Patient Care and Education - Day 2 2025 PDF

RAD 271 - CAPSTONE ARRT Review Section A: PATIENT CARE Week 2 Ch. 2 Mosby Textbook  ARRT Review PATIENT CARE 33 questions Includes: PATIENT INTERACTIONS AND MANAGEMENT Ethical and Legal Aspects Interpersonal Communication ...

RAD 271 - CAPSTONE ARRT Review Section A: PATIENT CARE Week 2 Ch. 2 Mosby Textbook  ARRT Review PATIENT CARE 33 questions Includes: PATIENT INTERACTIONS AND MANAGEMENT Ethical and Legal Aspects Interpersonal Communication Physical Assistance and Monitoring Medical Emergencies Infection Control Handling and Disposal of Toxic or Hazardous Material Pharmacology  ARRT Review PATIENT CARE This week Next week Medical Emergencies Sterile Field Infection Control Gloving Handling and Disposal of Patient Transfer Toxic or Hazardous Material Legal Doctrines, Medicolegal Pharmacology  Interpersonal Communication Patient Equipment  Hypoglycemia Hypoglycemia happens when the level of sugar or glucose TYPE 1 DIABETES in your blood drops. happens when the It’s also called low blood body does not make insulin sugar or low blood glucose. Hypoglycemia is common in TYPE 2 DIABETES people with diabetes, occurs when the especially Type 1 diabetes. body cannot use insulin it has properly  Seizures Due to various types of disease or trauma, PETIT MAL is subtle and goes genetic defects, structural abnormalities/ congenital malformations, brain tumors, and unnoticed by the patient and the stress. May last up to several minutes. observer. It is characterized by I.During the episode, the radiographer brief loss of consciousness should remove any objects in the area ~ 10–30 sec. and accompanied by that could harm the patient and loosen any tight clothing. eye or muscle fluttering. II.Never place hand in patient’s mouth! GRAND MAL SEIZURE is III.Do not try to hold the patient down IV.The patient’s head should be turned to characterized by loss of the side to allow any secretions to flow from consciousness and the mouth. V.Try to gently restrain the patient and try falling, followed by generalized to prevent him/her from injury. muscle spasms.  ANESTHESIA General anesthesia During general anesthesia, you are unconscious and have no awareness or sensations. Regional anesthesia Makes an area of the body numb to prevent the patient from feeling pain. It can completely block sensation to the area of the body that requires surgery. Anesthesiologist or RNA injects local anesthesia near the cluster of nerves that provides sensation to that area. Two common types are spinal and epidural anesthesia. Nerve blocks are another type. Sedation (sometimes called "monitored anesthesia care") Referred to in the past as "twilight“ and make the patient feel drowsy and relaxed. Under mild sedation a patient is awake and can respond to questions. With moderate sedation the patient may doze off but can be awakend easily. Deep sedation uses Propofol and is similar to general anesthesia. Patient is asleep and can breathe without assistance. Often used for procedures such as upper endoscopy or colonoscopy. Local anesthesia When medications such as lidocaine that are injected through a needle or applied as a cream to numb a small area. Local anesthesia alone may provide enough pain relief for limited procedures such as sewing up a deep cut or filling dental cavities.  Terminology with Anesthesia Anesthesia is the loss of sensation in all or part of the body with or without loss of consciousness. 1.Anesthesia may include: 2.Analgesia - absence of pain 3.Amnesia - loss of memory 4.Paralysis - loss of muscle function 5. Sedation - decreased consciousness 6.Unconsciousness - loss of consciousness Assessment of Changing Patient Conditions 1. Visual observation of patient 2. Changes in skin color to cyanotic or pallor 3. Patient verbalizations of discomfort or dizziness 4. Cyanosis of lips or nail beds 5. Patient is cool and diaphoretic to touch 01/14/25 RAD 271 - Patient Care 9  Medical Emergencies - Shock Shock is a critical medical emergency. This causes deficient amount of blood (oxygen) to the vital areas of the body due to failure of the circulatory system. Shock symptoms and signs: 1.Low blood pressure 2.Rapid pulse 3.Rapid breathing 4.Lack of control of body temperatures (low & high) (typically cool) 5.Flushed skin 6.Clammy skin. 7.A gray or bluish tinge to lips or fingernails. 