Patient Care Registry For Radiology

Patient Care
Scheduling & Sequencing Exams
General Considerations

Consider patient comfort & fiscal responsibility Sequence exams so they do not interfere with each other Schedule NPO patients first Schedule pediatric & geriatric patients early Schedule diabetic patients early because of need for insulin Emergency patients top priority
Contrast specific considerations
Radiographic exams not requiring contrast scheduled first Thyroid assessment must precede any exam involving iodinated contrast media Total doses of iodinated contrast must be calculated if a series of exams using it will be performed
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
Example
Day one

GB sono Lumbar spine IVU CT Abdomen BE UGI
Day two

Day three
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.
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 verify exam with attending physician, radiologist, or patients nurse NEVER DECIDE ON YOUR OWN WHAT EXAM IS TO BE PERFORMED
Modified or additional projections
If patient unable to assume routine projections, radiographer should be able to modify exams to provide required information (follows dept. protocol) It is outside radiographers scope of practice to supply additional, unrequested views
Should consult with radiologist if you believe additional images might be needed based on pathology Should inform attending physician if other projections or modifications might enable him to better visualize affected area
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
Patients rights
Right to privacy

Personal dignity Confidentiality HIPAA If patient refuses you must not perform exam If already begun you must stop as soon as it is safe to do so Signing informed consent does not invalidate right to refuse treatment once procedure has begun
Right to refuse treatment/examination

Advanced directives
Outline of specific wishes about medical care in the event individual loses ability to make or communicate 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 if patient unable to do so
Consent

Oral patient agrees to exam Implied

Provides for care when patient is unconscious Based on assumption that patient would approve of care if conscious
Written Informed consent
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 may sign for patient
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
Informed consent

Most procedures require physician to do (angio) Tech may explain & provide form for more routine procedures (IVU) Consent forms must be completed before being signed (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 after signing right to refuse examination
Verification 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
Torts

Violation of civil law AKA personal injury law Injured persons have right to compensation for injury
Intentional misconduct
Assault
Patient feels threatened or apprehensive about being injured Imprudent conduct by radiographer that causes fear in a patient is grounds for allegation of civil assault
Battery

Unlawful touching or touching without consent Harm resulting from physical contact with radiographer Also includes radiographing:

Wrong patient Wrong body part Performing exam against patients will
False imprisonment

Unjustified restraint of a person Care must be taken using restraint straps or other individuals to hold patient still We use positioning aids not restraining devices Get patient consent
Invasion of privacy

Violation of confidentiality of information Unnecessarily or improperly exposing patients body Unnecessarily or improperly touching patients body Photographing patients without their permission
Defamation
Spread of false information that results in defamation of character or loss of reputation Libel
Written false information Verbally spreading false information
Slander
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 similar circumstances Acts that demonstrate reckless disregard for life or limb
Gross negligence
Contributory negligence
Instance in which the injured person is a contributing party to the injury
Negligence
Four conditions needed to establish negligence

Establishment of standard of care (duty owed) Demonstration that the standard of care was violated (by radiographer) Demonstration that loss or injury was caused by person (radiographer) being sued Loss or injury actually occurred & is direct result of negligence
Respondeat superior

Literally let the master answer Legal doctrine stating that an employer will be held 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!
Res ipsa loquitur

Literally the thing speaks for itself Legal doctrine stating that the cause of the negligence is obvious
DUH?!
Burden of proof falls on defendant to disprove Physician is held liable for actions of those under his authority
Captain of the ship doctrine
Shit can roll uphill
Ethical Principles
Autonomy
Patients have the right to make decisions concerning their lives (and medical treatment) free from external pressure To abstain from inflicting harm & to prevent harm
Nonmaleficence
Ethical Principles
Beneficience
Acts must be meant to obtain a good result or be beneficial Requires action that either prevents harm or does the greatest good for the patient
Ethical Principles
Confidentiality
The concept of privacy information concerning patients state of health must not be disclosed to anyone not involved in the patients care
Ethical Principles
Fidelity
Duty to fulfill ones commitments & applies to promises both stated & implied Refers to all persons being treated equally or receiving equal benefits according to need
Justice
Ethical Principles
Sanctity of life
Refers to the belief that life is the highest good & no one has the right to judge anothers persons quality of life as so poor that his or her life is not of value & should be terminated
Ethical Principles
Paternalism
Refers to the attitude that the health care worker knows what is best for the patient & to make decisions regarding the persons care without consulting the person affected
Charting
Writing on patients chart by radiographer

Includes computerized entries Protocol varies by institution Write clear statements regarding patients condition, reaction to contrast agents, amount of contrast material injected, time & date of occurrence & so forth Include time & date of all information recorded Sign with full name & credentials
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
Radiograph retention (films!!)

