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Corporate Services

Edmonton Acute

Administrative / General Manual

 

as of November 7, 2016

 

Edmonton Acute Administrative Manual 

Quality Assurance / Risk Management / Utilization Management

Off-duty Staff, Physicians and Volunteers as Visitors

May 2005

I-D-30

Fundraising / Donations

Donations

August 23, 2011

I-F-5

Fundraising

August 23, 2011

I-F-10

Health, Wellness and Safety

Medical Emergency Response Procedure

February 2012

II-90

Safe Use of Lasers  Nov. 7, 2016  I-D-55 

Use of Lobby Space for Fundraising and/or Display Activities

April 2015   

I-F-20

Equipment / Facilities / Finance / Security

Capital Equipment Purchases / Requisitions

March 2010

IV-B-10

Decorative Lighting, Materials, and Displays

Nov. 7, 2016

IV-A-20

Illegal Drugs or Weapons; Patients

January 2008

V-C-1

Lost and Found Property

October 2007

V-C-15

Moves; Office / Furniture / Equipment

February 2010

IV-A-55

Petty Cash Purchases

January 2010

V-A-41

Storage and Disposition of Surplus Equipment and Furniture

July 2008

IV-A-10

 

Patient Care Manual

as of October 24, 2016          

Edmonton Acute- Patient Care Policy and Procedure Manual             

Other Links:

Instructions for use of the Nursing Assessment and Care Record (Form CH-0774)
<"Pharmacy/pm_edm/index.asp" target="_blank">Parenteral Manual - Drug Monographs
<"7723.asp" target="_blank">Guide to Blood Transfusion    
<"woundcareguidelines/" target="_blank">Wound Care
Adult Nutrition Support Manual 

Clinical Nutrition Update:
    
Guidelines in Adult Enteral Nutrition - May 2015
    
Med Pass Program Procedure
     Closed Enteral Feeding System Information - August 2016   
    
Temporary Substitutions for Adult Formulas - August 2016  
     PeriOlimel® and Olimel® Standard Parenteral Nutrition Solutions
    
Clog-Zapper - Enteral Feeding Tube De-clogging System (Mar. 28, 2016)

Total Parenteral Therapy (TPN) Resources:
    
<"pharmacy/pm_edm/index.asp">Drug Monographs:   SMOFlipid Emulsion  
     Olimel / PeriOlimel Parenteral Nutrition 
     Travasol Amino Acid Solution
    
Adult Nutrition Support Manual 

Table of Contents:

Patient Care General

Activation of the Rapid Response Team

October 2014

II-7

Patient Portering

April 2015

II-44

Medication Administration

Automatic Stop Orders

October 2008

III-10

Direct IV Medication Administration
    
<"Page1211.aspx" target="_self">Learning Module

January 2010

III-45

Independent Double Checks - Medication Administration

January 2010

III-73

Medication and Parenteral Fluid Admin by Alaris SMART Infusion Pumps
     Resources:
             Edmonton Region
<"smartivpumps/EducationalResources.htm" target="_blank">Infusion Pump Education Resource Link
            
<"6064.asp">AHS Provincial Infusion Pump Education (SMART User and SMART Culture Learning Module)
           
When to Use an Infusion Pump

March 2009

III-103

Medications for Patients on Pass to Family and Community Environment

Sept. 2007

III-110

Patient Controlled Analgesia (PCA) via PCA Pump – Care of the Patient and Infusion
    
<"Page1211.aspx" target="_self">Learning Module

May 2010

III-130

Patients/Residents on Temporary Transfer to Other Care Providers

January 2010

III-140

Documentation

Patient Chart Documentation

July 2010

V-20

Safekeeping Patient Valuables

June 2006

V-45

BODY SYSTEMS - Central Nervous System

Assessment and Care of the Adult Following Surgery or Procedures Completed Under General, Intraspinal Anaesthetic and/or Regional Nerve Block
     Accompanying forms for VII-A-5
            
CH-1343 (Jul 2008) Adult Inpatient Pain Assessment & Analgesic Monitoring Flow Sheet
            