8.Nausea or vomiting 9.Enlarged pupils 10.Weakness or fatigue 11.Dizziness or fainting 12.Changes in mental status or behavior, such as anxiousness or agitation.  Medical Emergencies - Shock 3 types of shock: 1. Hypovolemic 2. Cardiogenic 3. Distributive a. Neurogenic b. Septic shock c. Anaphylactic Blood  Medical Emergencies - Shock 5 types of shock: a.Hypovolemic shock – loss of blood (plasma) b.Cardiogenic shock – by a variety of cardiac disorders c.Neurogenic - causes blood to pool in the peripheral vessels and not be pushed out to vital organs. i. Vasogenic shock - Can be caused by spinal anesthesia or damage to the upper spinal cord. ii. Psychogenic Shock – from a sudden, unexpected bad news, scare, accident, etc. d.Septic shock – production of systemic toxins in the body from an infection. e.Anaphylactic Shock – when a severe allergic reaction affects the whole body. Histamines are released which causes blood vessels to expand and inflammation of the vessels. Fluid will leak into lungs cand cause Pulmonary Edema.  Radiographer’s response to shock 1. Stop procedure 2. Place patient in Trendelenburg position or place legs higher than the heart 3. Immediately obtain call for help or code 4. Determine blood pressure 5. Administer oxygen Crash Cart  Crash Cart Items 1. Backboard 12. Endotracheal tubes 25. Stopcocks and connectors 2. Stethoscope 13. Nasopharyngeal tubes 14. Suction catheters 26. Tongue blades 3. Blood pressure cuff 15. Levine tubing 27. Sterile gauze 4. Ambu bag 16. Jelco cannulas 28. Adhesive and paper tape 5. Laryngoscope 17. Tracheal tubes 29. Alcohol swabs 18. Cutdown tray 6. Flashlight 30. Surgical lubricant 19. Suction bottle 7. Batteries 31. Blood collection tubes 20. Hemostat 8. Extension cord 32. Povidone-Iodine swabstick 21. Scissors 9. Oxygen flow meter 33. Defibrillator and monitor or 22. Sterile gloves, various sizes automatic defibrillator 10. Tourniquet 23. Syringes, various sizes 34. A checklist of all supplies 11. Airways 24. Needles, various sizes included on crash cart RAD 271 - Patient Care 15 Crash Cart – Common Medications A B C D E F G H I J K L  Patient Preparation GI SYSTEM OR URINARY SYSTEM 1.Low-residue diet/low fiber or clear liquid diet 2.NPO for 8 to 12 hours before procedure 3.Cathartics and enemas are used to cleanse the GI system 4.If scheduled as an outpatient the patient must clearly understand the routine for proper preparation 5.Patient should be asked to explain the procedure back to the radiographer to verify understanding All procedures 1.Clothing is removed from area to be radiographed and replaced by patient gown when appropriate 2.All radiopaque objects are removed from area of interest 01/14/25 RAD 271 - Patient Care 19  History and Patient Care Preceding Injection of Iodinated Contrast Media A. Determine history of allergies or previous hypersensitivity to contrast media B. Determine extent of patient’s medical problems, including medications being taken C. Review possible reactions to contrast medium being used; determine the presence of contraindications D. Verify pertinent laboratory values (blood urea nitrogen (BUN), creatinine, and glomerular filtration rate) per department and contrast agent protocol E. Verify appropriate dosage related to patient weight and age F. Know the location of all emergency equipment G. Obtain informed consent from patient per department protocol H. Carefully observe and evaluate the patient, noting color of skin, tone and pitch of voice, and presence of apprehension or anxiety, so that changes from these baseline observations may be noted after injection 20  CONTRAST MEDIA Negative contrast agent Creates a higher density on the image Air is the most commonly used negative contrast agent Others are carbon dioxide and nitrogen Chest xrays are a common Xray using a negative contrast Organs will become radiolucent Produces an optimal density on the images Air can be used with positive contrasts for a double contrast study CONTRAST MEDIA Positive Positive = barium or iodinated Barium Sulfate is atomic # 56 and Iodine is atomic #53 This relatively high atomic number will result in a higher attenuation of xrays. Provides a lower density of the finished images Increases contrast between different structures CONTRAST MEDIA Positive Barium Sulfate (BASO4) 56 atomic # Inert salt, colloidal suspension Used orally and rectally  Upper GI series and Esophagogram, barium is most palatable when mixed with very cold water.  