Varies according to state law Normally maintained for 5-7 years after date of last exam & 5-7 years after minor turns 18 or 21 depending 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
Communication with patient

Verbal Non-verbal

Body language Therapeutic touch Appearance
Patient Education, Safety & Comfort
Communication with patient
Patient history assists radiographer in knowing extent of injury & range of motion Assists radiologist in interpretation of radiographs Begins with introduction of radiographer & verification of patients name
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 what extent
Possibility of pregnancy LMP Age specific factors
Patient History
Essential elements

Location - precise area, touch for emphasis, palpation Chronology Quality Severity Onset Aggravating or alleviating factors Associated manifestations
Explanation of current procedure
Includes
Detailed description of preparation necessary for procedure 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 in procedure Follow-up care necessary when procedure complete
Assessment 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 of him during transfer Patients acceptance of move Patients medication history Support equipment necessary (oxygen, IVACs, etc.)
Preparing for transfer
Plan what you are going to do & prepare your work area
Check equipment for safety and function
Verify patients identity Enlist patients help & cooperation
Explain to the patient what you are doing Make sure assistants understand their role in the transfer plan
Obtain additional help when necessary
Hold the patient, not the equipment
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 when moving or lifting heavy objects Pull dont push heavy objects
Transfer from wheelchair to x-ray table
Wheelchair parallel next to table Brakes applied, stepstool nearby Using face-to-face method, assist patient to standing position Have patient place hand on footstool handle & the other arm on your shoulder & step up on stool Patient pivots with back against table into sitting position on edge of table Place one arm around patients shoulder & the other under the knees Assist patient to supine position with patients head on pillow
Transfer from x-ray table to wheelchair
Check to see that brakes of wheelchair have been applied Assist patient into sitting position Allow patient to sit up for a short time to regain sense 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
Transfer from x-ray table to wheelchair
If patient non-ambulatory

Stand facing patient Reach around patient & place your hands on each scapula Lift patient upward to standing position Pivot so that back of patients leg is touching edge of wheelchair Ease patient down to sitting position Position foot & leg rests into place Cover patients lap with sheet
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 fluid motion to x-ray table
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 with exam Sponge under knees relieves back strain Pillow or sponge under head
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 or thin skin
Immobilizers
Manual, physical or mechanical device, material or equipment attached or adjacent to the persons body that the person cannot remove easily that restricts freedom of movement or normal access to ones body Must be ordered by physician

Standing orders In compliance with institutional policy
Should be used only after less restrictive measures have been attempted
Immobilizers
Use therapeutic communication to relieve patients anxiety & perhaps avoid need for immobilization Reasons for application
Control movement of extremity when IV or catheter is in place Remind sedated patient to remain in particular position Prevent patient who is unconscious, delirious, cognitively impaired or confused from injuring him/herself
Rules for application on p. 92 of Torres
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
Assisting patient to undress
When changing disabled or injured persons clothing 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
Assisting patient to undress

Give simple, clear instructions Provide two gowns if necessary to cover patient adequately Demonstrate if necessary Allow patient privacy to change Check for artifacts before imaging If assisting disabled person, be sure to change upper part of body first to provide coverage for lower body
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?
Cast Care
Assess for impaired circulation & nerve compression 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
Cast care

To move slide open hands under cast Support at both joints Never move traction bar or relieve or pull on traction device Get assistance from nurse
Traction
Infection Control

Pathogen: a microorganism known to produce disease Four major groups

Bacteria Fungi

Yeasts Molds
Viruses Parasites

Protozoa Helminths
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
Infection Control
Infectious Agent

Pathogenicity - ability to cause disease Virulence - ability to grow and multiply with speed Invasiveness - ability to enter tissues Specificity - attraction to a particular host
Infection Control

Process of infection Invades in stages
Latent period
pathogens enter body and lie dormant microbes shed, reproduce and disease process begins signs and symptoms reach full extent or produce vague, subclinical symptoms symptoms begin to diminish and disappear
Incubation period - communicable
Disease period - most communicable
Convalescence
Infection Control
Means of transmission

Direct contact Indirect contact Droplet Airborne Vehicle Vector
Infection Control
Direct contact - person or animal with disease or his

blood or body fluids are touched
Indirect contact - transfer by the touching of objects

Through coughing, sneezing, talking Droplets can travel 3-5 ft.
(fomites) that have been contaminated by infectious person
Droplet - contact with infectious secretions from carrier

Airborne - residue from evaporated droplets suspended in

air for long periods of time; infectious if inhaled by susceptible host
Infection Control
Vehicle - food water, drugs or blood

deposit microbes by bite or sting
contaminated with infectious microorganism
Vector - animal or insect carriers of disease,
Standard Precautions
Formulated by CDC and HHS
For all persons working in situations where they might come in contact with infected blood Based on assumption that every patient is potentially infectious Strict adherence to principles greatly reduces threat by forcing health care workers to handle all body fluids and substances with extreme care Apply standard precautions to all patients regardless of diagnosis or infection status
Used when performing procedures that may require contact with:

Blood Body fluids Secretions Excretions Mucous membranes Non-intact skin
Also included are items soiled or contaminated with any of these substances
OSHAs contributions:
Workplace plan
All workplaces in which employees may be exposed to contaminated body fluids Control employee exposure to pathogenic microorganisms borne by these fluids Plan available for review by all employees
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 without recapping or breaking Immunization against HBV Follow-up care for employees inadvertently exposed to bloodborne and body fluid-borne pathogens
Workplace plan
Warning labels in orange or red-orange on containers of regulated waste, separate refrigerators, freezers & other containers to transport potentially infected materials Use of standard precautions for all specimens or warning labels on potentially infectious specimens Annual training & documentation thereof for employees concerning standard precautions Confidential records kept on any employee exposed to bloodborne pathogens at work for the duration of his employment & 30 years after
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
Hand washing
Hand washing number one method for preventing spread of infection Friction (rubbing hands together) most effective way 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 friction can replace 30 sec. wash
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 of infection After caring for patients with known communicable disease Precede & follow each patient contact Time constraints
30 sec. Hand washing

Cleaning and proper waste disposal
Fresh uniform, keep soiled uniforms away from other personal clothing Change pillow covers and linens after each patient use Flush contents of bedpans & urinals promptly unless being saved for diagnostic specimen Rinse bedpans & urinals and send to proper place for resterilization or dispose of properly Use equipment & supplies for one patient only
Keep water & supplies clean & fresh, use paper cups Floors are heavily contaminated - if an item falls on the floor, discard it or send it to the proper place 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

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 & clearly marked as contaminated when sent for cleaning
Do not recap needles - place needles in punctureproof containers for disposal Send specimens to lab in solid or double bagged & clearly labeled containers Keep medical charts away from patient care areas to prevent contamination
Disinfection
Removal by chemical & mechanical processes of microorganisms Disinfected when items cannot withstand sterilization process Disinfect room, equipment, & anything patient has touched with disinfectant before removing gloves Wash hands after removing gloves
Transmission-based Precautions
Airborne precautions
Tuberculosis - Acid Fast Bacilli (AFB)
Droplet precautions Contact precautions
Airborne precautions
For pathogens that remain suspended in air for a long 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 leaving room AFB - tight fitting mask with hepa-filter
Droplet precautions
Pathogens disseminate through larger particular droplets expelled by the patient through coughing or sneezing Includes rubella, mumps, influenza Patients placed in private or semiprivate rooms with other patients who share the same disease Wear surgical mask when within 3 feet of patient Patient should wear mask when leaving room
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 rooms with other patients who share the same disease Wear gloves, gowns if necessary Patient should wear appropriate barriers when in radiology dept
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 protective bag, 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
Precautions for Compromised Patients
Reverse or protective isolation
Clean before entering Patients with limited immunity Organ transplants Chemotherapy Immunotherapy Burns Neonates
Who?
Asepsis
Medical asepsis
Reduction of microorganisms as far as possible by use of soap, water, friction & various chemical disinfectants Complete destruction of microorganisms & their spores by means of heat or chemical process
Surgical asepsis
Asepsis
Practice of medical asepsis required at all times Surgical asepsis required for invasive procedures
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)
Methods of Sterilization
Steam under pressure

Moist heat best overall method Autoclave - 250 Indicator strip changes color Method of choice for items that cannot stand moisture & high temperatures Items that cannot be autoclaved & gas sterilization not available
Gas
Chemicals
Methods of Sterilization
Dry heat

Rarely used in hospitals Temps over 300
Ionizing radiation
Used in commercial sterilization

Rapid method of sterilizing metal instruments, but not yet developed to obtain maximum potential
Microwaves/non-ionizing radiation
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 closed cupboard, 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 considered not sterile
Rules for Surgical Asepsis

If sterility of object questionable, consider it not sterile Sterile objects and persons must be kept away 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 considered not sterile If sterile gloves become contaminated, they must be changed
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 below elbows are sterile - cuffs of gown are not considered sterile Edges of sterile wrapper considered not sterile & must not touch sterile object Sterile drapes placed by sterile person who drapes area closest to him first to protect his sterile gown

Sterile persons must pass each other back to back Sterile person faces sterile field & keeps sterile gloved hands above his waist and in front of his chest Packs and materials that become dampened or wet considered not sterile Non-sterile persons do not reach across or lean over sterile field
All areas used for sterile procedures must be thoroughly mopped with disinfectant after each use Air conditioners & ventilation ducts must be kept clean & have special filters When pouring sterile solutions, place lid face upward & do not touch lid or lip of flask Pour off small amount of fluid before pouring remainder into sterile container

