert medication,with no label. If the syringe leaves the preparer’s handsbefore it is used, another practitioner could pick it upand use it on a patient as a saline flush, possibly withlethal consequences.

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ISMP says that practitioners should understand howrisky this procedure is. It recommends that medicationsshould be dispensed in ready-to-use form wheneverpossible. If it is necessary to reconstitute or dilute themedication on the unit, staff should be given blank sy-ringe labels, and these should be applied to the finalproduct immediately.

ReferencesLange, S., & Nguyen, Q.N. (2006). Cable and electrodes can burn

patients during MRI. BS Nursing, 36, 18.

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