Patient Care Registry for Radiology

7/30/2019 Patient Care Registry for Radiology

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Patient Care


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Scheduling & Sequencing Exams General Considerations

Consider patient comfort & fiscal responsibility

Sequence exams so they do not interfere witheach other

Schedule NPO patients first

Schedule pediatric & geriatric patients early

Schedule diabetic patients early because of needfor insulin

Emergency patients top priority


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Scheduling & Sequencing Exams Contrast specific considerations

Radiographic exams not requiring contrast

scheduled first

Thyroid assessment must precede anyexam involving iodinated contrast media

Total doses of iodinated contrast must becalculated if a series of exams using it willbe performed


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Scheduling & Sequencing Exams Sequencing

Fiber-optic (endoscopy) studies conducted

first in series

Exams of urinary tract

Exams of hepatobiliary system

CT scheduled before exams using barium Lower GI series

Upper GI series


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Scheduling & Sequencing Exams Example

Day one

GB sono Lumbar spine

IVU

Day two

CT Abdomen BE

Day three

UGI


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Legal Aspects of Radiography Request to perform examination

Written order from physician

Patient chart

Requisition

Patient name, ID #, DOB, physician name, date

Mode of travel

Pertinent Hx/admitting diagnosis

Infection control info.


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Legal Aspects of Radiography Request to perform examination

Clarification of terminology Must understand & clarify vague info. (leg vs. tib/fib)

Conflicting information Pt. Hx. does not match request

Verify correct patient (by at least two means)

Check to make sure order is not for comparison

If tech believes incorrect exam has been ordered verifyexam with attending physician, radiologist, or patientsnurse

NEVER DECIDE ON YOUR OWN WHAT EXAM IS TO BEPERFORMED


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Legal Aspects of Radiography Modified or additional projections

If patient unable to assume routine projections,radiographer should be able to modify exams toprovide required information (follows dept.protocol)

It is outside radiographers scope of practice tosupply additional, unrequested views

Should consult with radiologist if you believe additionalimages might be needed based on pathology

Should inform attending physician if other projections ormodifications might enable him to better visualizeaffected area


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Legal Aspects of Radiography Patients rights

Right to considerate & respectful care

Right to information Simple explanation of procedure

Identification of yourself & radiologist

OUTSIDE SCOPE OF PRACTICE TO RENDER

DIAGNOSIS Right to copies of medical records,

radiographs & billing information


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Legal Aspects of Radiography Patients rights

Right to privacy

Personal dignity Confidentiality HIPAA

Right to refuse treatment/examination

If patient refuses you must not perform exam

If already begun you must stop as soon as it is safe todo so

Signing informed consent does not invalidate right torefuse treatment once procedure has begun


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Legal Aspects of Radiography Advanced directives

Outline of specific wishes about medical care inthe event individual loses ability to make orcommunicate decisions

Legal document

DNR do not resuscitate If death is imminent no effort as resuscitation attempted

posted on chart Durable power of attorney

Names specific individual to act on patients behalf ifpatient unable to do so


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Legal Aspects of Radiography Consent

Oral patient agrees to exam

Implied

Provides for care when patient is unconscious

Based on assumption that patient wouldapprove of care if conscious

Written Informed consent


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Legal Aspects of Radiography Valid consent

Patient must be of legal age

Patient must be mentally competent Consent must be offered voluntarily

Patient must be adequately informed

Parent or legal guardian must consent for child

Person holding durable power of attorney maysign for patient


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Legal Aspects of Radiography Informed consent

Requires radiographer & radiologist to carefully

explain all aspects of procedure & risks involved Requires explanation to be provided in lay terms

that the patient understands

Patient must sign form before being sedated or

anesthetized For any procedure considered experimental or

involving substantial risk


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Legal Aspects of Radiography Informed consent

Most procedures require physician to do (angio)

Tech may explain & provide form for more routineprocedures (IVU)

Consent forms must be completed before beingsigned (all blanks filled in)

Only physician named on form may perform

procedure consent not transferable Any condition stated on form must be met

May be revoked by patient at any time aftersigning right to refuse examination


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Legal Aspects of RadiographyVerification of patient identification

Check wristband

Have patient restate or spell name

Verify DOB

Verify exam or nature of visit to dept.

Pursue source of inaccuracy if found


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Legal Aspects of Radiography Torts

Violation of civil law

AKA personal injury law

Injured persons have right tocompensation for injury


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Legal Aspects of Radiography Intentional misconduct

Assault

Patient feels threatened or apprehensive aboutbeing injured

Imprudent conduct by radiographer that causesfear in a patient is grounds for allegation of civil

assault


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Battery

Unlawful touching or touching without consent

Harm resulting from physical contact withradiographer

Also includes radiographing:

Wrong patient

Wrong body part

Performing exam against patients will


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False imprisonment

Unjustified restraint of a person

Care must be taken using restraint straps orother individuals to hold patient still

We use positioning aids not restraining devices

Get patient consent


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Invasion of privacy

Violation of confidentiality of information

Unnecessarily or improperly exposing patientsbody

Unnecessarily or improperly touching patients

body

Photographing patients without theirpermission


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Defamation

Spread of false information that results indefamation of character or loss of reputation

Libel

Written false information

Slander Verbally spreading false information


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Legal Aspects of Radiography Unintentional misconduct/negligence

Neglect or omission of reasonable care

Doctrine of reasonably prudent person Based on how a reasonable person with similar

education & experience would perform under similarcircumstances

Gross negligence

Acts that demonstrate reckless disregard for life or limb Contributory negligence

Instance in which the injured person is a contributingparty to the injury


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Legal Aspects of Radiography Negligence

Four conditions needed to establish

negligence Establishment of standard of care (duty owed)

Demonstration that the standard of care wasviolated (by radiographer)

Demonstration that loss or injury was causedby person (radiographer) being sued

Loss or injury actually occurred & is directresult of negligence


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Legal Aspects of Radiography Respondeat superior

Literally let the master answer

Legal doctrine stating that an employer will beheld legally liable for an employees negligent act

Its your fault you hired me!

Rule of personal responsibility

Each individual is responsible for own actions Its yours too!


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Legal Aspects of Radiography Res ipsa loquitur

Literally the thing speaks for itself

Legal doctrine stating that the cause of thenegligence is obvious DUH?!

Burden of proof falls on defendant to disprove

Captain of the ship doctrine Physician is held liable for actions of those under

his authority Shit can roll uphill


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Legal Aspects of Radiography Ethical Principles

Autonomy

Patients have the right to make decisionsconcerning their lives (and medical treatment)free from external pressure

Nonmaleficence

To abstain from inflicting harm & to preventharm


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Beneficience

Acts must be meant to obtain a good result orbe beneficial

Requires action that either prevents harm ordoes the greatest good for the patient


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Confidentiality

The concept of privacy informationconcerning patients state of health must notbe disclosed to anyone not involved in thepatients care


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Fidelity

Duty to fulfill ones commitments & applies topromises both stated & implied

Justice

Refers to all persons being treated equally orreceiving equal benefits according to need


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Sanctity of life

Refers to the belief that life is the highest good& no one has the right to judge anotherspersons quality of life as so poor that his or herlife is not of value & should be terminated


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Paternalism

Refers to the attitude that the health careworker knows what is best for the patient & tomake decisions regarding the persons carewithout consulting the person affected


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Legal Aspects of Radiography Charting

Writing on patients chart by radiographer

Includes computerized entries Protocol varies by institution

Write clear statements regarding patientscondition, reaction to contrast agents, amountof contrast material injected, time & date ofoccurrence & so forth

Include time & date of all information recorded

Sign with full name & credentials


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Legal Aspects of Radiography Radiographs

Legal documents

Images must include Patient name & unique ID

Correct anatomical markings inc. L or R

Date of exposure (exam) Markings added to finished radiograph may not

be legally admissible


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Legal Aspects of Radiography Radiograph retention (films!!)