Opening sterile packs Sterile gloving & gowning
Handling Biohazardous Materials
Definition
Objects or substances encountered in health-care workplace that may endanger the health of the health-care worker Body substances & associated equipment

Biomedical waste
Bandages, dressings, soiled linens & gowns Sharps, chest tubes, IV tubes, catheters, etc.
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 know station
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.
Rules cont.
Chemicals must remain in their own containers marked as toxic substances Chemical & toxic substances must be disposed of according to federal mandates & institutional policy Restrictions for disposal must be posted & followed Contrast agents & other drugs must be kept in safe storage area of limited access
Rules cont.
All containers of hazardous substances must be clearly marked with the name of the substance , a hazard warning & the name o& address of the manufacturer Hazardous substances may be labeled with a color code that designates the hazard category
Health, flammability, reactivity, etc.
First Aid Guidelines
Eye contact
Flush eyes with water for 15 min. or until irritation subsides Consult physician immediately Remove affected clothing Wash skin thoroughly with soap & water
Skin contact

First Aid Guidelines
Inhalation

Remove from exposure If breathing has stopped, begin CPR Call 911 & physician Do not induce vomiting Call 911 & poison control center
Ingestion

Routine Monitoring
Vital signs

Temperature Pulse Respirations Blood Pressure
Vital Signs
Temperature
Measurement of bodys metabolic state
Degrees centigrade (C) or Fahrenheit (F)
Fever is sign of increased metabolism, usually in response to infectious process

Oral - O Rectal - R Axillary - Ax Tympanic T
Rectal and tympanic temps are closest to bodys core temperature
Vital Signs
Pulse
The advancing pressure wave in an artery caused by 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 not pumping enough blood
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 nurse immediately
Vital Signs
Respirations
Body requires constant supply of oxygen to function Waste product of metabolism (CO2) also eliminated Failure of respiratory system a life threatening event Normally silent, effortless, & regular
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 & falls for 1 minute Symptoms of inadequate oxygen supply include dyspnea, cyanosis, diaphoresis, neck vein distention
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 Pressure when heart is relaxed
DIASTOLIC
Vital Signs
Blood pressure
Measured using sphygmomanometer & stethoscope Diastolic pressure over 90 indicates increasing level of hypertension Diastolic pressure lower than 50 gives some indication of shock Always expressed as systolic pressure over diastolic 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)
Vital Signs - Normals

Temperature: Respirations: Adult: Child: Pulse: Adult: Child: Blood Pressure: Systolic: Diastolic:
97.7 - 99.5 F (oral) 12-20 breaths/minute 20-30 breaths/minute 60-100 beats/minute 70-120 beats/minute 95-140 mm. Hg 60-90 mm. Hg
When to take Vital Signs

When the patient is admitted to the health care facility Before & after interventional or invasive diagnostic procedures Before & after administering medications (inc. contrast media) Any time the patients general condition changes Whenever the patient reports symptoms of distress
Medical Emergencies
Top priority: any threat to patients airway, breathing or circulation

Check for respiratory distress Reposition patient Check and change oxygen tank Call code
Level of consciousness Signs and symptoms of shock
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
Ask patient to state his name, the date, his address, and the reason he has come to the department

Assesses patients response to verbal stimuli Assesses patients orientation to time, place and situation Assesses undue need to repeat questions, slow response, difficulty with choice of words and unusual irritability
As you instruct patient in positioning for exam:

Note his ability to follow directions Take note of any movement that causes pain or presents difficulty Note alterations in behavior or lack of response
Provides baseline against which any changes in patients mental and neurological status can be assessed
Becomes increasingly irritable and uncooperative Begins giving inappropriate or delayed responses Stops following directions Becomes increasingly lethargic Loses consciousness
Change in LOC
Radiographers response
Check chart for possible explanations to behavior
Meds, diagnosis, nurses notes Be prepared to inform regarding:

Notify physician
Time of behavior change Preceding events Examinations performed Other pertinent information
Stop exam until physician gives OK to continue Stay with patient
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
Shock
Early signs & symptoms

Pallor and sweating (diaphoresis) Increased heart rate, respirations Anxiety level increases Decreased blood pressure Restlessness Confusion
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
Types of Shock

Hypovolemic Cardiogenic Neurogenic Distributive (Vasogenic)

Septic Anaphylactic
Obstructive
Hypovolemic Shock
Caused by abnormally low volume of circulating blood in body Maybe due to:

External or internal hemorrhage Loss of plasma from burns Loss of fluids from prolonged vomiting, diarrhea or medications
Cardiogenic Shock
Caused by failure of heart to pump adequate amount of blood to vital organs May be sudden or occur over a period of time Patients with MI, cardiac tamponade, dysrhythmias, cardiac pathology
Neurogenic shock
Causes blood to pool in peripheral vessels
Vasogenic Shock

