Jump to content

Pharmacological Stress testing


Recommended Posts

Hi, I'm currently finishing my last clinical rotation at a Cardiology office. Often I run the stress echo's in the presence of the doctor and read the echo tests along side him. One day it was busy in the office, and we had a few patients waiting for a pharmacological stress test where we inject persantine. The tech that takes the pictures for nuclear imaging went and asked me if I could just inject the patients myself, being that I am a student I told him I was not allowed so he went to ask the MD who came out and asked me if a PA-C could do the infusion or not. I told him I'm not sure. Throughout the test we kept asking ourselves if a PA can or cannot. I believe we could but couldn't find any source to go from to show him. So from any Cardiology PAs who are out there. Can we run the pharmacological stress test as a PA-C? Does the MD have to do infusion? Does the MD have to be present in the room at all times for the pharmacological stress test while the PA is there?. And any sources you could find stating that we could do it would be helpful? I'm aware of the PA practice act that states that we may practice within the scope of the MD practicing, but was wondering if there might be any exemptions.

Link to comment
Share on other sites

For the purpose of this statement, performance of exercise testing includes that the individual know the indications for and contraindications to the test, recognize normal end points and abnormal responses or complications that may require that the test be discontinued, manage complications of the test, and interpret the test results. In most patients, exercise testing can be safely supervised by properly trained nurses, physician assistants, exercise physiologists, physical therapists, or medical technicians working under the direct supervision of the physician, who should be in the immediate vicinity or on the premises or the floor and available in case of emergency situations.3 4 It is recommended that nonphysicians who supervise the actual exercise test have certain cognitive skills (see Table 1, part I), and they may be certified in exercise testing by organizations such as the American College of Sports Medicine.5

source: http://circ.ahajournals.org/content/102/14/1726.full

Link to comment
Share on other sites

I worked in a cardiology clinic as an exercise physiologist for 4 years....will be starting pa school in august. We never had a cardiologist or mlp in the room.....though a doctor was around the corner seeing pts if we ran into trouble. Anyway...we used both adenosine and regadenoson instead of persantine, the infusion time is shorter with them. The exercise physiologists ran the adenosine infusion and the nuke techs would run the regadenoson infusion. Rns ran the dobutamine. I worked both inpatient and outpatient without a doc in the room. Seems like a pa would be able to run an infusion no problem. Hope this helps.

Link to comment
Share on other sites

In Ohio, the MD has to be on the premises but not in the test. A PA can inject, but usually we have nuc techs or nurses do it. In the case of dobutamine stress tests, they usually come find me for their doses, for which I have an Excel spreadsheet to do the calculations. All the practitioners in our office (including me) see patients while testing goes on. If there is a problem, we get involved.

Link to comment
Share on other sites

I am in Texas so the rules might be different. It kind of depends on the facility. In Amarillo and Midland they do run stress tests all the time. The radioactive material is not something they can inject because they are not on the RAM license. As for the doctor being on the premises I have no idea. Both places in Amarillo were at Cardiology clinics so there was at least one Cardiologist there at all times, but not in the room. El Paso was a little different. The RSO for 3 of the major hospitals would not let PA's run a stress test. His reasoning was that if the are not an "authorized user" on the RAM license, he would not let them run a stress test on any of the hospital facilities. Nurses and PA's are not allowed to administer the myoview/cardiolite on their license. Texas law hasn't caught up with putting PA's on a RAM license yet due to what they call "a lack of training in radioactive materials." This also included any MD that wasn't a Radiologist or Cardiologist. If your not on his license then you could go fish LOL! I did ask the state if I could be on a RAM license since I am a nuke tech and will hopefully be a PA down the road, and they said they would have to get back to me. Now in El Paso the PA's do run stresses at the cardiology clinics, but again you will have a Cardiologist there on duty. So take from this what you will. I did have a question you can ask your Cardiologist. Why not use Lexiscan or at least Adenosine instead of Persantine? Both do basically the same thing but with less side effects and a shorter half life. The Lexiscan is pricey, but it is a 5 minute ordeal from injection to end of recovery. Persantine your looking at 30 minutes to recover with those nice side effects unless you intervene. In Amarillo nuclear took care of the infusion of whatever stress drug there was and the myoview/cardiolite injection. In El Paso the nurses took care of the stress agents.

