N.J. Admin. Code § 13:35-6.20

Current through Register Vol. 56, No. 11, June 3, 2024

Section 13:35-6.20 - Physician delegation of tasks to radiologic technologists and nuclear medicine technologists

(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.

"Authorized medical user" shall mean a licensed physician who is identified as an authorized user on a New Jersey Department of Environmental Protection radioactive materials license that authorizes the medical use of naturally occurring or accelerator-produced radioactive materials, or on a Nuclear Regulatory Commission license that authorizes the medical use of byproduct radioactive materials.

"Diagnostic x-ray technologist license" shall mean a license for general diagnostic radiology (LRT(R)).

"Direct physician supervision" shall mean instruction, direction and guidance by a physician who is personally aware of the procedure intended for a given patient; who is present in the facility and is readily available to physically attend to the patient; and who has assured that emergency equipment shall be available for immediate use by a licensed physician trained to use that equipment. All tasks which this section permits a physician to delegate may be performed in a licensed hospital or in a licensed outpatient facility or in the physician's private office, unless otherwise specified.

"Licensed nuclear medicine technologist" or "LNMT" shall mean an individual holding a license issued directly by the Department of Environmental Protection.

"Limited technologist license" shall mean a license in chest x-ray (LRT(C)), dental x-ray (LRT(D)), podiatric x-ray (LRT(P)), orthopedic x-ray (LRT(O)) or urologic x-ray (LRT(U)) issued by the New Jersey Radiologic Technology Board of Examiners.

"Medical resident" shall mean a graduate physician who is authorized to practice medicine and surgery by means of a valid permit issued by the Board of Medical Examiners to a person authorized to engage in the practice of medicine and surgery while in the second year or beyond of a graduate medical education program pursuant to 13:35-1.5.

"Physician," unless otherwise specified, shall mean an individual holding a plenary license to practice medicine and surgery issued by the State Board of Medical Examiners.

"Technologist" shall mean an individual who holds a current license in a specific category of radiologic practice from the New Jersey Radiologic Technology Board of Examiners or the Department of Environmental Protection, as applicable.

(b) A physician may direct a technologist holding the license for general diagnostic radiology (LRT(R)) from the New Jersey Radiologic Technology Board of Examiners to perform the tasks set forth in (c) below provided that:

1. The physician (or another plenary-licensed physician in the office or, in a licensed health care facility, the head of the pertinent Department) has personally certified and documented the radiologic technologist's training and competency to perform the task. The documents shall be preserved in the personnel record and retained for at least the duration of such technologist's employment by or for that physician or facility;

2. A physician or a medical resident is on the premises and immediately available to physically attend to the patient;

3. The physician is responsible for the choice and ordering of all pharmaceuticals and contrast materials and for the determination of dosage and route of administration; and

4. For pediatric patients, the physician shall have experience in the performance of the pertinent procedures with such patients.

(c) A physician may direct a technologist, in the circumstances set forth in (b) above, to perform the following tasks:

1. Establish a peripheral intravenous line;

2. Administer contrast material into a peripheral intravenous line or into a pre-existing central intravenous line;

3. Administer contrast material through the use of a power injector;

4. Administer contrast materials into pre-existing urinary catheters, whether indwelling or otherwise;

5. Administer contrast materials into pre-existing nasogastric tubes or other gastric or intestinal feeding tubes;

6. Administer intravenous flush solutions, such as saline or heparin;

7. Administer glucagon and such other pharmaceuticals as shall be approved by the Board; and

8. Administer compounds containing filtered sulfur colloid.

(d) Under (c) above, for pediatric patients, the physician shall have experience in the performance of the pertinent procedures with such patients.

(e) A physician shall not direct a diagnostic radiologic technologist holding the LRT(R) license to perform the following tasks:

1. Administer contrast material into the subarachnoid space;

2. Administer to a patient pharmaceutical materials other than those approved in accordance with (c) above; or

3. Administer radioactive materials in any form for any purpose.

(f) A physician who allows a medical resident to supervise a diagnostic radiologic student technologist shall assure that the supervision is performed concurrently with a licensed radiologic technologist or with the physician.