CH-1344 (Jul 2008) Adult Inpatient Pain Assessment and Analgesic Monitoring Flow Sheet Guidelines (Sheet #1)
             
CH-1345 (Jul 2008) Adult Inpatient Pain Assessment and Analgesic Monitoring Flow Sheet Guidelines (Sheet #2)
             
CH-1346 (Jul 2008) Adult Inpatient Pain Assessment and Analgesic Monitoring Flow Sheet Guidelines (Sheet #3)

Feb. 2009

VII-A-5

Regional Nerve Block
    
Learning Package

July 2010

VII-A-10

Epidural Catheters
    
Learning Module

Sept. 2010

VII-A-15

BODY SYSTEMS - Gastrointestinal

Enteral Tube; Insertion, Nutrition and Medication Administration, Decompression/Evacuation

Sept. 2010

VII-D-10

Feeding / Swallowing Problems

June 2005

VII-D-15

Oral Care Protocol for Adult Patients

July 2009

VII-D-23

BODY SYSTEMS - Genitourinary

Suprapubic Catheter Removal

March 2011

VII-E-15

BODY SYSTEMS - Musculoskeletal / Integumentary

Specialized Footcare

July 2009

VII-F-5

Removal of Wound Closure and Drainage Devices

May 2009

VII-F-10

Therapeutic and General Mobilization

July 2009

VII-F-15

Pressure Ulcer Assessment and Prevention
    
Standards of Practice

June 2010

VII-F-20

Pressure Ulcer Assessment and Prevention – Heels

June 2010

VII-F-25

BODY SYSTEMS - Endrocrine

Blood Glucose Monitoring

Feb. 2010

VII-G-5

Diabetes Management, Hypoglycemia

Feb. 2010

VII-G-10

Diagnostic / Interventional

Cardiac Catheterization

Sept. 11, 2015

VIII-10

Specimen Identification, Labelling and Transport   

Nov. 4, 2016

VIII-20

               

Neonatal / Child Health: A-Z Listing

as of November 8, 2016                                

Search Tip: To quickly scan the page for a topic, hold down the ctrl + F keys on your keyboard, then enter your search topic in the box.

Link to Corporate and Edmonton Acute Policies/Procedures - <"Page2099.aspx">click here  

Protocol Title

Last Revision Date

Admission Criteria to the Neonatal Nursery

Dec. 2013

Aerosol Therapy

 

March 2015

Antibiotic Resistant Organism (ARO) Screening

 

Oct. 2015 

Assessment of the Newborn Infant

 

April 2015 

Assisted Ventilation - Care of the Infant 

 

Aug. 2015 

Bilirubin:

Bilirubin - Neonatal Jaundice, Treatment Threshold Graphs
Hyperbilirubinemia less than 35 Weeks
Hyperbilirubinemia greater than 35 Weeks       
Phototherapy  
Universal Pre-Discharge TCB Screening for Term and Late Preterm Infants 

 

 

May 2010
Sept. 2015
Sept. 2015
Aug. 2015
July 2015 

Bladder Catheterization 

 

May 2015 

Bladder Tap Assisting  

 

Aug 2015 

<"Page2099.aspx" target="_blank">Blood and Blood Products Policy & Resource Page  
  
Addendum to corporate policy VII-B-397, Blood and Blood Products Administration

 

July 2015 
Aug. 2015

Blood and Fluid Warmer 

 

Sept. 2015 

Blood Culture 

 

Mar. 2015 

Blood Pressure Monitoring Arterial Lines

 

May 2015 

Blood Sampling - Assisting with Arterial Puncture 

 

Nov. 2015

Blood Sampling Arterial Lines 

 

Jan. 2012 

Blood Sampling Central Venous Lines 

 

May 2015 

Blood Sampling Heelstick 

 

Sept. 2015 

Blood Sampling Venipuncture 

 

May 2015 

Body Cooling - Pre-transport

Resources:      Hypothermia Blood Work Schedule
                           TBC Information Sheet for Parents (Mar. 28, 2014)
                           