Varies according to state law

Normally maintained for 5-7 years after date oflast exam & 5-7 years after minor turns 18 or 21depending on state of residence

Patients or legal guardian must sign for released

films Hospitals may make copies of most exams &

charge only the copying cost to the patient


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Legal Aspects of Radiography Communication with patient

Verbal

Non-verbal Body language

Therapeutic touch

Appearance


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Patient Education, Safety & Comfort Communication with patient

Patient history assists radiographer in

knowing extent of injury & range of motionAssists radiologist in interpretation of

radiographs

Begins with introduction of radiographer &verification of patients name


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Patient Education, Safety & Comfort Patient history

Patient may have multiple complaints

Focus history specific to procedure to be performed Include both objective & subjective information

Objective can be observed

Subjective related to what patient feels & to whatextent

Possibility of pregnancy LMP

Age specific factors


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Patient History

Essential elements

Location - precise area, touch for emphasis, palpation Chronology

Quality

Severity

Onset

Aggravating or alleviating factors

Associated manifestations


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Patient Education, Safety & Comfort Explanation of current procedure

Includes

Detailed description of preparation necessary forprocedure

Description of purpose of test, mechanics of procedure &

what will be expected of the patient

Approximate time procedure will take

Explanation of unusual equipment to be used inprocedure

Follow-up care necessary when procedure complete


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Patient Education, Safety & ComfortAssessment of patient condition

Make initial assessments Patients general condition

Patients mobility

Patients strength and endurance

Patients ability to maintain balance

Patients ability to understand what is expected ofhim during transfer

Patients acceptance of move

Patients medication history

Support equipment necessary (oxygen, IVACs, etc.)


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Patient Education, Safety & Comfort Preparing for transfer

Plan what you are going to do & prepare yourwork area Check equipment for safety and function

Verify patients identity

Enlist patients help & cooperation Explain to the patient what you are doing

Obtain additional help when necessary Make sure assistants understand their role in the transfer

plan

Hold the patient, not the equipment


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Patient Education, Safety & Comfort General rules for good body mechanics

Provide a wide & stable base of support Feet apart, one slightly advanced

Hold heavy objects close to the body

Keep back straight & knees bent when lifting DO NOT twist the body

DO NOT bend at the waist

Use the muscles of the legs & abdomen whenmoving or lifting heavy objects

Pull dont push heavy objects


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Patient Education, Safety & Comfort Transfer from wheelchair to x-ray table

Wheelchair parallel next to table

Brakes applied, stepstool nearby

Using face-to-face method, assist patient to standingposition

Have patient place hand on footstool handle & the otherarm on your shoulder & step up on stool

Patient pivots with back against table into sitting position onedge of table

Place one arm around patients shoulder & the other underthe knees

Assist patient to supine position with patients head on pillow


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Patient Education, Safety & Comfort Transfer from x-ray table to wheelchair

Check to see that brakes of wheelchair have beenapplied

Assist patient into sitting position

Allow patient to sit up for a short time to regainsense of balance

If ambulatory Assist to standing position & pivot Have patient reach back with both hands & grab arms of

wheelchair

Assist patient to sit in wheelchair


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Patient Education, Safety & Comfort Transfer from x-ray table to wheelchair

If patient non-ambulatory Stand facing patient

Reach around patient & place your hands on eachscapula

Lift patient upward to standing position

Pivot so that back of patients leg is touching edge ofwheelchair

Ease patient down to sitting position Position foot & leg rests into place

Cover patients lap with sheet


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Patient Education, Safety & Comfort Gurney transfer

Place gurney near & parallel to x-ray table

Do not attempt patient transfer from cart to x-ray table

without assistance One person supports head, neck & shoulders

Second individual lifts pelvis & knees

Other individuals (if necessary) support patient on both sides

Transfer or draw sheet should be used under patient

Slide board under sheet is best - requires fewer helpers Roll patient toward you, slide board under patient from

opposite side & adjust

On signal, all involved in transfer move patient in one fluidmotion to x-ray table


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Patient Education, Safety & Comfort Patient comfort

Taking into account patients condition

Radiolucent pad on table for long exams Carefully position pillows or radiolucent

sponges so that they will not interfere withexam

Sponge under knees relieves back strain Pillow or sponge under head


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Patient Education, Safety & Comfort Patient comfort

Evaluate patients condition

Ability to breathe Orthopnea elevate head as much as possible

Presence of nausea

Warmth need for blanket

Special care must be given to the elderly &patients with decubitus ulcers & sensitive orthin skin


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Patient Education, Safety & Comfort Immobilizers

Manual, physical or mechanical device, material orequipment attached or adjacent to the persons

body that the person cannot remove easily thatrestricts freedom of movement or normal accessto ones body

Must be ordered by physician Standing orders

In compliance with institutional policy

Should be used only after less restrictive measureshave been attempted


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Patient Education, Safety & Comfort Immobilizers

Use therapeutic communication to relieve patientsanxiety & perhaps avoid need for immobilization

Reasons for application

Control movement of extremity when IV or catheter is inplace

Remind sedated patient to remain in particular position

Prevent patient who is unconscious, delirious, cognitivelyimpaired or confused from injuring him/herself

Rules for application on p. 92 of Torres


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Patient Education, Safety & Comfort Patient positions

Supine dorsal recumbent

Lateral recumbent

Prone High Fowlers

Semi-erect with head at 45-90

Used for patients in respiratory distress

Semi-Fowlers

Patients head raised 15-30 Sims

For imaging lower bowel & inserting enema tip

Trandelenberg

Head lower than rest of body


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Patient Education, Safety & Comfort Assisting patient to undress

When changing disabled or injured personsclothing remove unaffected arm first

Place affected side in gown first

If patient has an IV Remove & cover unaffected side & bunch up soiled gown

Remove fluid bag from pole & slip soiled gown off &

clean gown over bag & arm Cannot remove gown from patients arm attached

to IV pump Roll gown up & out of way by shoulder & cover patient

as much as possible with new gown


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Patient Education, Safety & Comfort Assisting patient to undress

Give simple, clear instructions

Provide two gowns if necessary to cover patientadequately

Demonstrate if necessary

Allow patient privacy to change

Check for artifacts before imaging

If assisting disabled person, be sure to changeupper part of body first to provide coverage forlower body


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Patient Education, Safety & Comfort Support equipment

What is it?

Where should it be placed for transport &in department?