 

Andrew

 

PA-S

RT®(CT)(N)(MRI) (ARRT)

CNMT - NCT (NMTCB)

Link to comment
Share on other sites

I am in Texas so the rules might be different. It kind of depends on the facility. In Amarillo and Midland they do run stress tests all the time. The radioactive material is not something they can inject because they are not on the RAM license. As for the doctor being on the premises I have no idea. Both places in Amarillo were at Cardiology clinics so there was at least one Cardiologist there at all times, but not in the room. El Paso was a little different. The RSO for 3 of the major hospitals would not let PA's run a stress test. His reasoning was that if the are not an "authorized user" on the RAM license, he would not let them run a stress test on any of the hospital facilities. Nurses and PA's are not allowed to administer the myoview/cardiolite on their license. Texas law hasn't caught up with putting PA's on a RAM license yet due to what they call "a lack of training in radioactive materials." This also included any MD that wasn't a Radiologist or Cardiologist. If your not on his license then you could go fish LOL! I did ask the state if I could be on a RAM license since I am a nuke tech and will hopefully be a PA down the road, and they said they would have to get back to me. Now in El Paso the PA's do run stresses at the cardiology clinics, but again you will have a Cardiologist there on duty. So take from this what you will. I did have a question you can ask your Cardiologist. Why not use Lexiscan or at least Adenosine instead of Persantine? Both do basically the same thing but with less side effects and a shorter half life. The Lexiscan is pricey, but it is a 5 minute ordeal from injection to end of recovery. Persantine your looking at 30 minutes to recover with those nice side effects unless you intervene. In Amarillo nuclear took care of the infusion of whatever stress drug there was and the myoview/cardiolite injection. In El Paso the nurses took care of the stress agents.

 

Andrew

 

PA-S

RT®(CT)(N)(MRI) (ARRT)

CNMT - NCT (NMTCB)

 

Thanks for the information everyone. Yes I asked the MD why he uses Persantine. His answer was pretty simple. Lexiscan is expensive, and when he used Adenosine ppl felt like they were getting "choked" and is also expensive. Its cheaper for him to get persantine and reverse them after the test is done. Most patients don't complain about it, some get H/A but goes away after reversal. Most of the time they tell me their stories about their experience with adenosine.

Link to comment
Share on other sites

I think it may depend: whether you are in a physician's office or a hospital. And the laws of the state in which you work. In a hospital you would have to be specifically credentialed for the procedure--as a student you would not have the credentials to do so.

 

In a physician's office, it may depend on how the state laws are worded. In some states, a physician can delegate just about anything to his office personnel, but he remains responsible. However, for Medicare billing purposes, there is a requirement for physician supervision, and for stress tests, that requires onsite supervising (MD in the building, but not necessary in the room or directly supervising).

 

Also there are two different injections for a chemical nuclear stress test. One is the chemical stressor (Lexiscan, adenosine, dipyridamole, persantine, etc.). The other injection is the radioactive isotope. Where I have worked, I have supervised the stress tests from a medical standpoint, however a nuclear medicine technician has always injected the radioactive isotope.

Link to comment
Share on other sites

I think it may depend: whether you are in a physician's office or a hospital. And the laws of the state in which you work. In a hospital you would have to be specifically credentialed for the procedure--as a student you would not have the credentials to do so.

 

In a physician's office, it may depend on how the state laws are worded. In some states, a physician can delegate just about anything to his office personnel, but he remains responsible. However, for Medicare billing purposes, there is a requirement for physician supervision, and for stress tests, that requires onsite supervising (MD in the building, but not necessary in the room or directly supervising).

 

Also there are two different injections for a chemical nuclear stress test. One is the chemical stressor (Lexiscan, adenosine, dipyridamole, persantine, etc.). The other injection is the radioactive isotope. Where I have worked, I have supervised the stress tests from a medical standpoint, however a nuclear medicine technician has always injected the radioactive isotope.

 

Yes nuke med tech always does the radioactive isotope, thank you for the responses everyone.

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More