(g) A physician may direct an individual holding a general diagnostic or limited technologist license to perform such radiologic procedures as are authorized by the laws and rules of the State Department of Environmental Protection applicable to that licensure. A physician or a podiatric physician (DPM) may direct either a technologist holding the LRT(R) license or a technologist holding the limited license for podiatric x-ray LRT(P) to perform such radiologic procedures as are authorized and applicable to the holder of a LRT(P) license.

(h) A physician may direct a technologist holding the LRT(U) license to administer a contrast medium injection into a pre-existing peripheral intravenous line or into a pre-existing urinary catheter, whether indwelling or otherwise, so long as a physician or a medical resident is on the premises and is readily available to physically attend to the patient. The physician shall be responsible for the choice and ordering of all contrast materials and for the determination of dosage and route of administration. For pediatric patients, the physician shall have experience in the performance of the pertinent procedures with such patients or shall assure consultation with a physician having such experience.

(i) Prior to delegating the tasks set forth in (g) and (h) above, the physician (or another physician in the office or, in a licensed health care facility, the head of the pertinent Department) shall personally certify and document the radiologic technologist's training and competency to perform the task. The documents shall be preserved in the personnel record and retained for at least the duration of such technologist's employment by or for that physician/facility.

(j) Except as set forth in (h) above, a physician shall not direct a technologist holding the LRT(C), LRT(D), LRT(P), LRT(O), or LRT(U) license to perform any of the tasks set forth in (c) or (e) above.

(k) A supervising physician may direct the LNMT to establish a peripheral intravenous line.

(l) A physician who is an authorized medical user, as specified on a Byproduct Materials License issued by the Nuclear Regulatory Commission or on the Radioactive Materials License issued by the New Jersey Department of Environmental Protection, may direct an LNMT to inject radioactive materials used for diagnostic purposes when specifically designated by the supervising physician, and only as follows:

1. Into pre-existing urinary catheters, whether indwelling or otherwise;

2. Into pre-existing nasogastric tubes or other gastric or intestinal feeding tubes;

3. Into a peripheral intravenous line, into a pre-existing central intravenous line, or by direct intravenous injection; and

4. Into a spinal needle placed into the subarachnoid space by a physician who is continuously present with the patient throughout the procedure.

(m) A physician may direct the LNMT to administer, under direct physician supervision, nonradioactive pharmaceuticals as follows:

1. Adenosine and dipyridamole for use in nuclear medicine stress tests;

2. Aminophylline in conjunction with nuclear medicine stress tests;

3. Diuretics;

4. Angiotensin converting enzyme-inhibitor agents;

5. Vitamin B-12;

6. Intravenous flush solutions, such as saline or heparin;

7. Sincalide, a synthetic cholecystokinin;

8. Lexiscan; and

9. Compounds containing Technetium 99M.

(n) The Board may, from time to time, add or delete pharmaceuticals by amendment to (m) above, on its own initiative or through a petition for rulemaking.

(o) A physician shall not direct the LNMT to administer Controlled Dangerous Substances or other pharmaceuticals, including, but not limited to, atropine, neostigmine, other cardioactive medications or any other pharmaceuticals except as set forth in (m) above.

(p) The physician shall be responsible for the choice and ordering of all nonradioactive pharmaceuticals and for the determination of dosage and route of administration. The physician who is also an authorized user shall be responsible for the choice and ordering of all radioactive pharmaceuticals and for the determination of dosage and route of administration. For pediatric patients, the physician shall have experience in the performance of the pertinent procedures with such patients.

N.J. Admin. Code § 13:35-6.20

New Rule, R.1999 d.155, effective 6/7/1999.
See: 30 N.J.R. 1752(a), 31 N.J.R. 1496(a).
Petition for Rulemaking.
See: 32 N.J.R. 2166(a).
Amended by R.2003 d.286, effective 7/21/2003.
See: 34 N.J.R. 3058(a), 35 N.J.R. 3368(a).
In (m), added 7.
Amended by R.2011 d.155, effective 6/6/2011.
See: 42 N.J.R. 1310(a), 43 N.J.R. 1359(b).
In (c)6, deleted "and" from the end; in (c)7, substituted "; and" for a period at the end; added (c)8; in (m)6, deleted "and" from the end; in (m)7, substituted a semicolon for a period at the end; and added (m)8 and (m)9.