MRI under general anaesthetic: pathway for paediatric patients with congenital heart disease

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Objectives

To provide a guideline for the management of paediatric patients with congenital heart disease (CHD) requiring MRI under general anaesthetic.

Scope

This guideline is intended for all healthcare professionals involved in the care of paediatric patients with CHD requiring MRI under general anaesthetic.

Audience

All healthcare professionals involved in the care of paediatric patients with CHD requiring MRI under general anaesthetic should be familiar with this guideline.

Introduction

This guideline covers the pathway of a paediatric patient with congenital heart disease (CHD) requiring MRI under general anaesthetic.

Attendance to Day Surgery Unit (DSU) or ward 1E will depend on the patient’s clinical status.   The decision will be made by the cardiology multidisciplinary team (MDT) to provide optimum patient safety.

Patients requiring admittance to ward 1E should attend cardiac pre-assessment clinic, as ward 1E has no capacity to accommodate elective MRI patients the day before the procedure.

Ordering Cardiac MRI

Cardiac MRI is an investigation ordered by the patient’s cardiology consultant, via Trakcare.

There is a tick box to indicate any exclusion criteria to DSU, if there are no exclusions the patient will attend DSU, no contact with the Cardiology MDT.

Providing sufficient information on the request form will allow informed planning and a coordinated patient admission, consider:

  • Routine / Urgent
    If there is a degree of urgency, document the timescale within which the scan is required.
  • Specify Past Medical History
    Include details of previous surgery +/- implants (model, serial numbers etc), applicable MDT input. 
    If information is not available discuss with Dr Ruth Allen prior to requesting MRI.
  • Additional Investigations whilst under GA for MRI
    Document investigation on request form.
    Discuss with team undertaking additional investigation.
    Consent to be obtained by appropriate team.
    If bloods are required, forms and bottles to be provided by the requesting team (a request for bloods is not enough).
  • Consent
    Document on the request form if there are concerns regarding obtaining consent/checklist completion, this includes children under the care of local authority where parents have legal responsibility or adults with incapacity.
  • Critical Care Bed Requirement
    Document on request form if critical care bed required for post MRI observation.
No General Anaesthetic Required for MRI

Attend MRI department.

If difficult access they will attend ward 1C for cannulation.

No contact with the Cardiology MDT.

General Anaesthetic Required for MRI

Attend cardiac pre-assessment clinic, if cardiac investigations are not up to date - within the previous 3 months.

  • Cardiac MRI:
    • Minor CHD with stable circulation under general anaesthetic
      Attend general pre-assessment clinic and DSU.   
      No contact with the Cardiology MDT.
    • Complex CHD with potentially unstable circulation under GA Admit to ward 1E.
      If the Cardiac ANP is unsure the patient presentation will be discussed with the anaesthetist to decide on ward 1E or DSU attendance.
  • Non-Cardiac MRI:
    • Minor CHD with stable circulation under GA
      Attend general pre-assessment clinic and DSU.   
      No contact with the Cardiology MDT.
    • Complex CHD with potentially unstable circulation under GA
      Referring team to document the requirement for cardiac anaesthetist on the referral form.
      Attend cardiac pre-assessment clinic (this depends on the referring MDT alerting cardiac anaesthetist and referral received in a time frame to attend cardiac pre-assessment clinic).
      Admit to ward 1E on the day of procedure.
Non attendance at cardiac pre-assessment clinic

Admit to ward 1E:

  • If cardiac investigations are up to date, within previous 3 months, admit on day of MRI.  
  • If cardiac investigations need to be performed admit on the day before MRI
Discharge

The anaesthetist will decide if same day discharge is appropriate, instructions recorded on anaesthetic chart.

Prior to discharge ensure the following criteria are met:

  • Vital signs are stable and normal
  • The patient is awake and alert
  • Nausea and vomiting have been adequately managed

Same day discharge post general anaesthetic requires private transport. 

Accommodation

There is no facility to provide overnight hospital accommodation pre or post procedure, unless clinically indicated.

Parents are encouraged to make their own arrangements to stay in Glasgow if travelling from a distance.

The radiology department will attempt to provide timing of the procedure to assist with travel.    

Editorial Information

Last reviewed: 21 February 2017

Next review: 19 December 2019

Author(s): Alison Buller

Approved By: Clinical Effectiveness

Reviewer Name(s): Paediatric Cardiology Dept