Can or should it be clamped off?

Can it be emptied? Must it be plugged in?

What if it beeps?


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Patient Education, Safety & Comfort Cast Care

Assess for impaired circulation & nervecompression every 15 min Pain Coldness

Numbness

Burning or tingling sensation of fingers or toes

Swelling

Skin color changes - to pale or bluish color

Inability to move fingers or toes

Decrease in or absence of pulses

If present notify physician or nurse immediately


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Patient Education, Safety & Comfort

Cast care

To move slide open hands under cast

Support at both joints

Traction

Never move traction bar or relieve or pull

on traction device Get assistance from nurse


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Infection Control

Pathogen: a microorganism known toproduce disease

Four major groups Bacteria

Fungi Yeasts

Molds

Viruses Parasites

Protozoa

Helminths


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Infection Control

Chain of infection

Elements needed to transmit infection

Infectious agent (organism) Reservoir (environment in which to live and

multiply)

Portal of exit from reservoir

Means (mode) of transmission

Portal of entry into new (susceptible) host


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Infection Control

Infectious Agent

Pathogenicity - ability to cause disease

Virulence - ability to grow and multiply withspeed

Invasiveness - ability to enter tissues

Specificity - attraction to a particular host


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Infection Control

Process of infection

Invades in stages Latent period

pathogens enter body and lie dormant

Incubation period - communicable microbes shed, reproduce and disease process begins

Disease period - most communicable signs and symptoms reach full extent or produce vague,

subclinical symptoms

Convalescence symptoms begin to diminish and disappear


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Infection Control

Means of transmission

Direct contact

Indirect contact Droplet

Airborne

VehicleVector


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Infection Control

Means of transmission Direct contact - person or animal with disease or his

blood or body fluids are touched

Indirect contact - transfer by the touching of objects(fomites) that have been contaminated by infectious person

Droplet - contact with infectious secretions from carrier Through coughing, sneezing, talking

Droplets can travel 3-5 ft.

Airborne - residue from evaporated droplets suspended inair for long periods of time; infectious if inhaled bysusceptible host


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Infection Control

Means of transmission

Vehicle - food water, drugs or blood

contaminated with infectious microorganismVector - animal or insect carriers of disease,

deposit microbes by bite or sting


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Standard Precautions

Formulated by CDC and HHS

For all persons working in situations where theymight come in contact with infected blood

Based on assumption that every patient ispotentially infectious

Strict adherence to principles greatly reducesthreat by forcing health care workers to handle allbody fluids and substances with extreme care

Apply standard precautions to all patientsregardless of diagnosis or infection status


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Used when performing procedures that mayrequire contact with: Blood

Body fluids

Secretions

Excretions

Mucous membranes

Non-intact skin

Also included are items soiled orcontaminated with any of these substances


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OSHAs contributions:

Workplace plan

All workplaces in which employees may beexposed to contaminated body fluids

Control employee exposure to pathogenicmicroorganisms borne by these fluids

Plan available for review by all employees


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Workplace plan Employer obligated to provide methods and

materials necessary for compliance with the plan Gloves Gowns

Goggles

Methods to dispose of syringes and needles withoutrecapping or breaking

Immunization against HBV Follow-up care for employees inadvertently exposed to

bloodborne and body fluid-borne pathogens


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Workplace plan Warning labels in orange or red-orange on

containers of regulated waste, separate

refrigerators, freezers & other containers totransport potentially infected materials

Use of standard precautions for all specimens orwarning labels on potentially infectious specimens

Annual training & documentation thereof foremployees concerning standard precautions

Confidential records kept on any employeeexposed to bloodborne pathogens at work for theduration of his employment & 30 years after


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Techniques for Infection Control

Dress

Hair

Hand washing Personal protective equipment

Gloves

Eye protection

Fluid repellent gowns Face masks, resuscitation masks and bags

Cleaning and proper waste disposal

Disinfection


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Hand washing

Hand washing number one method for preventingspread of infection

Friction (rubbing hands together) most effectiveway to remove microorganisms

Specific technique

Before & after handling supplies used for patient care

Before & after patient contact even if wearing gloves

Waterless, alcohol-based cleansing using frictioncan replace 30 sec. wash


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2 minute hand washing Beginning of each work day

When in contact with patients blood or body fluid

When preparing for invasive procedures

Before touching patients at greatest risk ofinfection

After caring for patients with known

communicable disease 30 sec. Hand washing

Precede & follow each patient contact

Time constraints


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Cleaning and proper waste disposal Fresh uniform, keep soiled uniforms away from

other personal clothing

Change pillow covers and linens after each patientuse

Flush contents of bedpans & urinals promptlyunless being saved for diagnostic specimen

Rinse bedpans & urinals and send to proper placefor resterilization or dispose of properly

Use equipment & supplies for one patient only


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Cleaning and proper waste disposal Keep water & supplies clean & fresh, use paper

cups

Floors are heavily contaminated - if an item fallson the floor, discard it or send it to the properplace for recleaning

Avoid raising dust - clean with cloth or towel

moistened with disinfectant Clean table after each patient use

Start from least soiled to most soiled areas

Clean from top down


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Place wet items in waterproof bags for disposal

Do not reuse rags & mops for cleaning Pour liquids to be discarded directly into drains or

toilets - avoid splashing

If in doubt - do not use

Contaminated articles should be wrapped & clearlymarked as contaminated when sent for cleaning


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Do not recap needles - place needles in puncture-proof containers for disposal

Send specimens to lab in solid or double bagged &clearly labeled containers

Keep medical charts away from patient care areasto prevent contamination


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Disinfection Removal by chemical & mechanical

processes of microorganisms

Disinfected when items cannot withstandsterilization process

Disinfect room, equipment, & anything

patient has touched with disinfectantbefore removing gloves

Wash hands after removing gloves


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Transmission-based Precautions

Airborne precautions Tuberculosis - Acid Fast Bacilli (AFB)

Droplet precautions

Contact precautions


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Airborne precautions

For pathogens that remain suspended in air for along period of time on aerosol droplets

Includes Tuberculosis, varicella, and rubeola

Patients placed in negative-pressure rooms

Wear respiratory protection when entering room

Patients should wear surgical masks when leavingroom

AFB - tight fitting mask with hepa-filter


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Droplet precautions

Pathogens disseminate through larger particulardroplets expelled by the patient through coughingor sneezing

Includes rubella, mumps, influenza

Patients placed in private or semiprivate roomswith other patients who share the same disease

Wear surgical mask when within 3 feet of patient

Patient should wear mask when leaving room


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Contact precautions Used when caring for patient with virulent

pathogen that spreads by direct contact or indirect

contact with contaminated object MRSA, hepatitis A, impetigo, varicella and varicella

zoster

Patients placed in private or semiprivate roomswith other patients who share the same disease

Wear gloves, gowns if necessary

Patient should wear appropriate barriers when inradiology dept


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Portable radiography on infectious patients Two person technique the basics:

Get portable machine & the number of necessary

cassettes Wash hands and put on appropriate protective apparel

Dirty tech handles patient and cassettes in protectivebag, readies cassette for removal from bag