Neurological Assessment Before Cooling         
                           Pretreatment aEEG Record TBC for Treatment of Neonatal         
                           TBC
Temp. Record
                          
TBC Exclusion Criteria
                          
<"assets/policy/clp-capital-nicu-pp-neuro-body-cooling-info-sheet-inclusion-criteria-no-c.pdf" target="_blank">TBC Inclusion Criteria   

 

July 2015 

Bottlefeeding

 

July 2011 

Breast Milk / Human Milk  
     
Donor Human Milk  
     
Human Milk Misappropriation
     IPC Guidelines for Handling of Expressed Breast Milk
    
Mother's Own Milk (MOM)   

 

 
Dec. 2015
Dec. 2015
 
Dec. 2015 

Breastfeeding (BFHI)

 

Nov. 2016 

Car Seat Position Evaluations  

 

October 2014

Cellular and Wireless Devices   

 

Apr. 2016

Central Arterial / Venous Lines 

 

May 2015 

Central Line Dressing

 

May 2015 

Central Venous Catheter Insertion - Assisting  

 

May 2015

Central Venous Pressure Monitoring   

 

Nov. 2016 

Chest Drains

 

Apr. 2013 

Consents NICU

Oct. 2015

Cord Care   

 

Feb. 2015

Cranial Ultrasound Screen  

 

May 2015 

Deceased - Care of   

 

Oct. 2015

Defibrillation and Cardioversion (GNCH) 

 

May 2015

Defibrillation and Cardioversion (MCH) 

 

May 2015 

DEHP Exposure  

 

May 2015 

Delayed Cord Clamping in Preterm Infants Less Than 37 weeks

Feb. 2015

Developmental Care (NICU)

Related Policies         Cue-Based Care
                                          Lighting
                                          Positioning
                                          Skin to Skin Procedure
                                          Sound Recommendations 

 

Oct. 2012

July 2016

Diagnostic Imaging     

 

June 2015

Discharge from NICU

 

Sep. 2015 

Early Onset Neonatal Sepsis (EONS)

 

April 2016 

Emergency Evacuation - Code Green NICU     

 

Nov. 2015 

Endotracheal Extubation   

 

July 2016

Endotracheal Intubation - Assisting  

 

Sept. 2015 

Endotracheal Suction (Inline) 

 

Oct. 2015 

Enteral Feeding Guidelines   

 

Nov. 2015 

Enterostomy Care   

 

July 2016 

Enterostomy Refeeding  

 

July 2016 

Exchange Transfusion 

 

Mar. 2013 

Extravasation  

 

July 2016 

Eyes, Prophylactic Care of the Newborn Eyes Prophylaxis / Timing

July 2016

Falls Mitigation Strategy  

 

Oct. 2015 

Fluid Management  

 

July 2015 

Frenotomy - Assisting     

 

Dec. 2015 

Gastric Gavage Feeding  

 

Oct. 2015 

Gastrostomy Tube Care and Feeds

 

Oct. 2015 

Glucose Screening 

 

Oct. 2015 

Hearing Loss Screen   

 

Jan. 2012 

Hepatitis B Prevention - Infants    

 

June 2016

Heparin Use:  Recommendations  

 

Oct. 2015 

HIV Protocol - Regional Guidelines

Aug. 2014

INTERhospital Transfer 

 

April 2015 

INTRAhospital Transfer 

 

April 2015 

Intrapleural Aspiration - Assisting  

 

August 2015 

Intravenous Lock     

 

Sept. 2015 

Intravenous Therapy 

 

April 2015 

IVIG  

 

 

Jejunostomy Tube Care and Feeds 

 

Oct. 2015 

Late Pre-Term Infant Guidelines 

 

June 2013 

Line and Tubing Verification 

 

Nov. 15 

Lumbar Pumcture - Assisting 

 

Oct. 2015 

Maxilene Cream and EMLA Cream Use 

 

July 2016 

Neonatal and Infant Follow-up Clinic  

 