Occurs when there is pooling of blood in peripheral vessels Results in:

Decreased venous blood return to heart Decreased blood pressure Decreased tissue perfusion
Characterized by blood vessels inability to constrict and resultant ability to assist in blood return to heart
Anaphylactic Shock

Most common type seen by radiographers Result of exaggerated hypersensitivity reaction (allergic reaction) Histamine and bradykinin released causing widespread vasodilatation and peripheral pooling of blood Contraction of non-vascular muscles, particularly those in respiratory tract Common causes
Meds, contrast agents, chemo agents, anesthetics, food, insect venom
Anaphylactic Shock
Early signs and symptoms

Itching, nasal congestion, sneezing, coughing Tightness in chest Apprehensiveness Nausea, vomiting Edema Urticaria (hives) Wheezing, dyspnea, cyanosis Decreased BP - weak, thready rapid or slow pulse Altered LOC - possible respiratory arrest
Late

Septic Shock
Occurs when toxins produced during massive infection cause a dramatic drop in blood pressure
Shock

Stop procedure Notify physician & emergency team - have crash cart placed by patient Stay with patient Place patient supine (semi-Fowlers for dyspnea) Keep patient calm and quiet Monitor patients vital signs
Prepare to assist physician or code team *For bleeding don gloves, apply direct pressure with sterile gauze pads to site of wound Document
Hypoglycemia
Diabetic has:
Excess amount of insulin or hypoglycemic drug in bloodstream 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
Hyperglycemia
Diabetic has:

Insufficient amount of insulin in body Decreased glucose entering body cells Liver producing more glucose resulting in high levels of glucose in bloodstream Glucose-laden urine production resulting in dehydration an electrolyte imbalance Keytone bodies in blood (from liver breakdown of fat) result in metabolic acidosis
Leads to coma and possible death
Patient needs insulin you do not give it
Diabetic Emergencies
Hypoglycemia

Hyperglycemia

Rapid onset Causes

Slow onset Causes

Too much insulin Too little food Delayed meal
Too little insulin Failure to follow diet Infection, fever, stress Flushed skin Increased thirst Weakness, abd. pain Nausea, vomiting Coma
Signs & symptoms
Signs & symptoms

Diaphoresis, clammy skin Headache Hunger Pounding heart, trembling, impaired vision
Give sugar & call doctor Have patient rest
Call doctor, give fluids
Pulmonary Embolus
Occlusion of one or more pulmonary arteries by thrombus (blood clot) Onset of symptoms sudden Occurs following surgical procedures, prolonged medical illness, traumatic event
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
Pulmonary Embolus

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
CVA - Stroke

Occlusion of blood supply to brain Rupture of cerebral artery resulting in hemorrhage into brain tissue or spaces surrounding brain

Range from TIAs to severe Most occur with little or no warning
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
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
Syncope - Fainting
Transient loss of consciousness resulting from insufficient supply of blood to brain Possible causes
Heart disease Hunger Poor ventilation Extreme fatigue Emotional trauma Orthostatic hypertension
Syncope - Fainting
Signs and symptoms

Pallor Complaints of dizziness or nausea Hyperpnea Tachycardia Cold, clammy skin
Syncope - Fainting
With patient complaints have him lie down If patient has already fainted

Assist patient to floor Place him in supine position Elevate his legs Summon medical assistance
Seizures
Unsystemic discharge of neurons of cerebrum resulting 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 Infectious disease and high fever Extreme stress Structural abnormalities of cerebral cortex Epilepsy
Causes include:
Seizures - Generalized
Signs and symptoms

Sharply exhaled breath Rigidity of muscles - eyes open wide Jerky body movements with rapid, irregular respirations May vomit May froth at mouth (may be mixed with blood) May exhibit urinary or fecal incontinence Usually falls into deep sleep following seizure
Seizures Generalized
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 prevent possible aspiration Prepare to assist with suctioning Notice and report as much as possible about seizure to physician Reassure patient following seizure confusion likely
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
Reassure patient Notify physician
Seizures - Absence
Signs and symptoms
May have limb tremor accompanied by brief loss of consciousness Brief loss of awareness accompanied by blank stare May have eye blinking or mild body movement May be sudden loss of all muscle tone resulting in fall Reassure patient Notify physician

Nausea & Vomiting
Nausea
Psychological and physical reaction Instruct patient to breathe slowly and deeply through his mouth If vomiting occurs place patient in lateral recumbent position If movement prohibited, turn patients head to side Assist with emesis basin and moist cloths
Epistaxis
Nosebleed
Seldom life-threatening 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

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 additional sterile gauze (gloves) Once bleeding is under control tape dressing in place Extremity wounds should be raised above level of heart Notify patients nurse
Wounds
Burns