Barium Enema bags the barium sulfate is mixed with water approximately 100° F, approx. body temperature  Thick and thin 01/14/25 RAD 271 - Patient Care 23 CONTRAST MEDIA Positive Iodine = 53 atomic # Water-soluble contrast Introduced orally, urinary, IV, rectally Used for Perforations, pre & post surgery Ask good patient hx Non-ionic compound containing 3 iodine atoms (opacifying agents) Will not form into separate ions so no cation (+) = Less chance of reaction to contrast media Omnipaque and Isovue are common examples CONTRAST MEDIA Ionic vs Non-ionic Non-ionic contrast agents Contraindications to use of iodinated contrast media 1. Previous sensitivity to contrast agents 1. Known sensitivity to iodine 2. Asthma, hay fever, shellfish 3. Both ionic and nonionic contrast agents are iodinated 2. but can contain differing amounts 1. non-ionic does not mean noniodinated 01/14/25 RAD 271 - Patient Care 25  Important points about IV iodinated contrast 1. Age and weight play a role in the amount 2. Previous surgeries on urinary system will determine how much can be administered 3. Diabetic or not 4. Hydrated or not 5. Blood work – showing kidney function will work 6. Previous contrast studies in 24 hours 7. Allergic to shellfish, have asthma, hay fever, or other concerns 01/14/25 RAD 271 - Patient Care 26 Most Common Drugs Administered for Reaction to Iodine 1. Benedryl (dyphenhydramine hydrochloride) antihistamine 2. Epinephrine (adrenalin) vasoconstrictor and bronchodilator 3. Prednisone – steroid, given prophylactically 27 01/14/25 RAD 271 - Patient Care 28  Benzene Ring The Benzene ring is associated with the ANION 3 atoms of Iodine Cation (+) side chains add solubility Anion(-) stabilities Ring of six carbon atoms, bonded by alternating single and double bonds. 01/14/25 RAD 271 - Patient Care 29  Iodine based contrast 01/14/25 RAD 271 - Patient Care 30  Ionic Monomer vs Dimer Ionic MONOMER Ionic DIMER One ionic tri- Two non-ionic tri-iodinated iodinated benzoic benzene rings Na+/Meglumine Cation acid Iodine: particle ratio 6:2 Na+ / meglumine cation -Iodine: particle ratio 3: 2 01/14/25 RAD 271 - Patient Care 31  Non-ionic Monomer vs Dimer Non-ionic Non-ionic DIMER MONOMER Two non-ionic tri-iodinated benzene rings One non-ionic tri- Iodine: particle ratio 6:1 iodinated benzoic Low osmolality 300 mosm/kg acid Isomolar -Iodine: particle ratio 3: 1 01/14/25 RAD 271 - Patient Care 32  Terms related to iodinated contrasts Osmolality Viscosity Is measure of the # of Increased viscosity is thicker and dissolved particles per unit of more difficult to inject, causes more water in serum heat due to friction when injecting Higher the number more (causing pain). Viscosity will increase water in blood system as room temperature decreases. (Hypertonic) Toxicity Lower the number the less Greater with ionic contrasts with water in system (Hypotonic) Non –ionic is closer to the higher osmolality Avg. number is called Isotonic = homeostasis Miscibility (balance) and is between Contrasts agents should be “miscible” 275 to 295 mOsm/kg or ready-to-mix with blood  Contraindications for Barium in GI tract If a perforation is suspected somewhere along the GI tract – do not use barium! Barium could escape into the peritoneal cavity and result in peritonitis. Use water-soluble iodinated contrast medium such as gastrografin or gastroview designed for the GI tract.  Aftercare instructions for Barium studies Barium can become thickened as a result of absorption of water in the large bowel a process called inspissation causing symptoms of mild constipation to bowel obstruction. Tell patient to drink plenty of fluids and follow doctor’s protocol. Put these exams in order if needing to order. These may not all be ordered, but when considering a group of exams – which is 1,2,3,4? Gallblad Upper Barium IVU der GI Enema Study Correct Order Gallblad Barium Upper IVU der Enema GI Study  Scheduling of Multiple Exams 1.Sonography, Endoscopy procedures and CT procedures with no contrast (IV or oral) 2.Antegrade Urinary Tract – ex: Intravenous