Transcript Procedure - El Camino College

PORTABLE
OR applications and
Considerations
Week 13
RTEC 124
CAUTION:
SOME IMAGES MAY BE DISTURBING
BUT AS HEALTHCARE PROFESSIONALS
THIS IS WHAT YOU MAY EXPERIENCE
Who are these people?
Importance of maintaining
a sterile field…. Your role as an RT
STERILE IN OR
Must change clothing
 Wear a “cover gown” when leaving
 Masks, hair cover, and shoe covers
 Change when you leave the OR room
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DO NOT TAKE HOSP SCRUBS HOME!!
The Operating Room Team…you
are part of it!
What to expect…
From your point of view
do not touch sterile field
Surgical Radiography
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Imaging is commonly used in surgical
procedures
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But the surgeon already has the
patient’s body open, right?
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Sometimes it is used as a guide
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Must cover equipment in sterile drapes when it may
come into contact with patient , instruments, or
surgeons hands
Sterile trays
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The sterile incision
covered for portable
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Instruments away
from portable
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Never use portable
over sterile field
USE CAUTION!
Exchange the IR into the sterile
drape
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SURGERY
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Sterile procedures must be followed
– Not to contaminate surgical site
– Don’t touch anything BLUE or GREEN
– Be careful not to run into trays, etc
IMAGING IN THE OR
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Moblie Radiographic
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Mobile C-arm – fluoroscopic
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Dedicated room
– Cystography
– Radiography room
UNLIKE PORTABLE EXAMS ON THE UNITS
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Equipment in the OR must
be covered
– Must be cleaned before
bringing into room
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Protects patient
– Prevents contamination of
sterile field and instruments
C- ARM Mobile Fluoro
 Can
rotate
360° side to
side
 90°
top to
bottom
C-Arm FLUOROSCOPY
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Tube at one end and I.I. at other end
TV Monitor control cart separate from unit
Uses Digital Fluoroscopy
Last Image Hold
Image Enhancement
Save for hard copies from disk and video
Photographic Magnification
Subtraction
Static (pulsed) and continuous fluoroscopy
Set up room in advance if possible
Fluoroscan
Hand surgery table
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Never use IR as a
table
– Blood
– Fluids
– Water

Some tables have a
gap
– Allows for cassette
placement without
contaminating sterile
field
Tables without gap
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Slide cassette at top with
help of anesthesiologist
Considerations before procedure
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Find out where surgeon wants you to go
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Be careful not to contaminate
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Plug in C-arm and test it
– Marker check on II if possible
– Guard FOOT Switch
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Park portable equipment in corner –out of
the way
Orient anatomy using markers
Mobile Radiography
Considerations
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If surgery is already in progress
– Before entering, park machine outside of
room
– Survey room to get lay-out
– Rearrange equipment/furniture if necessary
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Place cassette in a STERILE WRAP
PATIENT CONSIDERATIONS
DURING SURGERY
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Patient may not always be “unconscious”
– Pain management
– Twilight state
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Always treat patient with respect and
courtesy
– They may be hearing everything
USING C-ARM vs PORTABLE
C-ARM
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Faster- instant image
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More radiation
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Portable
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Must have accurate
technique

