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.