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

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

Attendance Admittance to Day Surgery Unit (DSU) or ward 1E will depend on the patient’s clinical status to provide optimum patient safety. Patient details will be emailed by the MRI Unit Coordinator to the Cardiology Advanced Nurse Practitioners (ANP’s) who will vet requests, decide on patient placement and if cardiology investigations of echo and ECG are required pre procedure. If the Cardiology ANP is unsure the patient presentation will be discussed with the anaesthetist. to decide on admittance to ward 1E or DSU.

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

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.

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.

Attend MRI department.

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

No contact with the Cardiology MDT.

• Cardiac MRI:
• Minor CHD with stable circulation under general anaesthetic
  Admit to DSU
  DSU staff will contact the cardiology team to inform of patient arrival. Cardiology team will clerk the patient and provide documentation of last echo and ECG.
• Complex CHD with potentially unstable circulation under GA
  Admit to ward 1E.

• Non-Cardiac MRI:
• Minor CHD with stable circulation under GA
  Admit to 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.
  Admit to ward 1E on the day of procedure.

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. 

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.