Clean tech manipulates machine, makes exposure and

removes cassette from protective bag Remove protective apparel appropriately

Clean portable machine with disinfectant

Wash your hands again


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Precautions for Compromised Patients

Reverse or protective isolation

Clean before entering

Who? Patients with limited immunity

Organ transplants

Chemotherapy

Immunotherapy Burns

Neonates


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Asepsis

Medical asepsis

Reduction of microorganisms as far as

possible by use of soap, water, friction &various chemical disinfectants

Surgical asepsis

Complete destruction of microorganisms &their spores by means of heat or chemicalprocess


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Asepsis

Practice of medical asepsis required atall times

Surgical asepsis required for invasiveprocedures


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Antiseptics

Retard growth of bacteria

Isopropyl alcohol is example

Disinfectants

Destroy pathogens by chemical means

Examples

Hydrogen peroxide Boric acid

1:10 bleach & water (use for blood spills)


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Methods of Sterilization

Steam under pressure

Moist heat best overall method

Autoclave - 250

Indicator strip changes color

Gas

Method of choice for items that cannot stand

moisture & high temperatures Chemicals

Items that cannot be autoclaved & gas sterilizationnot available


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Methods of Sterilization

Dry heat

Rarely used in hospitals

Temps over 300

Ionizing radiation

Used in commercial sterilization

Microwaves/non-ionizing radiation

Rapid method of sterilizing metal instruments, butnot yet developed to obtain maximum potential


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Storing Sterile Supplies

Stored separately from non-sterile items

Must have expiration date printed on it No date - considered not sterile

Considered sterile for 30 days if stored in closedcupboard, 21 days if on open shelf

If sealed in plastic immediately after sterilization,considered sterile for 6-12 months if seal not

broken Commercial packages may be sterile for 2-3 years

If package is damaged or wet it is considerednot sterile


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Rules for Surgical Asepsis

If sterility of object questionable, consider itnot sterile

Sterile objects and persons must be keptaway from objects considered not sterile Sterile corridor

Area between sterile field and draped patient

Any sterile instrument or sterile area touched

by non-sterile object or person is considerednot sterile

If sterile gloves become contaminated, theymust be changed


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A sterile field must be created just prior to its use

Sterile fields must not be left unattended

Sterile fields end at tabletop or at waist of sterile

persons gown front of gown and arms to 2 belowelbows are sterile - cuffs of gown are not consideredsterile

Edges of sterile wrapper considered not sterile &must not touch sterile object

Sterile drapes placed by sterile person who drapesarea closest to him first to protect his sterile gown


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Sterile persons must pass each other back toback

Sterile person faces sterile field & keeps

sterile gloved hands above his waist and infront of his chest

Packs and materials that become dampenedor wet considered not sterile

Non-sterile persons do not reach across orlean over sterile field


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All areas used for sterile procedures must bethoroughly mopped with disinfectant aftereach use

Air conditioners & ventilation ducts must bekept clean & have special filters

When pouring sterile solutions, place lid faceupward & do not touch lid or lip of flask

Pour off small amount of fluid before pouringremainder into sterile container


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Opening sterile packs

Sterile gloving & gowning


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Handling Biohazardous Materials

Definition

Objects or substances encountered in

health-care workplace that may endangerthe health of the health-care worker

Biomedical waste

Body substances & associated equipment Bandages, dressings, soiled linens & gowns

Sharps, chest tubes, IV tubes, catheters, etc.


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Non-biomedical materials

Emergency Planning and Community Right

to Know Act Legislation stating that workers have right to

know about potentially hazardous substances

Information must be posted in easily accessible

location in the workplace right to knowstation


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Material safety data sheets Provide information about substances that are

potentially harmful

Rules Any toxic chemical or agent that may poison

patients or staff must be clearly labeled as such

These substances must be stored in safe area

designed for them Emergency instructions to be followed in case of

poisoning must be conspicuously posted in dept.


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Rules cont.

Chemicals must remain in their own containersmarked as toxic substances

Chemical & toxic substances must be disposed ofaccording to federal mandates & institutionalpolicy

Restrictions for disposal must be posted &

followed

Contrast agents & other drugs must be kept insafe storage area of limited access


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Rules cont.All containers of hazardous substances

must be clearly marked with the name ofthe substance , a hazard warning & thename o& address of the manufacturer

Hazardous substances may be labeled witha color code that designates the hazardcategory Health, flammability, reactivity, etc.


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First Aid Guidelines

Eye contact

Flush eyes with water for 15 min. or until irritationsubsides

Consult physician immediately

Skin contact

Remove affected clothing

Wash skin thoroughly with soap & water


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First Aid Guidelines

Inhalation

Remove from exposure

If breathing has stopped, begin CPR

Call 911 & physician

Ingestion

Do not induce vomiting

Call 911 & poison control center


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Routine Monitoring

Vital signs

Temperature

Pulse Respirations

Blood Pressure


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Vital Signs

Temperature Measurement of bodys metabolic state

Degrees centigrade (C) or Fahrenheit (F)

Fever is sign of increased metabolism, usually inresponse to infectious process Oral - O

Rectal - R

Axillary - Ax

Tympanic T

Rectal and tympanic temps are closest to bodyscore temperature


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Vital Signs

Pulse

The advancing pressure wave in an artery causedby the expulsion of blood when the left ventricle

of the heart contracts

Rapid pulse may result from excitement, exertion,or a damaged heart

Very slow pulse may mean the patient is athletic

or that the heart has a nerve conduction defect

Weak, thready pulse may indicate the heart is notpumping enough blood


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Vital Signs

Pulse Taken at radial or carotid artery

Count using watch with sweep second hand for 30

sec. & multiply by 2 If irregular, take for full minute

Abbreviation for pulse P Apical pulse - AP

Tachycardia more than 100 beats/min

Bradycardia fewer than 60 beats/min

Report abnormalities to physician or nurseimmediately


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Vital Signs

Respirations

Body requires constant supply of oxygen to

function Waste product of metabolism (CO2) also

eliminated

Failure of respiratory system a lifethreatening event

Normally silent, effortless, & regular


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Vital Signs

Respirations

Keep patient in present position

Observe chest wall for symmetry of movement

Observe skin color

Count number of times patients chest rises & fallsfor 1 minute

Symptoms of inadequate oxygen supply includedyspnea, cyanosis, diaphoresis, neck veindistention


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Vital Signs

Blood Pressure

Measure of the force exerted by blood on

the arterial walls during contraction &relaxation of the heart

SYSTOLIC

Peak pressure during contraction

DIASTOLIC

Pressure when heart is relaxed


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Vital Signs

Blood pressure Measured using sphygmomanometer &

stethoscope

Diastolic pressure over 90 indicates increasinglevel of hypertension

Diastolic pressure lower than 50 gives someindication of shock

Always expressed as systolic pressure overdiastolic pressure (e.g. BP 120/80) Record change in intensity of sound if heard (120/80/60)

Record any extraneous (Korotkoff) sounds heard(tapping, knocking, swishing)


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Vital Signs - Normals

Temperature: 97.7 - 99.5 F (oral) Respirations:

Adult: 12-20 breaths/minuteChild: 20-30 breaths/minute

Pulse:Adult: 60-100 beats/minuteChild: 70-120 beats/minute

Blood Pressure:Systolic: 95-140 mm. HgDiastolic: 60-90 mm. Hg


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When to take Vital Signs

When the patient is admitted to the healthcare facility

Before & after interventional or invasive

diagnostic procedures Before & after administering medications (inc.

contrast media)

Any time the patients general conditionchanges

Whenever the patient reports symptoms ofdistress


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Medical Emergencies

Top priority: any threat to patientsairway, breathing or circulation Check for respiratory distress

Reposition patient

Check and change oxygen tank

Call code

Level of consciousness Signs and symptoms of shock


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Level of Consciousness

Make quick assessment

Note if no complaints on initial

assessment Immediately report any changes to

physician

Stop procedure

Stay with patient

Summon assistance


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Ask patient to state his name, the date, hisaddress, and the reason he has come to thedepartment

Assesses patients response to verbal stimuli

Assesses patients orientation to time, place andsituation

Assesses undue need to repeat questions, slowresponse, difficulty with choice of words andunusual irritability


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As you instruct patient in positioning forexam:

Note his ability to follow directions

Take note of any movement that causes pain orpresents difficulty

Note alterations in behavior or lack of response

Provides baseline against which any changes in patients

mental and neurological status can be assessed


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Becomes increasingly irritable anduncooperative

Begins giving inappropriate or delayedresponses

Stops following directions

Becomes increasingly lethargic Loses consciousness


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Change in LOC

Radiographers response Check chart for possible explanations to behavior

Meds, diagnosis, nurses notes

Notify physician Be prepared to inform regarding:

Time of behavior change

Preceding events

Examinations performed

Other pertinent information Stop exam until physician gives OK to continue

Stay with patient


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Shock

Bodys pathological reaction to illness,or severe pathologic or emotional stress

Life-threatening condition Occurs rapidly, often without warning

May be irreversible if allowed to progress


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Shock

Early signs & symptoms

Pallor and sweating (diaphoresis)

Increased heart rate, respirationsAnxiety level increases

Decreased blood pressure

Restlessness Confusion


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Shock

Later signs & symptoms

Blood pressure continues to fall

Respirations are rapid & shallow Severe pulmonary edema

Tachycardia (up to 150 BPM)

Patient may complain of chest pains Mental status changes

Confusion, lethargy, loss of consciousness


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Types of Shock

Hypovolemic

Cardiogenic

Neurogenic Distributive (Vasogenic)

Septic

Anaphylactic

Obstructive


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Hypovolemic Shock

Caused by abnormally low volume ofcirculating blood in body

Maybe due to: External or internal hemorrhage

Loss of plasma from burns

Loss of fluids from prolonged vomiting,diarrhea or medications


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Cardiogenic Shock

Caused by failure of heart to pumpadequate amount of blood to vital

organs May be sudden or occur over a period

of time

Patients with MI, cardiac tamponade,dysrhythmias, cardiac pathology


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Neurogenic shock

Causes blood to pool in peripheralvessels


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Vasogenic Shock

Occurs when there is pooling of blood inperipheral vessels

Results in: Decreased venous blood return to heart Decreased blood pressure

Decreased tissue perfusion

Characterized by blood vessels inability toconstrict and resultant ability to assist inblood return to heart


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Anaphylactic Shock

Most common type seen by radiographers

Result of exaggerated hypersensitivityreaction (allergic reaction)

Histamine and bradykinin released causingwidespread vasodilatation and peripheralpooling of blood

Contraction of non-vascular muscles,particularly those in respiratory tract

Common causes Meds, contrast agents, chemo agents, anesthetics,

food, insect venom


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Anaphylactic Shock

Early signs and symptoms Itching, nasal congestion, sneezing, coughing

Tightness in chest

Apprehensiveness Nausea, vomiting

Late Edema

Urticaria (hives) Wheezing, dyspnea, cyanosis

Decreased BP - weak, thready rapid or slow pulse

Altered LOC - possible respiratory arrest


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Septic Shock

Occurs when toxins produced duringmassive infection cause a dramatic drop

in blood pressure


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Shock Radiographers response

Stop procedure

Notify physician & emergency team - have crashcart placed by patient

Stay with patient

Place patient supine (semi-Fowlers for dyspnea)

Keep patient calm and quiet

Monitor patients vital signs

Prepare to assistphysician or code team *For bleeding don gloves, apply direct pressure

with sterile gauze pads to site of wound

Document


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Hypoglycemia

Diabetic has:

Excess amount of insulin or hypoglycemic drug inbloodstream

Increased metabolism of glucose

Inadequate food with which to utilize insulin

Blood glucose level below 50-60 mg/dL

Must be treated immediately Interferes with oxygen supply to brain

Can result in cerebral damage or death

Patient needs glucose


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Hyperglycemia

Diabetic has: Insufficient amount of insulin in body

Decreased glucose entering body cells

Liver producing more glucose resulting in highlevels of glucose in bloodstream

Glucose-laden urine production resulting indehydration an electrolyte imbalance

Keytone bodies in blood (from liver breakdown offat) result in metabolic acidosis Leads to coma and possible death

Patient needs insulin you do not give it


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Diabetic Emergencies Hypoglycemia

Rapid onset

Causes Too much insulin

Too little food Delayed meal

Signs & symptoms Diaphoresis, clammy

skin

Headache

Hunger Pounding heart,

trembling, impairedvision

Give sugar & call doctor

Have patient rest

Hyperglycemia Slow onset

Causes Too little insulin

Failure to follow diet Infection, fever, stress

Signs & symptoms Flushed skin

Increased thirst

Weakness, abd. pain

Nausea, vomiting

Coma

Call doctor, give fluids


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Pulmonary Embolus

Occlusion of one or more pulmonaryarteries by thrombus (blood clot)

Onset of symptoms sudden Occurs following surgical procedures,

prolonged medical illness, traumatic

event


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Pulmonary Embolus

Signs and symptoms Chest pain abrupt in nature

Rapid, weak pulse

Hyperventilation Tachypnea, dyspnea

Tachycardia

Cough, hemoptysis

Diaphoresis Syncope

Rapidly changing level of consciousness

Coma, sudden death may occur


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Pulmonary Embolus

Radiographers response

Stop procedure

Call for emergency assistance

Notify physician

Bring emergency cart to patients side (dept. policy)

Monitor patients vital signs

Stay with patient reassure him

Prepare to assist with oxygen, IV fluids & meds


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CVA - Stroke

Occlusion of blood supply to brain

Rupture of cerebral artery resulting in

hemorrhage into brain tissue or spacessurrounding brain

Range from TIAs to severe

Most occur with little or no warning


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CVA - Stroke

Signs and symptoms Possible severe headache

Muscle weakness, flaccidity of face or extremities

(usually one-sided) Eye deviation or loss of vision (one side)

Dizziness or stupor

Dysphasia or aphasia

Ataxia May complain of stiff neck

Nausea, vomiting

Loss of consciousness


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CVA - Stroke


Stop procedure

Notify physician

Call for emergency assistance

Place patient in modified Fowlers position

Stay with patient

Monitor vital signs Prepare to assist with oxygen, IV fluids & meds

May need to start CPR


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Syncope - Fainting

Transient loss of consciousness resulting frominsufficient supply of blood to brain