May 2015 

Neonatal Abstinence Syndrome  

 

Oct. 2015 

<"9307.asp" target="_blank">Newborn Metabolic Screen Policy Suite - including Blood Spot Screening  @ <"9307.asp">http://insite.albertahealthservices.ca/9307.asp    

 

 

Non-Invasive Monitoring  

 

Oct. 2015 

Oral Immune Therapy 

 

Dec. 2013 

Oxygen Delivery 

 

Oct. 2015 

Pain Assessment and Management

 

Oct. 2015 

Parenteral Nutrition  / TPN  

 

Nov. 2015   

Peripheral Arterial Line Insertion and Removal - Assisting   

 

Oct. 2015 

Posting of Inpatient Names 

 

April 2015 

Pre-Term Infant (less than 37 weeks gestational age) NICU Monitoring Guidelines 

 

Oct. 2014 

Reports 

 

Sep. 2015 

Restraints 

 

Oct. 2015 

Resuscitation:
          Resuscitation in the Delivery Room (Neonatal)
                       
Grey Nuns 
                       
Misericordia
          Risk Assessment
          Documentation of NeoNatal Resuscitation
          Neonatal Resuscitation Record

 

July 2015
July 2015
July 2015
July 2015
June 2015 

Retinopathy of Prematurity  

 

Oct. 2014

RSV Prevention Program

 

2014 - 2015

<"9537.asp" target="_blank">Safe Infant Sleep - Resource Page  

 

Safety Guidelines  
    Resource:  Tu
b Bath Safety - October 2013

 

Oct. 2015 

Skin Antisepsis   

 

July 2015

Skin Care 

 

Aug. 2015 

Skin Injury Prevention Guidelines 

 

Sept. 2015 

Soothers 

 

Mar. 2010 

Subgaleal Hemorrhage 

 

June 2011 

Sucrose Administration  

 

June 2015 

Suctioning -  Gastric and Esophageal Suctioning     

 

Oct. 2015 

Surfactant Administration   

 

Dec. 2015 

T-Piece Ventilation  

 

Dec. 2015 

Transition to Cot 

 

Mar. 2014 

Transport Incubator Use 

 

June 2013 

Transpyloric Feeding Tube 

 

June 2013 

Umbilical Line Insertion 

 

 Oct. 2015

Visiting Guidelines - Neonatal Nursery  

Dec. 2015

Vitamin and Mineral Supplementation  

 

May 2015 

Vitamin K

 

April 2015 

 

 

 

Maternal / Newborn Health

As of October 24, 2016   

Search Tip: To quickly scan the page for a topic, hold down the ctrl + F keys on your keyboard, then enter your search topic in the box.

Link to Corporate and Edmonton Acute Policies/Procedures - <"Page2099.aspx">click here

Protocol Title

Date of Last

Revision

Amnioinfusion

 

Jan. 2013

Anesthesia Requests

 

July 2015

Bakri Balloon Catheter

 

June 2013

Bathing – Initial Infant Bathing

 

Sept. 2015

Bili Blanket - NeoBlue - Use of

 

March 2012

Bilibed - Use of

May 2009

Bilirubin Risk Nomogram 34-42+ Weeks

 

Aug. 2013

Bilirubin Screening Policy of Term and Later Preterm Infants

Procedure

Jan. 2009

Bilirubin Universal Transcutaneous Screening Algorithm

 

Aug. 2013

Bladder Scanner BVI 9400

 

Mar. 2011

Breast Milk / Human Milk
   
Assessment of Milk Transfer
    IPC Guidelines for Handling of Expressed Breast Milk
    Human Milk Management
   
Mothers Milk Safe Handling and Administration
    Storage of Expressed Breast Milk
    H
uman Milk
    Human Milk Misappropriation
    Supplementation for the Breastfed Well Term Newborn

 

 

Breastfeeding Policy (BFI)

Nov. 2016

Breech Management at Term

Jan. 2012

Chorioamnionitis

June 2014

<"ie/Page433.aspx" target="_blank">Consent to Treatment / Procedure

Jan. 2014

Consultation Protocol – Obstetrics

Individual Privileges and Required Skills for General Practitioners

Jan. 2012

Cord Care

 