Processing needed
– Longer
Smaller field of view

Larger field of view
Various Imaging Procedure
in Operating Room
SURGERY - Common Procedures
Ortho (Bone) Work
 Pinning/ Rod / Screw placement
 Fracture realignment
Organs / Vessels with contrast
 Arteries / Veins in the extremities
 Cholangiograms = ducts
 Urography
Pacemaker and Line Placements
etc
TECHNIQUE CONSIDERATIONS
Same principles of ALARA
 Change techniques if using grid
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– 3-5 times more if using grid
– Body parts larger than 12cm
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SID –
– VERY IMPORTANT TO MEASURE
– Chest usually done at 63-72”
– All others done at 40”
DEDICATED UNIT- CYSTO RM
Cystoscopic Studies
for Foreign Objects
Percutaneous Nephrolithotomy
Laparoscopic
Cholecystecomy
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.
Be careful not
to hit
laparoscopic
instruments
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Cholangiogram
– Sterile lead
drape used
– Contrast used
Operative cholangiogram
Op CHOLE
Digital can reverse images
Hickman Catheter placement
Starts at upper
thorax and
ends in heart
Catheter In Jugular
Upper Extremity Arteriogram
Bypass Surgery
Cervical Spine
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Shoulder pull
down
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Boost mode
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Magnification
mode
HIGHER DOSE
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Scout placement
– Checks placement
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Sequential imaging
– Watches placement of
screws and pins
– Final image for
documentation
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Print a hard copy
Lateral projection of the cervical spine with
patient supine.
Done to verify the correct position of instruments
before continuing surgery.
Often a spinal needle is placed in the disc space
to show position.
USE OF PORTABLE
CROSS TABLE LATERAL C.SPINE
Discectomy
Lateral Lumbar
Drape C-arm with sterile plastic conver
to protect patient and equipment
PA Lumbar
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AP or PA to lateral
– Caution not to hit patient or
equipment
– KEEP STERILE
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Familiarize yourself with
locks
– PRACTICE WITH CI, RT’S
X-table Lateral Lumbar Spine
Challenges ?
Positioning CR ?
Hip Pinning
Lateral Hip
Field of View smaller with C-arm
Rod Placement in
Femur
II parallel with long axis of leg
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Image of tibial nail screw
holes perfectly round,
and magnified to assist
proper alignment.
Image of tibial nail
screw holes in
incorrect alignment
and oblong in shape.
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Image of tibial nail screw
holes perfectly round,
and magnified to assist
proper alignment.
Image of tibial nail
screw holes in
incorrect alignment
and oblong in shape.
NOTE THE POSITION OF THE
II AND TUBE
KEEP II CLOSE TO
PATIENT
KEEP TUBE AS FAR
AWAY AS
POSSIBLE
MUST BE AT
LEAST ________
INCHES FROM PT
DSA
A subtraction mask is
taken before contrast
injected
 Each of digitized
image is from the
mask
 Images acquired form
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– 1 image every 2-3 sec
– Up to 30 images per
sec
91
Three Dimensional (3-D)
Intraarterial Angiography
92
RAD PROTECTION
in the O.R.
It’s your duty to protect the patient, yourself
and others (healthcare professional)
 Politely ask whoever can, to move back from
the area
 Provide aprons to those who cannot leave
 Announce your intent to make an exposure
and give time for others to move back
 IF personnel are in sterile drape – may not
be able to put on apron
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RAD PROTECTION in the OR
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C-ARM = HIGHER DOSE
STAND BEHIND C-ARM UNIT WHEN POSSIBLE
RAD PROTECTION
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RULES OF GOOD PRACTICE
Never place your hand or other body part in
primary beam
Provide gonadal protection for the patient if
possible
FOR C-ARM – IF BEAM FROM BELOW –
PLACE APRON ON TABLE BEFORE PATIENT
IS ON TABLE
Achieve maximum distance from the patient
and tube (stand 90° from the patient)
Minimum 6 foot exposure cord for
radiography
Label and handle cassettes carefully
RADIATION PROTECTION
Remember the “Cardinal Rules”
RADIOGRAPHIC
 6 ‘ exposure cord
 Minimum source to skin
distance = 12”
 Preferred SID of 40”to
72”+ ( mag  detail)
  Distance from tube
and patient
 At least .25mm lead
apron
FLUOROSCOPIC
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Minimum source to skin
distance = 12”
Preferred SSD OF 18”
 Distance from tube
and patient
5 min Audible Alarm
At least .25mm lead
apron to be worn
5 R/min - 10 R/min
Post operative Portables
Post operative images taken in
recovery room
All hardware must be included in the image
Pre-op
Post-OP
How were these images taken?
The Recovery Room
and good Radiation Safety Practices
Medical errors
& Foreign Bodies
How to avoid them
Medical errors & imaging
IT STARTS WITH
YOU
•CORRECT MARKER
•On the correct
side of the
patients body
There are many
Opportunities
For mistakes
And safeguards to
Prevent medical errors
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About 1,500 people
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Small amount considering
about 28.4 million
operations
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Yet this is no consolation
for the people who've
had it happen to them.
Sponges
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Most common
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Sponges fill up with
blood and can
resemble parts of the
body
Common medical devices left
inside patients
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Eyebrow Tweezer
Tissue expander
Retractor
Syringe
Purple Latex Gloves
Sharpie
Speculum
Mouth gag,
Hemostat
Chest Spreader
Nail in femoral artery
Chicken bone
Did you lose something?
A few more examples of OR
Peds images
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www.hawaii.edu/medicine/pediatrics
Don’t get yourself in
trouble…
Portable and Mobile
Competencies

YOU MUST ALWAYS HAVE
SUPERVISION
EVEN
AFTER COMPETENCY IS
DONE per JRCERT
DO NOT PUT YOURSELF IN A SITUATION WHERE
YOU DO NOT HAVE APPROIATE SUPERVISION !
OR / PORT COMPS
Still
need direct supervisioneven after you have a
competency
Must
have “DIRECT”
supervision for portables and
C-arm at ALL times
PORTABLE & C- ARM
COMPETENCIES
 Must
first
 C-
do a Pre-Portable check –off
Arm check off
 Must
do more than 3 exams of
each area – portable – before
attempting competency
?