Bedside Radiography: Special Conditions & Environments PDF

Chapter 20 Bedside Radiography: Special Conditions and Environments  Objectives  Demonstrate the appropriate procedure for gathering information before performing a bedside radiographic examination.  List three situations in which bedside radiography may be pref...

Chapter 20 Bedside Radiography: Special Conditions and Environments  Objectives  Demonstrate the appropriate procedure for gathering information before performing a bedside radiographic examination.  List three situations in which bedside radiography may be preferable to examination in the imaging department.  State the purposes of gastric, nasoenteric, tracheal, and thoracic suction.  List precautions to be taken when doing a bedside examination of a critical neonate in the intensive care unit (ICU).  List four important factors to be noted during an initial survey before radiography in the intensive care or coronary care unit (ICU/CCU).  List three essential precautions to be taken with patients who have a tracheostomy.  List and describe two types of central venous catheters.  Identify the correct locations for the tips of Swan–Ganz, Groshong, and PICC catheters.  Key Terms  Ambu bag  Nasogastric (NG) tube  Atelectasis  Neonatal intensive care unit (NICU)  Central venous catheter  Neonate (CVC)  Orthopedic traction  Coronary care unit (CCU)  Osseous  Decompression  Peripherally inserted central  Enclosed incubator catheter (PICC)  Intensive care unit (ICU)  Post-anesthesia care unit  Nasoenteric/nasoenteral (PACU) (NE) tube  Tracheotomy  Mobile Radiography  Radiographic procedures performed at the patient’s bedside Requires a special mobile radiographic unit  C-arm Mobile fluoroscopy unit  Mobile Radiography: General Guidelines  Call the nursing station before leaving the imaging department unless responding to a STAT request.  Ask nurse about the patient’s condition.  Confirm the order in the patient’s chart, if applicable.  Greet the patient and explain procedure.  Check patient ID, birth date on the wristband  Inspect and prepare the room before bringing in the x-ray equipment. Special Care Units  Intensive Care and Coronary Care Units  ICU and CCU are used to care for very ill patients who require frequent, if not constant, monitoring.  Chest radiograph is the most common mobile exam requested.  Must maneuver and work around a lot of equipment. Cables, pumps, tubing, lines, etc.  Shield patient and provide aprons for personnel who cannot exit area to protect from exposure.  Post-anesthesia Care Unit  Abbreviated as PACU or referred to as the “recovery room”  Located outside surgery for ease of transfer and access by surgeons and anesthesia personnel  Mobile radiographic exams are ordered to: Check line placement Rule out pneumothorax or atelectasis Check orthopedic hardware placement  Emergency Trauma Unit  Mobile used in ED: To avoid interruption of care for very critical patients Assess injuries of the spine, pelvis, and chest without removing immobilization or risking confounding injuries to the patient  Provide aprons for all essential ED personnel  Use proper protection from blood and other bodily fluids Self and equipment Neonatal Intensive Care and Newborn Nursery  NICU—special unit for care of babies who are premature, low birth weight, or have a health issue  Mobile exams often must be performed while the infant is in an incubator. Necessary to keep baby warm  Shielding is essential!  Gowns and gloves are often required when handling infants.  Quiz  Question 1: What is one of the most common mobile exams performed in the ICU or CCU? A) Abdomen radiograph B) Chest radiograph C) Pelvis radiograph D) Skull radiograph Question 2: When performing mobile radiography, what is the first thing you should do before leaving the imaging department? A) Grab the x-ray equipment B) Check the patient’s ID C) Call the nursing station D) Inspect the room  Question 3: Which of the following is a precaution when performing bedside radiography on a neonate in the NICU? A) Avoid shielding the infant B) Ensure the infant stays warm C) Remove the infant from the incubator D) Perform the exam without gloves Treatment Situations Involving Specialty Equipment  Special Beds and Mattresses  Equipment provides continual position and pressure changes. Decreases the frequency requirements for turning patients  Examples: Alternating pressure mattresses Air mattresses Rocking beds Various types of wave, flotation, and bead mattresses  Moving beds have to be turned off for mobile exams.  Air beds should be inflated to maximum pressure.  Warming/Cooling Devices  IR must be placed in front of those that use water or alcohol.  IR must be on top of reflective blankets.  Orthopedic Traction  Do not change or alter traction.  Ask patient to move as much as is tolerable.  Ask nurse if unsure of allowed movements.  Tracheostomies  A tube in an opening in the trachea to provide an open airway  Sometimes hooked to a ventilator  Mechanical Ventilation (1 of 2)  Machine that provides breathing through a tube passed through the mouth and into the trachea Also, may be attached to a tracheostomy  Time exposure to machine’s respiration to obtain a motion-free image Mechanical Ventilation (2 of 2)  Nasogastric and Nasoenteric Tubes  NG tubes—passed from nose to stomach  NE tubes—passed from nose to duodenum  Uses: Feeding Decompression or draining Radiographic examination Medication administration  May also be called nasointestinal (NI) tube  Watch for artifacts, such as safety pins, holding tube to patient gown NG Tube Image NE Tube Image  Question 4: What is the purpose of a nasogastric (NG) tube? A) Assist with breathing B) Remove air or fluid from the pleural space C) Decompression or draining D) Provide long-term intravenous access  Question 5: What is one of the key precautions when performing mobile radiography on a patient with a tracheostomy? A) Discontinue the ventilator before imaging B) Avoid disturbing the tracheostomy tube C) Ask the patient to hold their breath D) Remove the tracheostomy tube  Closed-Chest Drainage (1 of 3)  Used to remove fluid or air that has accumulated in the pleural space  Consists of a tube placed within the pleural cavity and connected to a suction device through a drainage receptacle  Extra caution is required with patients receiving chest suction treatment: Ensure that chest suction and drainage apparatus is not disturbed. Take care that the chest tube is not dislodged when positioning the IR for a chest radiograph. Be certain that the drainage unit remains below the level of the patient’s chest.  Closed-Chest Drainage (2 of 3) Chest tube placed to relieve Chest tube placed to drain fluid from pneumothorax. pleural space. Closed-Chest Drainage (3 of 3)  Question 6: What should you do if a patient has a special air mattress during a mobile radiography exam? A) Deflate the mattress completely B) Inflate the mattress to maximum pressure C) Turn off the air mattress D) Turn off the moving beds during the exam  Question 7: What is the most common purpose for a closed-chest drainage system? A) Assist with feeding B) Provide oxygen to the patient C) Remove fluid or air from the pleural space D) Deliver medications to the bloodstream  Specialty Catheters (1 of 4)  Placed to help monitor and manage critical patients and patients requiring long-term care  Placed in the pulmonary artery, central vein (CVC), or peripherally (PICC)  Care must be used to avoid disruption of the catheter  Often requires C-arm during insertion  Mobile images are often used to verify placement  Specialty Catheters (2 of 4) AP chest radiograph showing (1) tip of Swan–Ganz catheter advanced into right pulmonary artery, (2) endotracheal tube, (3) nasogastric tube, (4) chest tube, (5) sternal wires from open heart surgery, (6) monitor lines (external). Specialty Catheters (3 of 4) PA chest radiograph demonstrates proper placement of CVC. Specialty Catheters (4 of 4) Chest radiograph demonstrates venous access port (arrow).  Pacemaker  An electromechanical device that regulates the heart rate by providing low levels of electrical stimulation to the heart muscle  Often inserted under C-arm guidance  Pacemaker in Chest Radiographs