BILL ANALYSIS �
SB 1199
Page 1
Date of Hearing: June 19, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 1199 (Dutton) - As Amended: April 17, 2012
SENATE VOTE : 38-0
SUBJECT : Radiologic technologists.
SUMMARY : Authorizes a radiologic technologist (RT) who is
permitted to perform venipuncture in an upper extremity in
administering contrast materials, to use a saline-based solution
that is in accordance with the hospital or imaging center
protocol and is found to be an acceptable practice by the
federal Centers for Disease Control and Prevention (CDC), or
other nationally recognized accreditation society, to ensure the
security and integrity of the intravenous (IV) cannula. Makes
other technical, clarifying, and non-substantive changes.
EXISTING LAW :
1)Establishes the Radiation Control Law which establishes the
Radiologic Health Branch within the Department of Public
Health (DPH) and is responsible for licensing of radioactive
materials, registration of X-ray producing machines,
certification of X-ray and radioactive material users,
inspection of facilities using radiation, investigation of
radiation incidents, and surveillance of radioactive
contamination in the environment.
2)Requires an RT who administers or uses diagnostic or
therapeutic X-ray on human beings to obtain a certificate or
permit and meet certain education and requirements, as
specified.
3)Authorizes a certified RT under the general supervision of a
licensed physician and surgeon to perform venipuncture in an
upper extremity to administer contrast materials, manually or
by utilizing a mechanical injector if the RT has received
sufficient training and education. Requires that an RT who
performs venipuncture to receive a total of 10 hours of
instruction, as specified.
4)Authorizes an RT to perform a positron emission tomography
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(PET) scan (nuclear medicine imaging equipment) only on a dual
mode machine on which both a PET scan and a computerized
tomography (CT) scan may be performed if certain conditions
are met.
5)Authorizes a nuclear medicine technologist (NMT) to perform a
CT scan only on a dual mode machine on which both a nuclear
medicine procedure, including a PET scan and a CT scan may be
performed if certain conditions are met.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible costs.
COMMENTS :
1)PURPOSE OF THIS BILL . The California Radiological Society is
the sponsor of this bill. According to the author, this bill
is necessary to clarify that an RT is able to administer
saline-based solutions in accordance with hospital or imaging
facility protocol specific to ensuring the integrity of the IV
cannula. In some patients, it is necessary to inject a
saline-based solution related to the contrast injection or the
patency of the port of injection. The sponsor points out that
although it is not the standard of practice in all radiology
settings to use saline-based solution, in situations where
necessary, the radiology community would like to clarify
statute and allow for this possibility.
2)BACKGROUND .
a) Radiologic Technology . Existing law defines radiologic
technology as the application of X-rays on human beings for
diagnostic or therapeutic purposes. An RT must be
certified or granted a permit to administer or use
diagnostic or therapeutic X-ray and is under the
supervision of a physician and surgeon. There are separate
certificates for diagnostic radiologic technology,
mammographic radiologic technology, and therapeutic
radiologic technology. Limited permits could also be
issued to individuals who perform limited procedures or
apply X-rays to specific areas of the human body. DPH
approves schools for RTs, prescribes the minimum standards
of training and education, including courses of study and
laboratory requirements, and sets the examination
procedures for these practitioners.
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b) Performance of Venipuncture by RTs . Current law
authorizes an RT who is under the supervision of a licensed
physician and surgeon to perform venipuncture in an upper
extremity to administer contrast materials, manually or by
utilizing a mechanical injector if the RT has been issued a
certificate. This certification requires that an RT
receive a total of ten hours of instruction, and perform 10
venipunctures under supervision. The courses of
instruction are: anatomy and physiology of venipuncture
sites, venipuncture instruments, IV solutions, and related
equipment; puncture techniques; techniques of IV line
establishment; hazards and complications of venipuncture;
post-puncture care; composition and purpose of
antianaphylaxis tray; and, first aid and basic
cardiopulmonary resuscitation. The general supervision
required for the performance of venipuncture requires that
a physician and surgeon be physically present and available
within the facility where the procedures are performed to
provide immediate medical intervention to prevent or
mitigate injury to the patient in the event of an adverse
reaction.