Possible causes

Heart disease

Hunger

Poor ventilation

Extreme fatigue Emotional trauma

Orthostatic hypertension

S


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Syncope - Fainting

Signs and symptoms

Pallor

Complaints of dizziness or nausea Hyperpnea

Tachycardia

Cold, clammy skin

S F i i


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Syncope - Fainting


With patient complaints have him liedown

If patient has already fainted

Assist patient to floor

Place him in supine position

Elevate his legs Summon medical assistance

S i


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Seizures

Unsystemic discharge of neurons of cerebrumresulting in abrupt alteration of brain function Symptoms of disease not disease itself

Begins with little or no warning May last seconds or minutes

Accompanied by change in level of consciousness

Causes include: Infectious disease and high fever Extreme stress

Structural abnormalities of cerebral cortex

Epilepsy

S i G li d


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Seizures - Generalized

Signs and symptoms

Sharply exhaled breath

Rigidity of muscles - eyes open wide

Jerky body movements with rapid, irregularrespirations

May vomit

May froth at mouth (may be mixed with blood)

May exhibit urinary or fecal incontinence

Usually falls into deep sleep following seizure

S i G li d


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Seizures Generalized

Radiographers response Stop procedure

Prevent patient from injuring himself by restraining gently

Call for assistance

Stay with patient

Keep your fingers out of his mouth

Keep patient from falling off table

Provide privacy

Following seizure, move patient to Sims position to preventpossible aspiration

Prepare to assist with suctioning

Notice and report as much as possible about seizure tophysician

Reassure patient following seizure confusion likely

S i P ti l


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Seizures - Partial

Signs and symptoms Lip smacking

Chewing and facial grimacing

Swallowing movements Patting and picking or rubbing ones self or

clothing

Confusion for several minutes following seizure

Radiographers response Reassure patient

Notify physician

S i Ab


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Seizures - Absence

Signs and symptoms May have limb tremor accompanied by brief loss

of consciousness

Brief loss of awareness accompanied by blankstare

May have eye blinking or mild body movement

May be sudden loss of all muscle tone resulting infall

Radiographers response Reassure patient

Notify physician

N & V iti


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Nausea & Vomiting

Nausea Psychological and physical reaction

Radiographers response Instruct patient to breathe slowly and deeply

through his mouth

If vomiting occurs place patient in lateralrecumbent position

If movement prohibited, turn patients head toside

Assist with emesis basin and moist cloths

E i t i


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Epistaxis

Nosebleed Seldom life-threatening

Radiographers response Lean patient forward Pinch affected nostril against midline nasal

cartilage with finger pressure

Keep patient sitting, head forward so blood does

not run down throat If gentle pressure does not stop flow, apply moist

compress and seek medical assistance

W d


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Wounds

Hemorrhage Note condition of dressings at start of procedure

If they become saturated during procedure,

attention is necessary Do not remove dressing

Apply pressure directly to wound using additionalsterile gauze (gloves)

Once bleeding is under control tape dressing inplace

Extremity wounds should be raised above level ofheart

Notify patients nurse

W d


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Wounds

Burns Disrupt protective function of skin

Use sterile technique

Painful be very gentle Dehiscence

Sutures separate allowing abdominal contents tospill out

Cover wound with sterile dressing Keep patient in seated position, bent forward

Get immediate medical attention

E S ti i


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Emergency Suctioning

Items needed for suctioning Wall outlet or portable suction machine

Adapters for all wall outlets

Tubing Gloves, gown, mask

Sterile disposable suction sets Suction catheter with adapter

Sterile water or normal saline in container Padded tongue depressor

Packets of sterile, water soluble lubricant

Oxygen source

Eme genc S ctioning


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Signs that indicate need for suctioning

Profuse vomiting in patient that cannotvoluntarily change his position

Audible rattling or gurgling sounds comingfrom patients throat

Signs of respiratory distress



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RT Responsibilities

Ensure suctioning system is operational

Pump is working

Receptacle is connected to pump Adequate length of tubing connects suction catheter to

receptacle

Assortment of disposable suction catheters is on hand

Recognize the need for suction Assist physician or nurse in procedure

Ready suction equipment for use

Support Equipment


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Support Equipment

Oxygen therapy

Should not be removed during exams

May only be given or remove on physicians order

Care must be taken not to pinch tubing

High flow rates are toxic to patients with COPDbecause their respiration is controlled by thehigher levels of CO2 in their blood

O2 is combustible

Support Equipment


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Support Equipment

Oxygen therapy Supplied by wall system or portable tank

Physician determines amount of O2 needed &

delivery system Flow rate measured in liters/minute (LPM)

Delivery systems Nasal cannula low flow 21-60%, 1-4 LPM

Nasal catheter moderate to high flow

Face mask low flow Non-rebreathing can supply 100% oxygen

Partial rebreathing can supply up to 90% oxygen

Support Equipment


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Support Equipment

ET Tubes Indications

Need for ventilation or oxygen delivery Inadequate breathing Inadequate arterial oxygenation

Severe airway obstruction

Shock

Upper airway obstruction

Pending gastric acid reflux or aspiration

Tracheobronchial lavage

Images ordered for tube placement

Support Equipment


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Support Equipment

Tracheostomies Surgical opening into trachea

To relieve respiratory distress caused by

obstruction of upper airway To improve respiratory function by permitting

better access to lower respiratory tract

May be temporary or permanent

Tube inserted with obturator that is removedfollowing insertion tube anchored in placewith tape or ties at back of neck

Support Equipment


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Support Equipment

Tracheostomies Patients with newly inserted tubes are:

Very fearful

Unable to talk

Afraid of choking

Nurse should accompany these patients toRadiology Plan care with nurse before procedure begun

Dont touch the tracheostomy Nurse will suction to remove secretions sterile

technique

Support Equipment


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Support Equipment

Ventilators

Mechanical respirators attached totracheostomies or ET tubes

Patient on ventilator has been intubated

Care must be taken not to dislodge tubingconnected to tracheostomy

Support Equipment


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Support Equipment

Chest tubes In place to remove air or fluid from pleural or

mediastinal space

Insertion sites Hemothorax & pleural effusion

Fluids flow with gravity and accumulate near lung bases

Tubes placed low (5th to 8th intercostal space) laterally atmid-axillary line

Pneumothorax Air rises requiring higher insertion site in apical region

Tubes placed at 2nd or 3rd intercostal space at mid-clavicular line

Support Equipment


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Support Equipment

Chest tubes

Cautions

Vacuum must be maintained momentarydisconnection of tubing breaks vacuum sealand can cause serious consequences to patient

Handle drainage device carefully

Keep below level of patients chest

Never clamp a chest tube

Support Equipment


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Support Equipment

Central venous lines

Indications

Medication administration

Chemotherapy Total parenteral nutrition

Management of fluid volume

Blood analysis and transfusions

Monitor of cardiac pressures

Dialysis

Establishing long-term venous access

Support Equipment


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Support Equipment


Indications

Medication administration

Chemotherapy Total parenteral nutrition

Management of fluid volume

Blood analysis and transfusions

Monitor of cardiac pressures

Dialysis

Establishing long-term venous access

Support Equipment


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Support Equipment


Short-term, non-tunneled external catheters

Inserted in subclavian, jugular or femoral veins at neck,

shoulder, groin or antecubital fossa Secured at point of insertion with sutures and a dressing

