Shifting of Patient from ICU to MRI

Diploma ICU Technician - Final Exam Answer

1. INTRODUCTION

2. INDICATIONS FOR ICU TO MRI TRANSFER

• Suspected intracranial pathology (stroke, hemorrhage, abscess, mass)
• Spinal cord injury assessment
• Evaluation of deep infection or soft-tissue collections
• Neurological deterioration unexplained by CT findings
• Abdominal/pelvic pathology requiring soft-tissue contrast

3. PRE-TRANSFER ASSESSMENT (BEFORE LEAVING ICU)

A. Patient Stability Assessment

• Hemodynamic stability: MAP > 65 mmHg, HR 60-100/min
• Respiratory stability: SpO2 acceptable on current ventilator settings
• No ongoing active resuscitation or rapidly deteriorating condition
• Reassess need-vs-risk: if patient is unstable, transport should be deferred

B. Physician/Team Decision

• Transport must be ordered and approved by the ICU consultant
• Risk-benefit discussion documented
• Verbal handoff prepared for both the receiving team (MRI) and the ICU team remaining behind

4. MRI-SPECIFIC SAFETY CONSIDERATIONS

The 4 Zones of MRI Safety (ACR Guidelines)

The MRI Hazard: Ferromagnetic Projectile Effect

5. MRI CONTRAINDICATIONS / SCREENING CHECKLIST

Absolute Contraindications (Patient CANNOT enter MRI):

• Cardiac pacemakers (non-MRI conditional)
• Cochlear implants (non-MRI conditional)
• Certain intracranial aneurysm clips (ferromagnetic)
• Metallic foreign bodies near the eyes
• Some older implanted neurostimulators
• Ferromagnetic orthopedic implants (verify with manufacturer)

MRI Conditional Items (check before entry):

• Endotracheal tube - must be MRI-safe (no wire reinforcement unless stated MRI-conditional)
• IV cannulas and central lines - check compatibility
• ECG electrodes - standard electrodes have metal; must be replaced with MRI-conditional electrodes
• Temperature probes, surgical clips, stents - verify manufacturer data

Checklist Questions to Screen the Patient:

1. Any metallic implants or surgical hardware?
2. Any electronic implants (pacemaker, AICD, DBS)?
3. Any history of metal splinter/foreign body to the eye?
4. Any transdermal patches (some contain metallic foil)?
5. Any tattoos (some pigments contain iron oxide)?
6. Any history of intracranial aneurysm coiling or clipping?

6. EQUIPMENT PREPARATION

A. MRI-CONDITIONAL Equipment Required

B. Drugs and Fluids

• Calculate drug requirements for the full scan duration PLUS transport time both ways
• Emergency drugs prepared and drawn up before leaving ICU
• Note: no drugs are available inside the MRI suite - bring everything
• Bring 1000 ml 0.9% NaCl for additional flushes
• Sedation maintained via IV agent (e.g., propofol infusion) - can be controlled from the control room; volatile anaesthesia cannot be adjusted once the patient is in the scan room

C. Oxygen Supply

• Calculate oxygen requirement: (minute volume x respiratory rate) x estimated transport time x safety factor
• Carry sufficient portable oxygen for transfer TO and FROM MRI, plus full scan duration
• Aluminium O2 cylinders only in Zone IV

7. STAFF PREPARATION

• Minimum team: 1 ICU physician, 1 ICU nurse, 1 ICU technician/ODP (mandatory)
• All staff must complete MRI safety screening questionnaire before entry
• All staff must remove ALL metal objects: watches, phones, keys, pens, coins, belt buckles, hairpins, stethoscopes
• Credit cards and pagers must remain outside (magnetic damage)
• Staff with pacemakers or ferromagnetic implants must NOT enter Zone IV

8. STEP-BY-STEP TRANSFER PROCEDURE

STEP 1: Pre-Transfer (ICU)

