Myelogram PRINT

I. Equipment

a. Myelogram tray (site dependent)
b. Luer lock syringes (10ml, 20ml)
c. 25g 1.5” needle
d. 22g spinal needle, 3.5 or 5 inch depending on patient’s size.
e. Hemostat (non-sterile)
f. Marking pen
g. Sterile gloves
h. Mask
i. Myelogram Handoff Instructions & Lumbar Puncture Myelogram Questionnaire

II. Medications (contrast limits= adults only)

a. Lidocaine 1%
b. Isovue-M 200 (max 15mL), Isovue-M 300/ Omnipaque 300 (max 10mL), Omnipaque 240 (max 12.5mL)

III. Personnel

a. Radiologist, RA

i. Place pre and post procedure orders (site specific)
ii. Verify laboratory data is within the acceptable range (inpatients only)

1. INR <1.5, Platelets >50,000

iii. Obtain consent from the patient prior to positioning or changing for the procedure
iv. Performs the procedure (RPA/RRA may perform the lumbar puncture portion of the exam, radiologist must administer contrast.)

b. Radiology RNs or Technologists (site specific)

i. Performs pre-procedure call to check if the patient is on anticoagulation or has a contrast allergy.

1. Follow RIA Anticoagulation Guidelines & Myelogram Guidelines re: seizure medications
2. Myelograms are contraindicated for patients with an iodinated contrast allergy

c. Technologist

i. Review order with radiologist/RA
ii. Verify PLT & INR within normal limits (inpatients only)
iii. Complete Lumbar Puncture Myelogram Questionnaire
iv. Setup myelogram tray
v. Assists the rad/RA during the procedure
vi. Fills out Myelogram Handoff Instructions and delivers to CT technologist during patient handoff

IV. Procedure

a. Patient prone on table
b. Mark puncture site and perform exam under fluoroscopy guidance (mask)
c. Lower back prepped and draped in sterile fashion
d. Skin is anesthetized with subcutaneous injection of 1% lidocaine.
e. Contrast injection (radiologist only)
f. Needle is removed with stylet in place
g. Patient rolled and taken to CT (follow Myelogram Handoff Instructions)

V. Required Images

a. AP spot images are obtained to show contrast within the thecal sac

VI. Special Considerations

a. Cervical Myelogram

i. Shoulder braces in place for Trendelenburg positioning (tech positioned at pt’s head)

Authenticating

Myelogram PRINT