Transforming and Supporting Patient Care - Health Professions ...

151Chapter 6 – Scope of Practice of Medical Radiation TechnologyInstrument, Hand or FingerBeyond the LarynxMRTs administer radiation treatment to patients with head and neckcancers who often have tracheostomies and trachea tubes. A tracheostomyis a surgical procedure on the neck to open a direct airway through anincision in the trachea (windpipe). The opening is created below the larynx.Tracheal suctioning is performed to clean and remove secretions from theairway and to more effectively deliver oxygen to the lungs. As thesepatients must lie flat and remain immobile for the duration of treatment,they are unable to clear their own secretions.HPRAC heard that it is not always possible, realistic or efficient to have anurse, respiratory therapist or other authorized professional present duringtreatment in order to suction patients. MRTs are trained and certified toperform this procedure and are currently performing it under delegation.The College and Association assert that MRTs often relieve airwayobstructions caused by tracheobronchial secretions during radiationtreatment of patients with tracheostomies.MRT educators confirmed that students learn about such situations and thedidactic curriculum covers the indications for suctioning. The submissionby the College and Association included course outlines and other excerptsfrom various program curricula that clearly indicate that knowledge of theindications for and performance of tracheal suctioning is available in theeducational program. While the actual clinical practice of the skill ofsuctioning is not covered adequately at present, educators assure HPRACthat this could readily be accommodated.In the consultations there was considerable discussion on whether “beyondthe larynx” is the appropriate controlled act for tracheal suctioning. No otherjurisdiction authorizes MRTs to insert an instrument, hand or finger beyondthe larynx, though most authorize access beyond the pharynx, which is notas far down the respiratory tract. The College and Association confirmed thatthe sole purpose for which they would insert an instrument beyond thelarynx is to access a tracheostomy and not to access the larynx through themouth. Respiratory therapists currently have access to the controlled act ofputting an instrument, hand or finger beyond the larynx. Physiotherapistsalso have the authority to perform tracheal suctioning under the controlledact of putting an instrument, hand or finger beyond the larynx. Nurses haveaccess to the controlled act of putting an instrument, hand or finger bothbeyond the larynx and into an artificial opening into the body, but define theact of tracheal suctioning as a procedure into an artificial opening into thebody. Both respiratory therapists and nurses are supportive of MRTs havingthe authority to perform tracheal suctioning through a tracheostomy.HPRAC is satisfied that MRTs should be performing the act of trachealsuctioning of patients with tracheostomies under their own authority ratherthan under delegation. HPRAC suggests that the controlled act that mostappropriately describes the suctioning of patients with tracheostomies, thesole purpose for which authorization is being sought, is the act of insertingan instrument into an artificial opening into the body.HPRAC Critical Links January 2009