Disrupt protective function of skin Use sterile technique Painful be very gentle Sutures separate allowing abdominal contents to spill out Cover wound with sterile dressing Keep patient in seated position, bent forward Get immediate medical attention
Dehiscence
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
Signs that indicate need for suctioning
Profuse vomiting in patient that cannot voluntarily change his position Audible rattling or gurgling sounds coming from patients throat Signs of respiratory distress
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
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 COPD because their respiration is controlled by the higher levels of CO2 in their blood O2 is combustible
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
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
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 removed following insertion tube anchored in place with tape or ties at back of neck
Support Equipment
Tracheostomies
Patients with newly inserted tubes are:

Very fearful Unable to talk Afraid of choking
Nurse should accompany these patients to Radiology

Plan care with nurse before procedure begun Dont touch the tracheostomy Nurse will suction to remove secretions sterile technique
Support Equipment
Ventilators
Mechanical respirators attached to tracheostomies or ET tubes Patient on ventilator has been intubated Care must be taken not to dislodge tubing connected to tracheostomy
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 at mid-axillary line Air rises requiring higher insertion site in apical region Tubes placed at 2nd or 3rd intercostal space at midclavicular line
Pneumothorax

Support Equipment
Chest tubes
Cautions
Vacuum must be maintained momentary disconnection of tubing breaks vacuum seal and can cause serious consequences to patient Handle drainage device carefully
Keep below level of patients chest Never clamp a chest tube
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
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
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 atrium to aid evaluation of right heart function
Support Equipment
Long-term, tunneled external catheters
Surgically placed beneath skin and directed to desired vein Scar tissue secures Dacron cuff of catheter in place preventing accidental dislodging Advanced into superior vena cava Hickman long-term parenteral nutrition Groshong (single or multiple lumen) administration of medications or drawing of blood Raff double lumen used in dialysis
Examples

Support Equipment
Long-term infusion ports (venous access ports)
Implanted ports
for patients with long-term illness requiring frequent IV meds, chemotherapy, transfusions, or blood sampling from superior 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
Pulmonary arterial catheters
Indications

Diagnose right and left ventricular failure Monitor effects of medications, stress & exercise on heart function Single or multiple lumen Small electrode at distal end for pressure monitoring Balloon tip
Commonly called Swan-Ganz catheters

Support Equipment
Pacemakers
Electromechanical device providing electrical stimulation to heart muscle

Regulates heart rate Used to treat conduction defects

Internal pacemakers surgically implanted in chest External pacemakers temporary with bulk of instrument outside chest
Inserted under fluoro guidance or with CXR confirmation of tip placement in apex or right ventricle
Support Equipment
Tissue drains
Placed at or near wound sites

When large amounts of drainage expected Poor drainage can interfere with healing and may cause infection or fistula tract Hemovac & Jackson-Pratt
Examples
Plastic drainage tubes that maintain constant low negative pressure by means of small bulb Squeezed and slowly re-expands to create suction Soft rubber tube held in place by sterile safety pin
Penrose
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 drainage diminishes
Require surgical aseptic technique and care plan to prevent tension on the drain
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
Urinary catheters
Two types
Indwelling (Foley) designed to be left in place for prolonged periods of time

Retention balloon tip Catheter bag No balloon
Straight catheter used for intermittent catheterization
Require surgical asepsis for
Insertion, specimen collection, irrigations
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 attempting to remove catheter Keep bag below level of bladder to prevent backflow of urine into bladder
Support Equipment
Nasogastric tubes
Tube inserted through nose & esophagus into stomach 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
Common NG tubes

Levin Sump Nutriflex Moss
Gastric decompression Drain fluid from stomach Feedings Aspiration Duodenal feedings Sengstaken-Blakemore Control bleeding of esophageal varices
Support Equipment
Common NE tubes

Cantor Harris Miller-Abbot
Relieve SB obstructions Gastric & intestinal decompression Decompression
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, or soda water (CO2) Oxygen rarely used because it is absorbed too quickly by cells Often used in combination with radiopaque media to outline the lumens of, or spaces within body structures, called double contrast studies
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
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 following administration Prevention of errors
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
Medication orders
Meds given by RT only under physicians orders Conditions meeting requirements of orders

Written Oral Standing
Routes of Administration
Enteral

Oral Sublingual Buccal Rectal Skin Eyes, Nose, Throat Respiratory mucosa Vagina
Parenteral

Topical

Intradermal Subcutaneous Intramuscular Intravenous Intra-arterial Intrathecal Intra-articular
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 to administration: if need outweighs risk drug is prescribed with caution
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

