Special Situations and Environments

1. Special Situations and Environments

2. Typically patients come to the department But…… Mobile xrays are becoming more common Acute care and long term care Machines and diagnostics are more portable It may be easier and often safer to go to the pt Special Situations and Environments

3. Special Situations and Environments

4. Many different manufacturers and machines Some still require developing Many can be sent via computer for instant reading Some have instant pictures on screen so RT can determine clarity Most portable images are just as sharp Huge advantage for the patient and the company Special Situations and Environments

5. Disadvantages: some limitations on quality some limitation on studies more expensive for the patient more difficult for the RT less controlled environment Special Situations and Environments

6. Advantages: able to perform studies when the patient’s condition prevents travel may be more cost effective when you figure in travel expense traction isolation invasive lines OR/reduction procedures NEVER change the requisition without an order Special Situations and Environments

7. General Rules: Call the nursing unit and assess the feasibility patient in a private room overall condition able to assist (patient and/or staff) special needs (isolation/translation/consent) check the patient’s armband may need help moving furniture and/or equipment Special Situations and Environments

8. Special Care Units: ICU, CCU, NICU, PICU, PACU, ED patients need acute care cardiac monitoring IV lines and CVADs – typically on pumps ventilators wound drains altered LOC (unable to assist) family presence Special Situations and Environments

9. PACU: typically an open area must consider how to obtain film without unintentional exposure may have to gown to enter patients are in various stages of consciousness Special Situations and Environments

10. ED/Trauma: typically patients are off long board but still have cervical collar must maintain spinal precautions universal precautions lead for anyone who stays in room (include thyroid shield) work quickly in a chaotic environment no unnecessary noise Special Situations and Environments

11. Trauma: explain procedure to patient use caution with machine and IR blood on floor and stretcher, IV lines, ETT patient may be restless/agitated degree of injury may be severe ask for help Special Situations and Environments

12. NICU/Newborn Nursery: many newborns (neonates) require xrays lung, skull, extremities, abdomen may be in a warmer, incubator, O2 tent keep environmental exposure to a minimum may require protective precautions hand hygeine disinfect equipment ask about handling precautions Special Situations and Environments

13. Special Situations and Environments

14. Special Situations and Environments NICU/Newborn Nursery: Most incubators and warmers have built in xray trays Never place the IR against bare skin May have to immobilize infant with tape, gauze, blanket Use gonad shield

15. ICU/CCU: require a lot of portables (especially CXR) may need a C-arm bronchoscopy, central line placement, pacemaker use caution if you have to move machine or change positions ventilator, IV line, drains, monitor assume sleeping and comatose patients can hear talk to them (not about them – avoid commenting on condition) offer explanations Special Situations and Environments

16. Special Situations and Environments ICU/CCU: assess ability and necessity to cover IR monitors all have sensors and alarms may trigger alarms with movement or may signal disconnect ask the nurse if it is safe to continue return them to the previous position

17. Specialty Beds and Mattresses: immobilized patients are at great risk for skin breakdown many devices are used to improve circulation assess equipment – does it help or hinder your exam may have ‘auto stop/inflate’ mechanism cooling heating mattresses take care not to snag or tear mattresses many are radiographic but not all Special Situations and Environments

18. Special Situations and Environments

19. Traction: keeps fractures in alignment prior to surgery used mainly for long bones and spine skeletal or skin (Buck’s) never release traction support the weights if you must move them take care not to bump the bed or weights keep them free hanging prevent your own injury have the patient use a trapeze Special Situations and Environments

20. OR Suite: RT plays a critical role in the OR many surgical procedures require images before – during – after may be required to stay in room proper attire must be worn per facility policy equipment should be properly cleansed and covered may have designated machines that do not leave the OR area do not contaminate the sterile field Special Situations and Environments

21. OR Rooms: typically large (cold) aseptic environment positive pressure limited access – keep door closed watch overhead lights/equipment many different types of tables/positions – check yours most are height adjustable Special Situations and Environments

22. Special Situations and Environments

23. OR Rooms: personnel are deemed sterile or unsterile low noise volume, fast paced environment avoid sudden movements and loud noises if you must wait be patient and get comfortable Sterile Corridor: area between the patient and the instrument table do not pass between or turn your back against watch for dangling sleeves, jewelry, pocket contents Special Situations and Environments

24. Surgical Localization: used to locate a foreign body buttons, screws, needles, lap pads – you name it…. lap pad count must be correct before closing – radiographic strip sonography can be used to locate tumors – needle localization Special Situations and Environments

25. References Adler, A. & Carlton, R. (2012). Introduction to radiologic sciences and patient care (5th Ed.). St. Louis: Mo.: Elsevier Saunders.