BILL ANALYSIS �
SB 1199
Page 1
SENATE THIRD READING
SB 1199 (Dutton)
As Amended June 25, 2012
Majority vote
SENATE VOTE :38-0
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hern�ndez, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Hall, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, V. Manuel | |Solorio, Wagner |
| |P�rez, Silva, Smyth, | | |
| |Williams | | |
| | | | |
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SUMMARY : Authorizes a radiologic technologist (RT) who is
permitted to perform venipuncture in an upper extremity in
administering contrast materials, and a person certified in
nuclear medicine technology and who is authorized to perform a
computerized tomography scanner only on a dual-mode machine, 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.
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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
(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 Assembly Appropriations
Committee, negligible costs, if any.
COMMENTS : 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.
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
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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.
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 10 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.
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
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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
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.
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.
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
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efficiently and safely.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
FN: 0004904