special situations and environments. typically patients come to the department but…… mobile...
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Special Situations and Environments
Special Situations and Environments
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
Special Situations and Environments
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
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
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
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
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
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
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
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
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
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
Special Situations and Environments
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
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
Special Situations and Environments
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
Special Situations and Environments
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
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
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
Special Situations and Environments
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
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
References
Adler, A. & Carlton, R. (2012). Introduction to radiologic sciences and patient care (5th Ed.). St. Louis: Mo.: Elsevier Saunders.