Urogram (IVU) – excretes quickly 3.Imaging of the Biliary System – ex: Gallbladder Study 4.CTs should be scheduled before exams with barium sulfate 5. Barium Enema 6. UGI Endo u d i e St s Gallblad Barium Upper IVU der Enema GI Study Scheduling of Multiple Exams Can be scheduled on Can be scheduled on the same day the same day GB IVU Study Bariu Uppe m r GI Enema  Scheduling of Radiographic Examinations General considerations a. Schedule in an appropriate and timely sequence to ensure patient comfort and g. Thyroid assessment must precede any fiscal responsibility examinations involving iodinated contrast media b. Sequence so that examinations do not interfere with one another h. Schedule radiographic examinations not c. Schedule barium or contrast requiring contrast agents first studies last i. Total doses of iodinated contrast d. Schedule several examinations in a media should be calculated if they are single day if the patient is able to to be used in a series of examinations tolerate them j. Schedule patients who have been held e. Seriously ill or weak patients may be NPO (nothing by mouth) first able to tolerate only one examination per day or must have a rest between k. Schedule pediatric and elderly examinations patients early f. If sedation is used, patient must be l. Schedule diabetic patients early given time to recover from because of their need for insulin sedation before beginning fluoroscopic studies 40 Contrast - Blood Work 1. GFR estimates the % of kidney function (Glomerular Filtration) it estimates how much blood passes through the glomeruli each minute. https://www.kidney.org/kidney-topic s/estimated-glomerular-filtration-rat e-egfr  Contrast - Blood Work 2. BUN measures urea nitrogen that's in your blood BUN (Blood Urea Nitrogen) levels (adult) 8 - 25 mg/100 mL Measures Urea nitrogen in your blood that is the waste product from the liver when breaking down proteins.  Contrast - Blood Work Check blood chemistry—normal ranges: Creatinine level (adult) 0.6 - 1.5 mg/dL From protein and muscle waste breakdown Copyright © 2018, Elsevier Inc. All Rights Reserved. 43  Pharmacology – Side effects Contrast Overdose: May occur in infants or adults who have renal, cardiac, or hepatic failure. Also would occur in patients who have one kidney, dehydrated or other medical complications. Anaphylactic reactions: Flushing, hives, nausea a. Cardiovascular reactions: Hypotension, tachycardia, b. cardiac arrest Psychogenic factors: May be caused by patient c. anxiety or suggested by the possible reactions described during the informed consent process  Other symptoms of contrast agent reactions  Nausea and vomiting Adverse Reactions  Sneezing  Sensation of heat  Itching Moderate  Hoarseness Requires Treatment Mild Severe  Coughing Self-limited Not immediately life Life threatening  Urticaria threatening  Dyspnea  Loss of consciousness  Convulsions  Cardiac arrest  Paralysis 01/14/25 RAD 271 - Patient Care 45 01/14/25 RAD 271 - Patient Care 46  Pharmacology Complications may occur at site of injection Extravasation – when contrast media leaks outside of the vein into the soft tissue. a. Immediately I. Pain, tenderness II. Swelling III. Itching IV. Tightness of Skin V. Redness b. Complications i. Worsened pain, swelling ii. Change in sensations, loss of function  Skin grafts Skin ulceration, blistering iii.  Amputations iv. Necrosis v. Infections  Pharmacology Extravasation – Steps to take if it happens 1)Remove the needle 2)Apply pressure to the site 3)Raise extremity above heart 4)Immediate attention is needed to reduce tissue necrosis. a. Apply a cold pack for at least 20 minutes b. The cold compress will cause vasoconstriction to minimize bleeding and damage to the tissues, as well as relieve pain. 5)Radiologist, pharmacy, physician, etc needs to be contacted to provide details for specific steps needed 6)Apply a warm compress after the ice pack for 20 minutes, then alternate these steps until physician or supervisor indicates. a. Warm compress will increase circulation to encourage uptake of the extravasated contrast medium. 7)This rotation of cold and warm compresses can continue for a length of time specified by the physician. 