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Difficulty: HardAccident, Error, and Injury Prevention

A client with rapidly progressing lower extremity weakness is scheduled for an emergent magnetic resonance imaging (MRI) scan of the spine. During the pre-procedure safety screening, the nurse obtains the following information. Which finding represents the highest priority for the nurse to communicate immediately to the healthcare provider and the radiology team?

  1. A
    The client has a documented severe anaphylactic reaction to iodinated intravenous contrast media.
  2. The client had a cerebral aneurysm surgically repaired with a metal clip twenty years ago.Answer
  3. C
    The client has an implanted titanium rod in the right femur from a motor vehicle accident.
  4. D
    The client is currently wearing a transdermal clonidine patch for blood pressure management.

Answer

The presence of a cerebral aneurysm clip placed twenty years ago represents the highest priority and an absolute safety contraindication.
Older cerebral aneurysm clips are typically made of ferromagnetic materials. The powerful magnetic field generated by an MRI can cause these clips to torque, move, or dislodge, resulting in catastrophic and potentially fatal intracranial hemorrhage. This represents an absolute contraindication to the procedure until the exact make and model of the clip can be verified as MRI-safe.

Step-by-Step Solution

1
Analyze the proposed imaging modality.
The client is scheduled for a magnetic resonance imaging (MRI) scan.
MRI utilizes a powerful magnetic field that strongly interacts with ferromagnetic materials.
2
Evaluate the safety risk of an iodinated contrast allergy.
An iodine allergy is relevant for CT scans, but MRI uses gadolinium. This is not a primary safety concern for this procedure.
Differentiating contrast media types prevents unnecessary delays in care.
3
Evaluate the safety risk of titanium implants.
Titanium is non-ferromagnetic and is considered safe in MRI environments.
Knowledge of safe versus unsafe metals is critical for MRI screening.
4
Evaluate the safety risk of a transdermal patch.
Patches with metal backing can cause burns but can simply be removed prior to the scan.
This is an easily mitigated risk that does not require halting the procedure.
5
Evaluate the safety risk of an older cerebral aneurysm clip.
Clips placed decades ago are highly likely to be ferromagnetic. The magnet can dislodge the clip, causing fatal hemorrhage.
Ferromagnetic materials in the brain represent an absolute contraindication and the highest priority risk.

Key Concept

MRI Safety and Ferromagnetic Contraindications
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Topics

Accident, Error, and Injury Prevention

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