Feb. 2015

Cord Sampling at Delivery

 

June 2011 

Deliveries in the Absence of Medical Staff:

    Grey Nuns

    Misericordia

 

 

June 2011

May 2012

Diabetic Management of the Obstetrical Patient Guidelines

July 2016

<"Page2099.aspx" target="_self">Early Induction of Labour - corporate policy

Early Pregnancy Loss Program (EPLP): November 2014
   
Surgical Management of a Non-viable Pregnancy
   
Medical Mgmt. of a Non-viable Intrauterine Pregnancy
   
Outpatient Expectant Mgmt. of Non-viable Intrauterine Pregnancy  

 

 

Emergency Dept – Mgmt. of an Obstetrical Patients

Aug. 2011

Entonox - Use of

 

June 2011

Epidural Regional Analgesia / Anaesthesia Infusions

    Epidural for Labour - Mgmt. of Patients, Procedure

July 2015

July 2015

External Cephalic Version – ECV

Jan. 2012

Eyes, Prophylactic Care of the Newborn Eyes Prophylaxis / Timing

Oct. 2012

Falls Mitigation Strategies

 

Oct. 2011 

FentaNYL – Administration During Labour

 

Apr. 2015 

Fetal Health Surveillance Womens Health Edmt Zone

Apr. 2016

Fetal Scalp Sample

 

June 2015 

Glucose Screening Newborn

 

Oct. 2015 

Group B Strep (GBS):
   
Group B Strep – Maternal
    Early Onset Neonatal Sepsis (EONS)

April 2016
April 2016

Hepatitis B Prevention - Infants

 

Sept. 2015 

HIV Perinatal Protocol - Regional Guidelines

Aug. 2014

Hypertensive Disorders of Pregnancy
    Magnesium Sulfate Infusion for the Obstetrical
        Patient
Guideline June 2011

    Magnesium Sulfate Post Partum Admin. Dec. 2013

Nov. 2014

<"ie/Page142.aspx" target="_blank">Identification of Patient, Resident or Client Using Two Identifiers

    & Addenum

June 2011

Induction & Augmentation of Labour

    Standard Oxytocin Increment Table

June 2014

 

Inpatient Transfer:

    Grey Nuns (Mar. 2014)

    Misericordia (January 2016)

Intrauterine Pressure Catheter (IUPC)

 

Aug. 2011 

Magesium Sulfate for Fetal Neuroprotection in the Obs. Patient

Jan. 2014

Management of the Obstetrical Patient in Emergency

 

Aug. 2011 

Managing Obstetrical Patients Requiring a Cesarean Section in the Main OR (Delivery in the Main OR)

Oct. 2014

Midwifery Guidelines for Physician Consultation and Transfer of Responsibility of Care

April 2016

<"9307.asp">Newborn Metabolic Screen Policy Suite

 

 

Non-Stress Test (NST)

Mar. 2014

Obstetrical Emergency

    Stat 99 MCH (Dec. 2013)

    Stat 35 GNCH (Dec. 2016)

Obstetrical Operating Room Standards

Feb. 2011

Oxytocin Challenge Contraction Stress Test

 

July 2015 

<"ie/Page142.aspx" target="_blank">Patient Request for Specific Gender of Health Care Provider

Jan. 2012

Phototherapy:
   
MCH Phototherapy Nursing Considerations - Sept 2011
   
MCH Algorithm
   
GN Policy & Procedure - Oct. 2011
   
GN Phototherapy Readmit - July 2010
   
GN Setting up the Drager Isolette

 

 

Physician - Family Practice Privileges

 

 

Placenta Processing for the Laboratory

 

Oct. 2011

Postpartum Bladder Management     Aug. 2016 

Postpartum Hemorrhage Prevention and Treatment

Jan. 2012

Preterm Labour – Tocolysis*

Jan. 2007

Resuscitation:

    Resuscitation in the Delivery Room (Neonatal)

