acr–asnr–assr–sir–snis practice guideline for the performance of ...

4. The facility must provide adequate resources forobserving patients during and after vertebralaugmentation. Physiologic monitoring devicesappropriate to the patient’s needs – includingblood pressure monitoring, pulse oximetry, andelectrocardiography – and equipment forcardiopulmonary resuscitation must be availablein the procedural suite.B. Surgical and Emergency SupportAlthough serious complications of vertebral augmentationare infrequent, there should be prompt access to surgical,interventional, and medical management ofcomplications.C. Patient Care1. Preprocedural carea. The clinical history and findings, includingthe indications for the procedure, must bereviewed and recorded in the patient’smedical record by the physician performingthe procedure. Specific inquiry should bemade with respect to relevant medications,prior allergic reactions, and bleeding/clotting status.b. The vital signs and the results of physicaland neurological examinations must beobtained and recorded.c. The indication(s) for the procedure,including (if applicable) documentation offailed medical therapy, must be recorded.d. The indication(s) for treatment of thefracture should have documentation ofimaging correlation and confirmation.2. Procedural carea. Adherence to the Joint Commission’scurrent Universal Protocol for PreventingWrong Site, Wrong Procedure, WrongPerson Surgery is required for proceduresin non-operating room settings includingbedside procedures.The organization should have processes andsystems in place for reconciling differencesin staff responses during the “time out.”b. Vital signs should be obtained at regularintervals during the course of the procedure,and a record of these measurements shouldbe maintained.c. Patients undergoing vertebral augmentationmust have intravenous access in place forthe administration of fluids and medicationsas needed.d. If the patient receives sedation, pulseoximetry must be used. Administration ofVII.sedation for vertebral augmentation shouldbe in accordance with the ACR–SPRPractice Guideline for Sedation/Analgesia.A registered nurse or other appropriatelytrained personnel should be present and haveprimary responsibility for monitoring thepatient. A record of medication doses andtimes of administration should bemaintained.3. Postprocedural carea. A procedural note should be written in thepatient’s medical record summarizing thecourse of the procedure and what wasaccomplished, any immediatecomplications, and the patient’s status at theconclusion of the procedure (see sectionVIII.A.2 below). This note may be brief ifthe formal report will be available within afew hours. This information should becommunicated to the referring physician in atimely manner. A more detailed summary ofthe procedure should be written in themedical record if the formal typed reportwill not be on the medical record within thesame day.b. All patients should be at bed rest andobserved during the initial postproceduralperiod. The length of this period will dependon the patient’s medical condition.c. During the immediate postproceduralperiod, skilled nurses or other appropriatelytrained personnel should monitor thepatient’s vital signs, urinary output,sensorium, and motor strength. Neurologicalstatus should be assessed frequently atregular intervals. Initial ambulation of thepatient must be carefully supervised.d. The operating physician or a qualifieddesignee (another physician or a nurse)should evaluate the patient after the initialpostprocedural period, and these findingsshould be summarized in a progress note onthe patient’s medical record. The physicianor designee must be available for continuingcare during hospitalization and afterdischarge.EQUIPMENT QUALITY CONTROLEach facility should have documented policies andprocedures for monitoring and evaluating the effectivemanagement, safety, and proper performance of imagingand interventional equipment. The quality controlprogram should be designed to maximize the quality ofthe diagnostic information. This may be accomplished aspart of a routine preventive maintenance program.6 / Vertebral Augmentation PRACTICE GUIDELINE