This bill authorizes an RT who is permitted to perform
venipuncture when administering contrast materials to use a
saline-based solution so as to ensure the security and
integrity of the IV cannula. An IV cannula is a tube
inserted into the vein, primarily for administration of IV
fluids, obtaining blood samples, and administration of
medication. It is important to ensure the patency of the
cannula prior to injection of contrast materials to ensure
that the IV line is open and not blocked. A patent IV line
is one that is correctly placed, allowing the treatment to
flow directly into the patient's vein, and a poorly placed
IV is not patent and can cause side effects.
c) Practice Guideline for the Use of Intravascular Contrast
Media . According to the American College of Radiology
(ACR) Practice Guideline for the Use of Intravascular
Contrast Media (guidelines), intravascular contrast media
are used for a wide variety of imaging studies, and the
majority of which usually involve iodinated contrast media,
and could also be used for magnetic resonance imaging,
ultrasonic imaging, and angiography. The goal of
radiologists and other personnel administering
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intravascular contrast media is to utilize these agents
appropriately and properly so that the imaging studies are
optimized and risk to the patient is minimized. The
guidelines also specify the appropriate health care
personnel that should perform the injection, including RTs,
nurses, physician assistants, physicians, or other
appropriate credentialed personnel under the direct
supervision of a radiologist, as specified. Training and
proficiency in cardiopulmonary resuscitation is also
recommended for those who attend to patients undergoing
contrast-enhanced examinations. The ACR's Manual on
Contrast Media includes recommendations on technique, and
indicates that if saline can be injected through the
catheter without abnormal resistance, contrast media can be
administered through the catheter safely, and if abnormal
resistance or discomfort exists, an alternative venous
access should be sought. Additionally, CDC's Basic
Infection Control and Prevention Plan for Outpatient
Oncology Settings recommends the flushing of valve
catheters or closed tip catheters with normal saline.
d) Nuclear Medicine Technologists . An NMT is someone who
holds a valid certificate in nuclear medicine technology as
issued by DPH. The standard of competence to qualify as an
NMT is as follows: successful completion of college level
instruction, laboratory training on specified courses; and,
clinical experience, as specified. Existing law also
allows an NMT to perform a CT scan on a dual mode machine
in which both a nuclear medicine procedure, including a PET
scan, and a CT scan if the NMT holds a current, valid
certificate in CT issued by the American Registry of
Radiologic Technologists, or a similarly recognized
organization, and the NMT is under the supervision of a
physician and surgeon, as specified.
3)SUPPORT . The California Radiological Society states that this
bill would clarify existing law to specify that an RT can also
inject other substances related to the contrast injection to
ensure the patency of the cannula or port of injection. For
example, in some practices an RT might be asked to inject
saline for that purpose. The California Medical Association
states that this bill would allow more options for RTs to
perform their duties efficiently and safely.
4)PREVIOUS LEGISLATION . AB 2720 (Spitzer), Chapter 220,
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Statutes of 2006, allows a person who holds a certificate in
nuclear medicine technology to perform a CT scan only on a
dual mode machine, and an RT to perform a PET scan only on a
dual mode machine, if he/she receives a valid certificate,
registers with DPH, and is under the direct supervision of a
physician and surgeon, as specified.
5)SHOULD THIS BILL APPLY TO NMTs WHO OPERATE DUAL MODE MACHINES ?
In 2006, legislation was adopted to authorize an NMT to
operate dual mode machines only if he or she meets certain
certification requirements, registers with DPH, and is under
the supervision of physicians and surgeons. The education and
training of NMTs focuses on the utilization and administration
of radiopharmaceuticals to patients for diagnostic purposes,
including administration of contrast material when utilizing
nuclear imaging equipment. Similar to the requirements for
RTs who perform venipuncture, prior to certification, NMTs are
also required to receive instruction on all of the following:
anatomy and physiology of all possible venipuncture sites;
choice of instruments, IV solutions, and equipment; proper
puncture techniques; techniques of IV line establishment;
hazards and complications of venipuncture; post-puncture care;
composition and purpose of antianaphylaxis tray; first aid and
instruction in basic cardiopulmonary resuscitation; and, care
of specimen. The instruction on these subjects is mandatory
to fulfill the requirement of 10 administrations of
radioactive materials to human beings for nuclear medicine
technology procedures. Since the training and education of
NMTs focuses on the utilization of radioactive materials, they
are required to fulfill similar requirements as RTs who
perform venipuncture, and the law permits a special class of
NMTs to operate dual mode machines, the sponsor and staff are
recommending that NMTs who can operate dual mode machines
should also be able to use a saline-based solution in
administering contrast materials. This bill should be amended
as follows:
SECTION 2: Subparagraph (2) shall also apply to a person
who meets the standards of competence in nuclear medicine
technology who is authorized to use a computerized
tomography scanner only on a dual mode machine and meets
the requirements of Section 106976.
REGISTERED SUPPORT / OPPOSITION :
SB 1199
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Support
California Radiological Society (sponsor)
California Medical Association
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097