Examples

PICC used for medicine administration(peripheral insertion)

CVP measures pressure of blood returning to right atriumto aid evaluation of right heart function

Support Equipment


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Support Equipment

Central venous lines Long-term, tunneled external catheters

Surgically placed beneath skin and directed to desiredvein

Scar tissue secures Dacron cuff of catheter in placepreventing accidental dislodging

Advanced into superior vena cava

Examples Hickman long-term parenteral nutrition

Groshong (single or multiple lumen) administration ofmedications or drawing of blood

Raff double lumen used in dialysis

Support Equipment


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Support Equipment


Long-term infusion ports (venous access ports)

Implanted ports

for patients with long-term illness requiring frequent IVmeds, chemotherapy, transfusions, or blood sampling fromsuperior vena cava

Surgically implanted in tissue of arm or chest

Not visible, but can be felt

Catheter runs from port to subclavian or jugular vein Huber needle inserted to access

Support Equipment


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Support Equipment

Pulmonary arterial catheters

Indications

Diagnose right and left ventricular failure

Monitor effects of medications, stress & exercise onheart function

Commonly called Swan-Ganz catheters

Single or multiple lumen

Small electrode at distal end for pressure monitoring

Balloon tip

Support Equipment


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Support Equipment

Pacemakers

Electromechanical device providing electricalstimulation to heart muscle

Regulates heart rate Used to treat conduction defects

Internal pacemakers surgically implanted in chest

External pacemakers temporary with bulk of instrumentoutside chest

Inserted under fluoro guidance or with CXR confirmationof tip placement in apex or right ventricle

Support Equipment


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Support Equipment

Tissue drains Placed at or near wound sites

When large amounts of drainage expected

Poor drainage can interfere with healing and may causeinfection or fistula tract

Examples Hemovac & Jackson-Pratt

Plastic drainage tubes that maintain constant low negativepressure by means of small bulb

Squeezed and slowly re-expands to create suction

Penrose Soft rubber tube held in place by sterile safety pin

Support Equipment


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Support Equipment

Tissue drains Other examples

T-Tube used in common bile duct

Cecostomy tube used in cecum

Cystostomy tube used in urinary bladder

One end placed in or near operative site

Other end exits through body wall

Removed by surgeon (or radiologist) when drainagediminishes

Require surgical aseptic technique and care planto prevent tension on the drain

Support Equipment


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Support Equipment

Urinary catheters

Indications

Bladder emptying before procedures

Relieve retention of urine or bypass obstruction

Irrigate bladder

Introduce drugs

Permit accurate measuring of urine output Relieve incontinence

Support Equipment


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Support Equipment

Urinary catheters

Two types

Indwelling (Foley) designed to be left in place for

prolonged periods of time Retention balloon tip

Catheter bag

Straight catheter used for intermittent catheterization

No balloon

Require surgical asepsis for Insertion, specimen collection, irrigations

Support Equipment


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Support Equipment

Urinary catheters Indwelling catheter must be clamped before

performance of IVP Clamp distal to connection between catheter and

collection bag

Use screw-type clamp or forceps without teeth

Put no pulling pressure on catheter tubing

Unclamp catheter following procedure

Drain water from balloon with syringe before attemptingto remove catheter

Keep bag below level of bladder to prevent backflow ofurine into bladder

Support Equipment


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Support Equipment

Nasogastric tubes

Tube inserted through nose & esophagus intostomach

Used to feed patient or to conduct gastric suction Care must be taken not to pull on tube while

moving patient or performing exam

Radiographers may, on physicians orders, remove

NG tubes, but never NE tubes Never clamp a double lumen tube

Support Equipment


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Support Equipment

Common NG tubes

Levin Gastric decompression

Sump Drain fluid from stomach

Nutriflex Feedings

Moss Aspiration

Duodenal feedings

Sengstaken-BlakemoreControl bleeding ofesophageal varices

Support Equipment


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Support Equipment

Common NE tubes

Cantor Relieve SB obstructions

Harris Gastric & intestinaldecompression

Miller-Abbot Decompression

Contrast Media


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Contrast Media

Negative contrast agents Radiolucent appears dark on films

Have low atomic numbers

Air most commonly used

Chest x-ray

Administered as gas (air), gas producing tablets, crystals, orsoda water (CO2)

Oxygen rarely used because it is absorbed too quickly bycells

Often used in combination with radiopaque media to outlinethe lumens of, or spaces within body structures, calleddouble contrast studies

Contrast Media


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Contrast Media

Positive contrast agents Opaque to x-rays

Have relatively high atomic numbers

Iodine (atomic number 53)

Barium (atomic number 56)

Result in greater attenuation of x-rays

Contrast-filled anatomy appears light on films

Provides increase in contrast between structure to be

visualized & surrounding structures Can be used alone or as part of a double contrast study

Contrast Media


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Contrast Media

Role as physician extender History taking

Preparation of drugs for administration

Administration of drugs Under direction of licensed practitioner

If state and institutional policy permit

Monitoring of patient followingadministration

Prevention of errors

Contrast Media


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Contrast Media

Legal implications RTs not licensed to dispense drugs

RTs who administer drugs expected to know:

Safe dosage Safe route of administration

Limitations of drug

Toxic reactions

Side effects

Potential adverse reactions Indications and contraindications for use

Documentation

Contrast Media


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Contrast Media

Medication orders

Meds given by RT only under physiciansorders

Conditions meeting requirements oforders

Written

Oral Standing

Routes of Administration


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Routes of Administration

Enteral Oral

Sublingual

Buccal Rectal

Topical Skin

Eyes, Nose, Throat Respiratory mucosa

Vagina

Parenteral Intradermal

Subcutaneous

Intramuscular

Intravenous

Intra-arterial

Intrathecal Intra-articular

Adverse Effects


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Adverse Effects

Side effect

Unintended effect that is essentially not harmful

Adverse reaction

Harmful effect

Immediate

Delayed

Purpose of drug weighed against risk factors prior toadministration: if need outweighs risk drug isprescribed with caution

Adverse Reactions


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Adverse Reactions

Idiosyncratic reaction Unexpected effect the first time a patient receives

a drug

Allergic reaction Occurs when bodys immune system is

hypersensitive to presence of a drug

Can only occur after repeated exposure to a drug

or chemically related compound Prior sensitization to a drug may have taken place

without patients knowledge

Barium Sulfate


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Barium Sulfate

Heavy metal with an atomic number of 56, soradiopaque

Inert powder composed of crystals used forexamination of the GI system

Chemical formula is BaSO4 so it is a compound

Non-soluble, must be mixed or shaken with water toform a suspension Depending on environment (such as acid in stomach) it can

come out of suspension and clump - flocculation - stabilizingagents such as sodium carbonate or sodium citrate used toprevent this