        Grey Nuns

        Misericordia

        Attendance at Delivery

        Documentation of NeoNatal Resuscitation

        Neonatal Resuscitation Record

 

Sep. 2011

Sep. 2011

Oct. 2012

Sep. 2011

<"9537.asp">Safe Infant Sleep

 

 

<"ie/Page142.aspx" target="_blank">Safe Surgical Checklist

Skin to Skin Care    

 

Nov. 2015 

Sponge and Needle Count

Mar. 2014

Thermal Regulation Temperature Monitoring

 

Oct. 2011 

Trauma in Pregnancy

 

Sept. 2010 

Vaginal Birth after Cesarean Section (VBAC)

June 2014

Visiting Policy
   
Grey Nuns

    Misericordia
     Off Duty Staff, Physicians and Volunteers

 

Oct. 2011

March 2014
May 2005

Vitamin K

 

April 2015

 

 

Diagnostic Imaging

GENERAL INFORMATION - All Sections

Administration of Contrast Media in Lactating Patients (July 2015)    II-A-56

Booking Examinations-Specialty Imaging (July 2015)   II-A-20

Booking Examinations (July 2015)   II-A-12

Confidentiality (July 2015)   II-A-40

Consultation Request (July 2015)   II-A-15

Contrast Media Utilization/Administration (July 2015)   II-A-55

Emergency Service-Specialized Imaging (July 2015)   II-A-10

Fluoroscopic Equipment Utilization (July 2015)   II-A-70

Hours of Operation (July 2015)   II-A-5

Outpatient Referrals-External Health Care Facilities (July 2015)   II-A-23

Patient Care Following Diagnostic Nuclear Imaging Procedures (July 2015)   II-A-90

<"Page433.aspx">Patient Consent    (Corporate)

<"7890.asp">Patient Consent for Examinations Requiring the Injection of Intravenous Contrast Media

Patient Dress (July 2015)   II-A-35

Patient Transportation and Portering Service (July 2015)   II-A-30

Retention of Imaging Records (July 2015)   II-A-45

Scheduled Procedure Commencement (July 2015)   II-A-25

Sequencing of Abdominal Examinations Using Contrast Medium (July 2015)   II-A-53

Still Born Radiography (July 2015)   II-A-85

Use of Intravascular Radiographic Contrast Media in Diabetic Patient Treated with Metformin (Glucophage) (July 2015)   II-A-63

 

DIAGNOSTIC RADIOLOGY PROCEDURES

Arthrogram – Knee (July 2015)   IV-5

Arthrogram – Shoulder (July 2015)   IV-6

Bronchoscopy (July 2015)   IV-10

Cardiac Fluoroscopy/Chest Fluoroscopy (July 2015)   IV-15

Cholangiogram T-Tube (July 2015)   IV-20

Colon (Barium Enema) (July 2015)   IV-25

Cystogram (July 2015)   IV-30

Endoscopic Retrograde Cholangiopancreatography (ERCP) (July 2015)   IV-35

Esophagus (July 2015)   IV-40

Hysterosalpingogram (July 2015)   IV-45

Joint Aspiration (July 2015)   IV-55

Joint Injection (July 2015)   IV-60

Loopogram (July 2015)   IV-65

Lumbar Puncture (July 2015)   IV-67

Nephrostogram (July 2015)   IV-75

Retrograde Pyelogram (July 2015)   IV-80

Sialogram (July 2015)   IV-85

Sinogram (July 2015)   IV-90

Stomach and Duodenum  (July 2015)   IV-95

Stomach and Duodenum and Follow-Through (July 2015)   IV-105

Swallowing Mechanism Assessments (July 2015)   IV-110

Urethrogram (July 2015)   IV-120

 

INTERVENTIONAL RADIOGRAPHY PROCEDURES

Vascular Procedures (Services consolidated to Referral System)

