Location - BWH BTM, First Floor, Overflow Reading Room
Hours - 7:30am to 6:00pm
Important Reference Documents
Responsibilities Overview
- Perform lumbar punctures and myelograms (attending 3).
- Perform CSIR procedures (attending 5).
- Ensure upcoming patients are not on anticoagulants and are otherwise tucked in (i.e. appropriate indication, coordinate with oncology for intrathecal chemo cases, etc.)
- Work up and coordinate inpatient/add-on lumbar punctures, myelograms, and CSIR procedures.
- Call patients as needed based on reading room assistant’s workup. See link to checklist document below.
- Protocol CSIR procedures.
- Read exams on Neuro Master list with Attending 5 if no procedures.
- Send email update at end of week with schedule of lumbar punctures and myelograms for the following week if reading room assistant is away. See template below.
Additional Notes
- Outpatient LP/myelo cases are in Epic snapboard BWH IMG XRAY MSK IR BTM.
- Inpatient LP/myelo cases will be added to Epic snapboard BWH IMG FL GI.
- CSIR cases are listed in Epic snapboard BWH IMG IR CSIR Exams.
- Check the CSIR and LP schedule the night before on Epic. If you have an 8am start, you should have the patient consented by 7:30am.
- You will be paged for inpatient add on cases for both the LP/myelo service and the CSIR service which you need to evaluate for their appropriateness and schedule upon approval by the appropriate attending.
- Email is generally the easiest way to contact ordering providers to discuss non-urgent risks/benefits, premedication for contrast allergy, incorrect orders, etc.
- You are encouraged to focus on lumbar punctures and myelograms until you are comfortable with them, then you are encouraged to get residents involved in them and focus on CSIR procedures.
- Per ACGME criteria, you need to perform a total of 50 non-vascular procedures.
- See the Phone List Neuro tab for important phone numbers for scheduling etc.
Procedure Workflow
- Safety pause.
- Procedure attending will be present for entire procedure and will show you what to do.
Post-Procedure Workflow
- If myelo: Have patient sign discharge paperwork before they leave the procedure room. They will then be discharged 1 hour later.
- If LP: Deliver CSF samples to lab yourself to ensure they do not get lost, all tubes must be appropriately labeled (2nd floor 75 Francis St, under stairs that lead to 3rd floor DFCI bridge).
- Brief op note in Epic (select patient in snapboard -> post-procedure -> brief op note “.CSIR”).
- Additional patient instructions “.raym”--> print and sign for outpatients.
- If inpatient, call referring MD for signout.
- Dictation (Powerscribe).
- Case log (New Innovations): log all your LPs, myelos, CSIR cases, angio cases. Easier to keep the log up to date than trying to document everything months later.
Notes About Inpatient Add-Ons
- We perform LPs for patients admitted to oncology. They do not have to try on the floor.
- For all other services (e.g. general medicine) LPs should have been tried by a physician on the floor before referring to us.
- If we need sedation or it's an ICU patient or the patient is over 300lbs, it needs to be done in the neuroIR suite and we need a nurse. It makes scheduling a lot harder.
Off-Hours Procedures
- Nights: Emergent LP/myelo only (e.g., myelo for suspected cord compression and patient will go to the OR overnight if positive).
- Weekends: urgent LP/myelo only.
- CSIR add-ons: Essentially always bump to Monday. We do not have staff on call for CSIR procedures.
- If you get a request for an off hours case:
- Page neurorad attending on call to discuss
- Get to hospital and consent patient
- Coordinate scheduling with xray (or with IR if sedation/ICU patient)