Mobile and Surgical Radiography

RAD 113 Summer 2015 The images in the following presentation follow the “fair use” rules of the U.S. Copyright law.

Objectives

On completion of this class, you should be able to: • Describe the use of portable radiographic and fluoroscopic units.

• • • Identify the steps followed during bedside radiography: ▫ Technical Considerations ▫ Communication and Patient Care ▫ Infection Control ▫ Isolation Considerations ▫ Initial Procedures ▫ Examination ▫ Patient Considerations/Skin Safety Identify the steps followed during surgical radiography: ▫ Surgical Team ▫ Proper Surgical Attire ▫ Operating Room Attire ▫ Equipment Preparation and Cleaning ▫ Sterile Fields ▫ Communication Understand Radiation Protection procedures for: ▫ Patient ▫ Radiographer ▫ Other

Mobile Radiography

• Principles of Mobile Radiography ▫ Mobile radiography using transportable radiographic equipment allows imaging services to be brought to the patient.

     Patient rooms Emergency departments Intensive care units Surgery and recovery rooms Nursery and neonatal units

Mobile X-Ray Machines

• • • • Vary in their exposure controls and power sources (or generators) ▫ Typical machines have controls for setting kVp and mAs ▫ Maximum settings differ among manufacturers AEC Computed Radiography Digital Radiography

Technical Considerations

• Optimal Mobile Examinations: ▫ Grid   Level, centered to central ray, correctly used at recommended focal distance.

▫ Anode Heel Effect Causes a decrease in image density under the anode side of the tube.

 Heel effect more pronounced with:    Short SID Larger field size Small anode angles ▫ Source-to-Image receptor Distance (SID)  Should be maintained at 40 inches for most exams.

▫ Exposure Charts  Should be available for use with every mobile machine.

Accurate Grid Position in Mobile Radiography

Communication and Patient Care

• • Communication with: ▫ Nurse ▫ Other members of the health care team ▫ Patient  AIDET ▫ Family members Patient Care ▫ Effective communication ▫ Compassion ▫ Recognizes and meets patient’s needs

Infection Control

• • • • Chain of Infection ▫ Host ▫ Infectious microorganism ▫ Mode of transmission ▫ Reservoir Nosocomial Infections ▫ Hospital-acquired condition Compromised Patients ▫ Hospital patients have a greater sensitivity to infection Standard Precautions

Isolation Considerations

1.

Patients who have infectious microorganisms that could be spread to health care workers and visitors.

▫ Gown, cap, mask, shoe covers, and gloves 2.

Patients who need protection from potentially lethal microorganisms that may be carried by health care workers and visitors.

▫ Follow institutional policy ▫ Reverse Isolation

Isolation Considerations

• • • • • • • • Wash hands with warm soapy water before putting on gloves.

Don protective apparel.

X-ray machine taken into room and moved into position.

Place IR in Rad Bag.

Place lead shield in Rad Bag before placing on patient.

Proper removal and disposal of Rad Bags and protective apparel worn by radiographer.

Proper cleaning of equipment.

Wash hands before leaving the patient’s room.

Initial Procedures

• • Ensure all necessary equipment is on machine ▫ IR, grid, tape, markers Ensure machine is charged • Before entering the patient’s room with the machine: ▫ Announce your presence to the nursing staff, and ask for assistance if needed.

▫ Introduce yourself ▫ Verify the correct patient ▫ Verify the correct exam   Explain the exam ▫ Observe medical equipment in the room and move if necessary.

▫ Ask family members and visitors to leave Children are the exception

Examination

• • • • • • Move obstacles in room Adjust lighting, if necessary Position of machine in the room ▫ Patient supine ▫ Patient erect ▫ Lateral and/or decubitus radiographs Proper IR and tube alignment CR to center of the IR Collimation

Patient Considerations

• • • • • • • Patient assessment Patient mobility Fractures Interfering devices Positioning and asepsis Neonates Orthopedic patients

Patient Assessment

• • • • Level of alertness Respiration Communication Ability to cooperate/any limitations • A thorough examination of the patient’s condition and room allows the radiographer to make necessary adaptations to ensure the best possible patient care and imaging outcome.

Patient Mobility

• • • • • Assess patient’s ability to move or tolerate mobility Gentleness and caution Check with nursing staff or physician Broken limbs and/or surgical repaired limbs Inappropriate movement of the patient

Fractures

• • • • • • Simple fractures Multiple fractures Traction Conscious vs. Unconscious patients Critical Thinking and Analytical Reasoning ASK FOR HELP!

Interfering Devices

• • • • • • Wires Tubes Oxygen Masks Splints Hardware Traction

Skin Safety

• • • Rad Bags ▫ Skin integrity ▫ Skin tears  Infection Communication Ask for help!

Positioning and Asepsis

• Positioning: ▫ IR is perceived as cold, hard, and uncomfortable ▫ Warn the patient of possible discomfort ▫ Assure the patient the exam will go as quick as possible • Asepsis: ▫ Rad Bag ▫ Cloth ▫ Proper cleaning of contaminated IR and equipment

Neonates

• • • • • • Radiation protection Proper handling Proper central ray placement Collimation Immobilization Chest Radiographs ▫ Not intubated: keep head and neck straight ▫ Intubated: do NOT move head and neck  Could inadvertently advance an endotracheal tube too far into the trachea

Orthopedic Patients

• • • • • • Assessment of patient is key Communication If able to move, support limb above and below fracture site.