Abdominal Aortogram, Retrograde (performed at GNH only) (July 2015)   V-5

Arch (Thoracic) Aortogram (performed at GNH only) (July 2015)   V-10

Arterio-Venous Fistulogram  (July 2015)   V-15

Cerebral Angiography (Carotid and Vertebral Circulation) (performed at GNH only) (July 2015)   V-25

IVC Filter Removal (July 2015)   V-26

Percutaneous Transluminal Angioplasty (July 2015)   V-30

Peripheral (Femoral or Antecubital) Arteriogram (performed at GNH only) (July 2015)   V-40

Perm Cath (Performed at GNH only) (July 2015)   V-45

PICC Line Insertion (performed at GNH only) (July 2015)   V-50

Pulmonary Angiography (July 2015)   V-60

Renal Arteriogram  (July 2015)   V-70

Trans-Brachial Angiogram  (July 2015)   V-80

Vascular Embolization (July 2015)   V-90

Vascular Stent Insertion  (July 2015)   V-100

Vena Cavogram/Vena Cava Filter Insertion (July 2015)   V-110

 

Non-Vascular Procedures

Abscess Drainage and Tube Insertion Percutaneous (July 2015)   V-160

Biopsies (July 2015)   V-170

Fallopian Tube Canalization (July 2015)   V-180

Gastrostomy Percutaneous (performed at GNH only) (July 2015)   V-190

Percutaneous Nephrostomy (July 2015)   V-195

Pleurx Catheter Insertion (July 2015)   V-197

Sympathectomy Percutaneous (Lumbar, Thoracic or Celicac) (July 2015)   V-200

Tube Exchange or Replacement Percutaneous (July 2015)   V-205

Ureteral Stent Insertion (July 2015)   V-210

 

COMPUTED TOMOGRAPHY PROCEDURES

Intravenous Injection of Iodinated Contrast and Screening form and patient questionnaire 

Computed Tomography Procedures Booking Authorization (July 2015)   VI-1

Computed Tomography, Cranium (Head) (July 2015)   VI-5

Computed Tomography, Chest (July 2015)   VI-10

Computed Tomography, Abdomen and/or Pelvis (July 2015)   VI-15

Computed Tomography, Spines (July 2015)   VI-25

Percutaneous Biopsy Under CT Guidance (July 2015)   VI-30

Computed Tomography, Extremities (July 2015)   VI-35

 

DIAGNOSTIC ULTRASOUND PROCEDURES

Abdomen (July 2015)   VII-1

Amniocentesis (July 2015)   VII-25

Arterial System (July 2015)   VII-60

Biophysical Profile, Fetus (GNH site) (July 2015)   VII-30

Biopsy Under Ultrasound Guidance (July 2015)   VII-90

Breast (July 2015)   VII-50

Carotid Doppler (July 2015)   VII-70

Drainage Under Ultrasound Guidance (July 2015)   VII-92

Echocardiography (July 2015)   VII-80

Neonatal and Infant Heads (July 2015)   VII-35

Obstetrical Ultrasound (July 2015)   VII-20

Paracentesis Under Ultrasound Guidance (July 2015)   VII-100

Pelvis (July 2015)   VII-5

Percutaneous Renal Biopsy (July 2015)   VII-95

Popliteal Space (Knee) (July 2015)   VII-55

Pylorus (July 2015)   VII-15

Scrotum (Testes) (July 2015)   VII-10

Thoracentesis Under Ultrasound Guidance (July 2015)   VII-105

Thyroid (July 2015)   VII-40

Transesophageal Echocardiography (performed at GNH only) (July 2015)   VII-75

Venous Doppler Lower Limb +/- Popliteal Space (July 2015)   VII-65

Venous Doppler Upper Limb (July 2015)   VII-67

 

 Nuclear Medicine Procedures

Cardiac System:

Cardiac First Pass Study (July 2015)   VIII-50

Cardiolite (MIBI) Rest/Stress Scan, Myocardial Perfusion Scan (July 2015)    VIII-55

Cardiolite (MIBI) Rest/Persantine Scan (July 2015)   VIII-60

Rest Gated Cardiac Blood Pool Scan (July 2015)   VIII-65

Thallium Viability Scan (Resting Components) (July 2015)   VIII-75

Thallium Stress/Rest/Reinjection Scan (July 2015)   VIII-80

 