Barium Sulfate


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Barium Sulfate

Administered either orally or rectally

For oral administration also contains vegetable gums,flavorings and sweeteners to increase palatability

(mix with very cold water and use straw to preventcoating of the mouth)

Must be concentrated enough to be absorbed by x-rays, but flow easily enough to coat linings of organs

Barium Sulfate


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Barium Sulfate

COOL tap water Generally recommended for lower GI studies to reduce

irritation of the colon and to aid the patient in holding theenema

Cool tap water reduces spasm and cramping (roomtemperature)

Cautions include increased water absorption by thecolon Can result in excess water entering the circulatory system

(hypervolemia) which is serious and sometimes fatal 2 tsp. Of salt per liter of water in the enema preparation

reduces this risk

Barium Sulfate


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a u u a

Residual barium tends to become thickened as result

of absorption of its fluid - inspissation Can solidify causing a bowel obstruction

Constipation is the major symptom of obstruction notify

physician if it lasts longer than a day Stools will be light colored for a few days

Increased fluids & fiber must be taken

May need minor laxative

Not absorbed by body tissue NEVERinject into the bloodstream or subarachnoid space

NEVERuse when there is a possibility of perforation or priorto surgery - if it enters the peritoneal cavity it can causeperitonitis and must be removed surgically

Aqueous Iodine Compounds


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q p

Gastrografin & Hypaque Sodium Used in GI studies only in special cases when

administration of barium sulfate might behazardous to the patient

Examples When rupture of GI tract is suspected such as a

perforated ulcer or ruptured appendix

When there is a high risk of barium impaction

With neonates

When immediately preceding a surgery

May cause significant dehydration

Cannot be used in when risk of aspiration possible

Iodinated Contrast Media


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High atomic density - #53

Salts of organic iodine compounds

Visualizes structures when little naturalcontrast exists

Most frequently used contrast

Used in intravascular studies

Has variables that must be considered

Variables to Consider


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Miscibility

Ability of agent to mix with body fluids

Viscosity Thickness or stickiness of agent

Warming agent reduces viscosity

Osmolality

Ionic strength of agent

Potentialtoxicity

Types of Iodinated Contrast


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yp

Water-based

Ionic vs. Non-ionic

Non-ionic does not mean non-iodinated

both contain various concentrations of iodine

HOCAs - high-osmolar contrast agents

LOCAs - low-osmolar contrast agents

Oil-based

Water-based Contrast


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Stocked in wide variety of types, sizes &strengths

Used for many purposes Excreted by kidneys through urinary

system

Chosen for use by specificcharacteristics



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Ionic vs. Non-ionic

Refers to structural composition ofmolecules contained in contrast agent

Ionic

Molecules dissociate into two charged particles ions

Non-ionic Molecules remain whole in solution



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Osmolality Ratio of the number of iodine atoms to the

number of particles

HOCM - 3:2 3 atoms of iodine to 2 particles in solution

iothalamate meglumine

Renografin

LOCM 3:1 3 atoms of iodine to 1 particle in solution Meglumine ioxaglate (Hexabrix)

Metrizamide (Amipaque)



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Non-ionic, low osmolality Newest contrast agents

3:1 but do not separate into ions in solution

iopamidol (Isovue, Niopam)

iohexol (Omnipaque)

Less toxic than conventional contrast agents

Less like to stimulate anaphylactic response

More comfortable for patient less heat &

discomfort on injection More expensive to use



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Type of contrast, amount & route ofadministration selected by radiologist

Depends on patient condition

Toxicity especially significant in pediatricpatients

Considerations include age & weight

Recommended dose 2-5 cc/kg



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Guidelines for use of non-ionics Patients < 1 year of age

Patients with histories of adverse reaction tocontrast

Patients with significant cardiovascular disease

Patients with asthma or histories of severeallergies

Severely debilitated or very old patients

Patients with multiple myeloma or sickle celldisease, diabetics taking Glucophage

Patients with impaired renal function

Oil-based Contrast


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Designed for slow absorption

Insoluble in water & relatively viscous

Decompose easily Cannot be used in plastic syringe - Toxic

Persist in body

Rarely used today Ethiodol lymphangiography

Propyliodone (Dionisil oily) - bronchograms

Pre-injection Patient Care


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j

Take allergy history

Identify possible heart & respiratory problems &overall extent of medical problems

Patients at high risk for allergic reaction: Procedure may be cancelled

Special pre-medication protocol may be followed

Review possible reactions to contrast mediumbeing used

Know location of emergency equipment

Carefully observe & evaluate patient for baselines

Checklist for Pre-contrast History


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Kidney disease or failure Check charts for BUN, eGFR & creatinine levels

History of diabetes Check for Glucophage medication

Heart disease of high blood pressure Check current BP

Iodine contrast studies within past 48 hours Check to determine when, which agent, concentration &

dose

History of allergies or asthma Previous allergic reactions to contrast medium

What agent, what reaction

Current meds

Contrast Administration


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Via many routes

Oral

Vaginal

Intravascular Percutaneously

Generally bolus administration

Potential for adverse effects High osmolality causes sudden shift of body fluids

into systemic circulation

Toxic Responses


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Toxic responses may result from: Poor kidney function

BUN - normal: 8-25 mg/dl

Creatinine normal: 0.6-1.5mg/dl

eGFR normal: 90-120 ml/min

Report abnormal test levels to radiologist before contrastadministration

Overdose of contrast Maximum 24 hr. dose

Question patient about other contrast studies

Allergic reactions Occur due to sensitivity to iodine or some other

component of contrast medium

Contrast Media Reactions


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Psychogenic factors

May be caused by patient anxiety

May be suggested by possible reactionsdescribed during informed consent process

Contrast Media Reactions


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Mild to moderate

Flushing (side effect)

Hives/urticaria

Nausea & vomiting (se)

Sneezing

Sensation of heat (se)

Itching

Hoarseness (or change in

pitch of voice) Coughing

Headache (se)

Metallic taste (se)

Moderate to severe

Dyspnea

Hypotension

Tachycardia

Change in level oforientation

Loss of consciousness

Convulsions

Paralysis Cardiac arrest

Complications


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Site of injection

Local irritation may occur if solution extravasates

Stop infusion immediately

Remove cannula Elevate affected arm

Apply ice packs or warm compresses

Document location, appearance of area, amount ofsolution infiltrated & palliative action taken

Phlebitis may occur in the vein in which contrastagent was injected

Rights of Medication Administration


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Right patient

Right drug

Right amount or dose Right time

Right route

Right documentation

Rules for Safe Drug Administration


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If you handle the drug - you are responsiblefor the patients safety

Patients have the right to be informed & the

right to refuse medication Verify & document correctly

Never leave a patient who may be having adrug reaction unattended

Always be prepared for a serious drugreaction

Types of Injections


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Bolus

Designated amount of drug administered at onetime generally over a period of several minutes

Infusion Larger amount of a drug, fluid or fluid containing

electrolytes or drugs administered over a longertime frame several hours of more

Items Needed to Start an IV


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Tourniquet

Alcohol wipes

Precut adhes

Patient Care Registry for Radiology

Documents

Transcript of Patient Care Registry for Radiology