Get help, if needed Move tube and IR versus the patient Radiation Protection

Radiation Protection

• • • • • • •

TIME, DISTANCE, SHIELDING

Radiographer must wear a lead apron Stand as far away from patient, x-ray tube, and useful beam as possible.

▫ Minimum of 6 feet ▫ Lowest amount of scatter radiations occurs at a right angle from the primary x-ray beam.

Proper technical factors Lead protection provided for anyone in the room Lead protection for the patient SID should be maintained at 40 inches ▫ Source-to-Skin Distance (SSD) cannot be less than 12 inches

Surgical Radiography

• • • • • • • • • Dynamic experience Unique challenges Capabilities and limitations of equipment Communication Common procedures Familiarity with equipment Teamwork Preparedness Standard health and safety protocols

Surgical Team

• • • • • • Surgeon Assistants (1-2) Surgical Technologist Anesthesia provider Circulating nurse Various support staff • The surgical team is subdivided, according to the functions of its members, into sterile and non sterile teams.

Sterile Team Members

• • Scrub hands and arms, don a sterile gown and gloves over proper surgical attire, and enter the sterile field.

Work in sterile environment and only handle sterile items.

• • • • • Surgeon Surgical Assistant Physician Assistant Scrub Nurse Certified Surgical Technologist (CST)

Non-Sterile Team Members

• • Do not enter the sterile field; they function outside and around it.

Maintain sterile techniques during procedure, but handle supplies and equipment that are not sterile; follow aseptic technique.

• • • • Anesthesia provider Circulator Radiographers Others

Proper Surgical Attire

• Common standards: ▫ Proper facility design and surgical attire regulations ▫ Infection control practices       Personal fitness for work Skin disinfection Preparation of personnel hands Surgical attire Personal technique Daily body cleanliness and clean hair

Operating Room Attire

• • • • Street clothes-never worn within semi-restricted or restricted areas of the surgical suite.

Clean, fresh attire-donned at the beginning of each shift in the OR and as needed if attire becomes wet or soiled.

One time wear of attire.

Underclothing should be clean and totally covered by the scrub attire.

Other Aspects of Proper OR Attire:

• • • • • • • • Protective eyewear Masks Shoe covers Caps Gloves Radiation badge Identification Personal hygiene

Dance of the Operating Room

• • • • • • • • • • Maintain sterile field in the OR Proper adherence to aseptic technique Infection control ▫ All levels Non-sterile team members: ▫ Never reach over sterile field Sterile drape Sterile cover on c-arm Notify OR staff if sterility is compromised Communication Proper IR handling in the sterile field Enemies of the sterile field

Equipment in the OR-Technical

• • • Dedicated radiologic equipment C-arm Mobile machine (portable radiography) • No matter what equipment used, you must: ▫ Demonstrate knowledge of routine positioning ▫ Demonstrate knowledge of radiographic equipment ▫ Manipulate radiographic equipment ▫ Understand the imaging process ▫ Demonstrate critical thinking and problem solving skills

Cleaning of Equipment

• • • • • • Clean after EVERY surgical case ▫ Try to clean in the OR suite-helps reduce the chance of cross-contamination.

Use only hospital-approved cleaning solution Do NOT spray cleaning solutions during the procedure.

Wear gloves-always Clean after an isolation case Less frequently used machines: thorough cleaning at least once a week and just before going into the OR.

Sterile Fields

• • Area of the OR that immediately surrounds and is especially prepared for the patient.

To establish a sterile field, all items necessary for the surgical procedure are sterilized.

▫ After this process, the scrubbed and sterile team members function within this limited area and handle only sterile items.

Communication

• Communication is of utmost importance.

▫ Professional communication ▫ Verbal ▫ Non-verbal ▫ Ask questions

Fluoroscopic Procedures for the OR

• • • • • • Cholangiography Line Placement Bronchoscopy Spines Extremities Arteriogram

Mobile Radiography Procedures for the OR

• • • Spines Search films Extremities (post-op)

Safety and Radiation Protection

• • •

TIME, DISTANCE, SHIELDING

Wear a lead apron.

▫ Everyone in the room.

Stand as far away from the patient, x-ray tube, and useful beam as possible.

▫ Most effective means of radiation protection is distance.

  Minimum of 6 feet.

Stand at right angle to the primary beam and patient being radiographed.

 Least amount of scatter

Safety and Radiation Protection

• • • X-ray tube placed under the patient.

Gonadal shielding.

Source-to-skin distance (SSD) should not be less than 12 inches.

VIDEO

 OEC Clinical Excellence

This power point presentation contains material, text and pictures extracted from: Adler, A.M., & Carlton, R.R. (2010).Introduction to Radiologic Sciences and Patient Care (Fifth Ed.) St. Louis: Saunders Ballinger, P.W., & Frank, E.D. (2012). Merrill’s Atlas of Radiographic Positions and Radiologic Procedures (12th ed.). (Volume Three). St. Louis: Mosby