1. Check and document patient's vitals; ensure hemodynamic stability
2. ICU technician checks MRI-conditional anaesthetic machine and monitoring IN the MRI suite before leaving ICU
3. Switch patient from ICU ventilator to MRI-conditional transport ventilator; check ventilator settings and SpO2 post-switch
4. Ensure all IV infusions are loaded onto MRI-safe pumps or extension tubing arranged
5. Complete MRI safety checklist for patient and all staff
6. Communicate with MRI team: confirm scanner readiness, minimise waiting time

STEP 2: Transport to MRI

1. Maintain continuous monitoring throughout: SpO2, HR, BP, EtCO2
2. Keep infusions running; watch for line disconnection during movement
3. Ensure adequate oxygen during transit
4. Accompany with emergency drugs

STEP 3: Arrival at MRI Suite (Zone II Screening)

1. Final re-screening of patient and staff at Zone II
2. Replace standard ECG electrodes with MRI-conditional electrodes
3. Remove any remaining non-MRI-safe items

STEP 4: Transfer to MRI Scan Bed (Zone III/Anaesthetic Room)

1. Move patient onto MRI scan table
2. Attach MRI-conditional monitoring
3. Infusion lines from ICU pumps are passed through the waveguide (a small opening in the MRI room wall) to maintain infusions from outside the scan room
4. Clamp ET tube before any circuit change/disconnection, then reconnect to MRI anaesthetic machine circuit

STEP 5: During Scan (Zone IV)

1. MRI technician/radiographer operates scanner from control room
2. ICU team monitors patient through observation window and MRI-conditional monitoring displays
3. Maintain sedation via IV infusion controlled from outside
4. If emergency occurs: patient must be immediately removed from Zone IV before defibrillation or use of ferromagnetic equipment

STEP 6: Post-Scan Transfer Back to ICU

1. After scan is complete, move patient out of scan room
2. Clamp ET tube; disconnect from MRI anaesthetic machine; reconnect to transport ventilator
3. Reconnect to original ICU infusion pumps
4. Disconnect extension lines passed through waveguide; dispose appropriately
5. Transfer patient back to ICU trolley in anaesthetic room
6. Confirm stable vitals before moving

STEP 7: Return to ICU

1. Transport with continuous monitoring
2. Re-connect to ICU ventilator, monitoring, infusions
3. Check humidifier, nutrition, insulin infusions are restarted
4. Document all observations throughout the transfer
5. ICU technician returns to MRI to clean anaesthetic equipment; replace breathing circuit

9. MONITORING DURING TRANSPORT

10. COMPLICATIONS AND RISKS

During Transport:

• Accidental extubation
• IV line dislodgement
• Hemodynamic deterioration (BP fall, arrhythmia)
• Oxygen supply failure
• Equipment failure

In MRI Environment:

• Missile effect - ferromagnetic object attracted to magnet
• Implant heating/movement
• Burns from ECG leads (from radiofrequency energy loops) - avoid loops in leads
• Acoustic noise injury (ear protection)
• Contrast reactions (if gadolinium given)
• Worsening respiratory function (studies show deterioration of respiratory function after return from transport)
• Emergency resuscitation difficulty (defibrillator/crash cart CANNOT be used in Zone IV)

11. EMERGENCY MANAGEMENT IN MRI

1. Do NOT use standard defibrillator in Zone IV
2. Immediately remove patient from the scan room to Zone II/III
3. Begin CPR only after exiting Zone IV
4. Use AED/defibrillator outside the scan room
5. Call rapid response team

1. Check patient first
2. If safe, troubleshoot equipment
3. If unstable, abort scan and return to ICU

12. ROLE OF ICU TECHNICIAN SPECIFICALLY

1. Checks MRI suite equipment (anaesthetic machine + monitoring) BEFORE the transfer begins
2. Ensures ventilator is MRI-conditional and properly set
3. Coordinates oxygen supply calculation
4. Completes equipment checklist
5. Accompanies patient throughout (mandatory team member)
6. Operates and monitors MRI-conditional monitoring during scan
7. Reconnects all ICU equipment on return
8. Cleans and restores MRI anaesthetic equipment post-transfer
9. Documents all transfer-related observations and incidents

13. KEY POINTS TO REMEMBER (Exam Summary)

14. MNEMONIC - "SAFE MRI TRANSFER"