Heavy metal with an atomic number of 56, so radiopaque Inert powder composed of crystals used for examination of the GI system Chemical formula is BaSO4 so it is a compound Non-soluble, must be mixed or shaken with water to form a suspension
Depending on environment (such as acid in stomach) it can come out of suspension and clump - flocculation - stabilizing agents such as sodium carbonate or sodium citrate used to prevent this
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 prevent coating of the mouth) Must be concentrated enough to be absorbed by xrays, but flow easily enough to coat linings of organs
Barium Sulfate
COOL tap water
Generally recommended for lower GI studies to reduce irritation of the colon and to aid the patient in holding the enema Cool tap water reduces spasm and cramping (room temperature)
Cautions include increased water absorption by the colon
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
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 NEVER inject into the bloodstream or subarachnoid space NEVER use when there is a possibility of perforation or prior to surgery - if it enters the peritoneal cavity it can cause peritonitis and must be removed surgically
Not absorbed by body tissue

Aqueous Iodine Compounds
Gastrografin & Hypaque Sodium
Used in GI studies only in special cases when administration of barium sulfate might be hazardous 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
High atomic density - #53

Salts of organic iodine compounds Visualizes structures when little natural contrast exists
Most frequently used contrast Used in intravascular studies Has variables that must be considered
Variables to Consider
Miscibility
Ability of agent to mix with body fluids
Viscosity
Thickness or stickiness of agent
Warming agent reduces viscosity
Osmolality
Ionic strength of agent
Potential toxicity
Types of Iodinated Contrast
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
Stocked in wide variety of types, sizes & strengths Used for many purposes Excreted by kidneys through urinary system Chosen for use by specific characteristics
Ionic vs. Non-ionic
Refers to structural composition of molecules contained in contrast agent Ionic
Molecules dissociate into two charged particles ions
Non-ionic
Molecules remain whole in solution
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 3 atoms of iodine to 1 particle in solution Meglumine ioxaglate (Hexabrix) Metrizamide (Amipaque)
LOCM 3:1

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
Type of contrast, amount & route of administration selected by radiologist

Depends on patient condition Toxicity especially significant in pediatric patients

Considerations include age & weight Recommended dose 2-5 cc/kg
Guidelines for use of non-ionics

Patients < 1 year of age Patients with histories of adverse reaction to contrast Patients with significant cardiovascular disease Patients with asthma or histories of severe allergies Severely debilitated or very old patients Patients with multiple myeloma or sickle cell disease, diabetics taking Glucophage Patients with impaired renal function
Oil-based Contrast

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
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 medium being used Know location of emergency equipment Carefully observe & evaluate patient for baselines
Checklist for Pre-contrast History
Kidney disease or failure
Check charts for BUN, eGFR & creatinine levels Check for Glucophage medication Check current BP Check to determine when, which agent, concentration & dose
History of diabetes
Heart disease of high blood pressure
Iodine contrast studies within past 48 hours
History of allergies or asthma Previous allergic reactions to contrast medium
What agent, what reaction
Current meds
Contrast Administration
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
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 contrast administration Maximum 24 hr. dose Question patient about other contrast studies Occur due to sensitivity to iodine or some other component of contrast medium
Overdose of contrast

Allergic reactions
Contrast Media Reactions
Psychogenic factors

May be caused by patient anxiety May be suggested by possible reactions described during informed consent process
Contrast Media Reactions
Mild to moderate
Moderate to severe
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)
Dyspnea Hypotension Tachycardia Change in level of orientation Loss of consciousness Convulsions Paralysis Cardiac arrest
Complications
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 of solution infiltrated & palliative action taken
Phlebitis may occur in the vein in which contrast agent was injected
Rights of Medication Administration

Right Right Right Right Right Right
patient drug amount or dose time route documentation
Rules for Safe Drug Administration
If you handle the drug - you are responsible
for 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 a drug reaction unattended Always be prepared for a serious drug reaction
Types of Injections
Bolus
Designated amount of drug administered at one time generally over a period of several minutes
Infusion
Larger amount of a drug, fluid or fluid containing electrolytes or drugs administered over a longer time frame several hours of more
Items Needed to Start an IV

Tourniquet Alcohol wipes Precut adhesive tape Correct drug (contrast) Sterile, disposable IV infusion set (tubing) IV stand IV catheter/needle Sterile gloves May need padded armboard
Equipment for Drug Administration
Needles

Hub part that attaches to syringe Shaft elongated part of needle
Length usually between 3/8 and 3 inches Gauge measure of the diameter of the lumen the larger the gauge, the smaller the lumen Viscosity of fluid determines gauge selected
Lumen hollow interior tube
Bevel sharp, angulated tip
Equipment for Drug Administration
Syringes

