Bret is a CST working with Dr. Jones on an open cholecystectomy procedure. Both of Dr. Jones’ hands are occupied, so she asks Bret to inject contrast medium into the cystic duct under her direct supervision.

Question

1. What scope of practice issues can you identify?
2. Is this act any different from injecting a medication into an IV line? If so, how?
3. What do you think Bret should do in this situation?
4. How do you think the surgeon may respond if Bret refuses?
5. How can Bret know if he should perform this act?

Answer 1

Answer:

1. Certified Surgical technologist.The ultimate judgement regarding the propierity of any specific procedure or course of action must be made by the practicioner in light of all the circumstances presented.,nor should thdey be used to establish a legal standard of care.A practicioner may responsibly adopt a course of action different ,in the reasonable judgement of the practicioner ,such course of action is indicated by the condition of the patient or due to limitations of available resources .A doctor who employs such an approach should document in the patient record information sufficent to explain the approach taken.

2. Alll administrations of intravascular contrast material should be directed by a radiologistor other appropriately trained physician or by another appropriately credentialled health care professional when ordering a pre-defined protocol exam ,where that protocol has been defined by aProtocoling Radiologist or otheer physician.In the latter case the ordering physician takes on the responsibility for the decision to administer contrast material and should recognize contraindications.

3. Bret in this situation can definitely perform injections of contrast media ,since he is a certified Surgical Technologist.But it is necessary that the technologist performing injections should be in compliance with existing operating policiesand procedures at the faciliy in which they are working.At a minimum ,the technologist shouldshould undertand the general benefits of contrast media administrations,follow protocols that involve intravascularinjection of contrast media,understand contraindications to intravascular injection of contrast mediaand recognize adverse events following contrast media administration.

4. Since it is an emergency situation ,the physician can definitely take actions against Bret for negligence of duty and he could be held liable for any unfortunate incident due his unethical behaviour.

5.Being a Certified Surgical Technologist assisting surgeons ,he knew the consequences of his act and since he is under the direct supervision of the surgeon he is quite confident .He knew that the sugeon supervising the injection of contrast media administration is knowledgeable in the recognition and treatment of adverse events related to contrast media administration.