Central Nervous System:

Brain Scan Flow and Scan (CNS, non routine) (July 2015)   VIII-5

Brain Flow and Scan (Perfusion, routine) (July 2015)   VIII-10

Shunt Patency Scan (July 2015)   VIII-20

 

Circulatory System:

Arm Venogram With Lung Scan (MCH only) (July 2015)   VIII-100

Lymphoscintigram (July 2015)   VIII-110

Red Cell Venogram (MCH only) (July 2015)   VIII-115

Sentinel Lymph Node Lymphoscintigram (July 2015)   VIII-120

Superior Vena Cavogram  (July 2015)   VIII-125

Venogram With Lung Scan – Bilateral Legs (July 2015)   VIII-130

 

Gastrointestinal System:

Gastric Emptying Scan (July 2015)   VIII-150

Gastroesophageal Reflux (MCH only) (July 2015)   VIII-155

GI Bleed Scan (Red Blood Cell) (July 2015)   VIII-160

GI Bleed Scan (Sulphur Colloid) (July 2015)   VIII-165

Meckel’s Diverticulum (July 2015)   VIII-170

Peritoneal Scan (July 2015)   VIII-175

 

Genitourinary System:

Capoten Renogram (July 2015)   VIII-250

Diuretic Renogram (July 2015)   VIII-255

DTPA Renogram (July 2015)   VIII-260

Effective Renal Plasma Flow (ERPF) (July 2015)   VIII-265

Glomerular Filtration Rate (July 2015)   VIII-270

MAG-3 Renogram (July 2015)   VIII-275

Nuclear Cystogram (July 2015)   VIII-280

DSMA/Renal Scan (July 2015)   VIII-285

Testicular Scan (July 2015)   VIII-290

 

Glandular System:

Adrenal Scan With Meta-Iodobenzylguanadine (mIBG) (July 2015)   VIII-350

Nuclear Dacrocystogram (GNH only) (July 2015)   VIII-355

Octeriotide Scan (July 2015)   VIII-357

Parathyroid Scan (July 2015)   VIII-360

Thyroid Scan  (July 2015)   VIII-370

Thyroid Therapy (For Treatment of Hyperthyroidism) (July 2015)   VIII-375

Thyroid Uptake (July 2015)   VIII-380

 

Hepatic System 

Gallbladder Ejection Fraction (July 2015)     VIII-200

HIDA Scan (Hepatobiliary) (July 2015)   VIII-205

Liver and Spleen Scan (July 2015)    VIII-210

Red Blood Cell Liver Scan (RBC Liver Scan) (July 2015)   VIII-215

 

Pulmonary System:

Perfusion Lung Scan (July 2015)   VIII-400

Ventilation Lung Scan – Aerosol (July 2015)   VIII-405

 

Skeletal System 

Bone Flow Study (July 2015)   VIII-300

Bone Marrow Scan (MCH only) (July 2015)   VIII-305

Bone Scan (July 2015)   VIII-310

 

Miscellaneous

Gallium Scan (July 2015)    VIII-455

Scinti-Mammography (July 2015)   VIII-460

White Blood Cell (WBC) Scan (July 2015)   VIII-470

 

LITHOTRIPSY PROCEDURES

Renal Extracorporeal Shock Wave Lithotripsy (MCH only) (July 2015)   IX-1

Biliary Extracorporeal Shock Wave Lithotripsy (MCH only) (July 2015)   IX-5

 

MAGNETIC RESONANCE IMAGING PROCEDURES

MRI Abdomen/Pelvis (July 2015)   X-15

MRI Angiography (July 2015)   X-20

MRI Brain (July 2015)   X-25

MRI Musculoskeletal (MSK) (July 2015)   X-35

MRI Pediatrics (July 2015)   X-40

MRI Spine (July 2015)   X-45

MRI Screening for Orbital metallic foreign bodies (July 2015)   X-50