Tip end to which needle is attached Barrel body of syringe Plunger inner part that fits into barrel Many have needles attached in manner to prevent accidental needle sticks
Drug Administration Common Abbreviations

ac before meals bid twice a day g gram gtt(s) drop(s) h hour hs bedtime IM intramuscularly IV intravenously mg milligram ml milliliter mm milliliter Ppc after meals
po bu mouth prn as needed qh every hour q2h every 2 hours q3h every three hours qid four times a day sc subcutaneously stat immediately tid three times a day
IV Considerations
IV standard 18 20 above vein
Affects rate of infusion

Too low not enough medication administered Too high increased risk of fluid toxicity
Needle position also affects rate of flow If IV not dripping, check:

Bag still has fluid Not clamped off Needle is still positioned correctly in vein
Drug Facts
Classification by name
Chemical name

Identifies chemical structure of drug Name remains unchanged Named when it becomes commercially available Simpler name derived from chemical name Name remains unchanged AKA trade name, proprietary name Name given to drug manufactured by specific company
Generic name

Brand name

Drug Facts
Packaging data required

Trade name Generic name Chemical composition Chemical strength Usual dose Indications Contraindications Reported side effects
Drug Facts
Containers
Ampules single dose
Made of glass with indented neck for opening Glass container with rubber stopper protected by a metal cap & surrounded by metal band
Vials
Large volume containers

Glass bottles Plastic bags
Drug Classifications
Analgesics Relieve pain
Acetaminophen, Demerol, morphine Pentothal, nitrous oxide, lidocaine
Antidepressants Relieve or prevent depression
Anesthetics Promote loss of feeling
Elavil, Tofranil, Prozac Compazine
Antiemetics Relieve vomiting
Antiarrhythmics prevent or relieve cardiac arrhythmias
Quinidine, Verapamil, lidocaine
Antihistamines Relieve symptoms of allergic reactions
Anticholinergics depress parasymphathetic nervous system
Benadril (diphenhydramine), Chlor-Trimetron
Atropine, belladonna, Pro-Banthine
Anticoagulants Inhibit clotting Anticonvulsants Inhibit convulsions
Antimicrobials Supress growth of microorganisms
Penecillin, tetracyclines, Betadine Paregoric, Imodium
Dilantin
Heparin, warfarin (Coumadin)
Antiperistaltics Slow peristalsis
Drug Classifications
Bronchodilators Dilate smooth muscle
Vasodilators Relax walls of blood vessels
Proventil, albuterol, epinepherine
Nitroglycerin hydralazine (Apresolne)
Cathartics Stimulate peristalsis
Dulcolax, magnesium citrate Diuril, Lasix
Diuretics Stimulate urine flow
Vasoconstrictors Relax smooth muscles of bronchi & constrict blood vessels, stimulate heart muscle
Epinephrine (Adrenalin) ephedrine (Isuprel)
Hypoglycemics - Lower blood sugar level
These are just the basics!!
Insulin, metformin (Glucophage) Caffeine, amphetamines Valium (diazepam), Versed
Stimulants Stimulate CNS
Tranquilizers Reduce anxiety
Last Thoughts
Review all of those terms I taught you you will definitely see some of them on your exam You are probably exhausted & brain dead by now, but it would be a good idea to:
Reread Torres Basic Medical Techniques and Patient Care in Imaging Technology, chapter 13 Refer to material from your venipuncture class Review CPR

Patient Care Registry For Radiology

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Patient Care

Scheduling & Sequencing Exams

Scheduling & Sequencing Exams

Contrast specific considerations

Scheduling & Sequencing Exams

Scheduling & Sequencing Exams

GB sono Lumbar spine IVU CT Abdomen BE UGI

Legal Aspects of Radiography

Request to perform examination

Written order from physician

Patient chart Requisition

Legal Aspects of Radiography

Request to perform examination

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

Legal Aspects of Radiography

Modified or additional projections

Legal Aspects of Radiography

Right to considerate & respectful care Right to information

Right to copies of medical records, radiographs & billing information

Legal Aspects of Radiography

Right to refuse treatment/examination

Legal Aspects of Radiography

If death is imminent no effort as resuscitation attempted posted on chart

Durable power of attorney

Names specific individual to act on patients behalf if patient unable to do so

Legal Aspects of Radiography

Oral patient agrees to exam Implied

Written Informed consent

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Verification of patient identification

Pursue source of inaccuracy if found

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Written false information Verbally spreading false information

Legal Aspects of Radiography

Neglect or omission of reasonable care Doctrine of reasonably prudent person

Instance in which the injured person is a contributing party to the injury

Legal Aspects of Radiography

Four conditions needed to establish negligence

Legal Aspects of Radiography

Its your fault you hired me!

Rule of personal responsibility

Each individual is responsible for own actions

Its yours too!

Legal Aspects of Radiography

Res ipsa loquitur

Captain of the ship doctrine

Shit can roll uphill

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography

Legal Aspects of Radiography