8)Document all details for the patient’s chart 48 01/14/25 RAD 271 - Patient Care 49  ACR Documentation about Extravasations Extravasations and severe extravasation injuries are more common in patients who 1) are uncommunicative 2) have altered circulation in the injected extremity 3) have had radiation of the injected extremity 4) are injected in the hand, foot, or ankle -Extravasations are also more common in patients injected with more viscous contrast material Risks can be minimized by 1)using angiocath rather than butterfly needles 2)Good technique when inserting needle 3)Using a flush as a test prior to injecting contrast 4)Securing the catheter 01/14/25 RAD 271 - Patient Care 50  Complications may occur at site of injection Phlebitis Inflammation of vein a. Trauma to the vein during venipuncture b. Blood clots Signs & Symptoms a. Pain b. Swelling c. Redness d. Warmth around site Treatment a. Continue using affect arm/leg b. Warm, moist cloth over area c. Raise affected area above heart d. Take OTC pain reliever e. Prevent Pulmonary Embolisms (PE) PATIENT PREP - NPO A. GI system or urinary system Low-residue diet (e.g., low fiber) or 1. clear liquid diet (e.g., tea, gelatin, bouillon) NPO for 8 to 12 hours before 2. procedure Cathartics and enemas are used to 3. cleanse the GI system  Medical Administration routes: 1.ENTERAL - by mouth or NG/PEG tube 2.PARENTERAL – any route other than the digestive tract I. Pulmonary - inhalers and nebulizers through respiratory system II. Transdermal – Nicotine and hormonal patches through skin into bloodstream. III.Topical – Direct application to the skin or mucosal membrane. Ex: creams, ointments, eye drops, ear drops. “Parenteral” par = beyond, enteral = intestines Medication or nutrition that is administered in the body other than the mouth and alimentary canal. Four examples of the parenteral route include 1. Intramuscular (IM) 2. Subcutaneous (SUBQ) 3. Intravenous (IV) 4. Intradermal (ID) 01/14/25 RAD 271 - Patient Care 54  Intramuscula r IM injections administer medication or vaccinations deep into the muscles. The Deltoid is commonly used. Much better absorption than SUBQ due to the larger blood supply within muscle tissue. Some drugs are not absorbed Examples: orally. Antibiotics Some drugs are too harsh to be EpiPen administered directly into vein. TdAP Hepatitis 01/14/25 RAD 271 - Patient Care 55  Subcutaneous SUBQ injections are given in the fatty tissue just underneath the skin. Fatty tissue allows for slower absorption. Examples: Insulin, Heparin/Lovenox, MMR, Varicella, Fertility, and some palliative care pain medications 01/14/25 RAD 271 - Patient Care 56  Intravenous IV administration occurs by: 1. IV “Push” or Bolus 2. IV Infusion Administers the drug directly into the venous system. Examples when needed/used: Gaining blood samples Drip infusions Pump infusions Quick access 01/14/25 RAD 271 - Patient Care 57  Intradermal Needle enters at a shallow angle. Injects drug into the dermis Examples when used: TB test Allergy tests Rabies vaccines – just in case you needed to know that  01/14/25 RAD 271 - Patient Care 58 Types of Needles used in Venipuncture 59 Types of Needles used in Venipuncture 60  Angiocath 01/14/25 RAD 271 - Patient Care 61  Intravenous injections are found within the antecubital fossa. Typically large, easy to access, and durable enough to withstand injections. Most commonly used Use antecubital intravenous injection sites fossa 1st include the median cubital, If known difficulties cephalic, and basilic veins. in area, then start as Median Cubital is most distal as possible (to optimal due to size, well use a larger bore) to allow moving anchored, least painful, proximal if issues and less likely to bruise. occur Use >18g Radial vein in wrist 62 could be a good  Drug Administration & Documentation Patient Rights The doctor is the one who: a.determines the details of medication administration b.Is ultimately responsible. a. Right Dose b. Right Medication Document, c. Right Patient Document, The 6 Rights of d. Right Time Document! Drug e. Right Route Administration f. Right Documentation Steps in Venipuncture & Intravenous Drug Injection 10. Hold needle with the bevel facing 1. Obtain patient, check 2 patient identifiers at a 15–30 degree angle. Blood 2. Explain the procedure to the patient. Ask the patient should flow back into tubing. about any allergies. 11. Flush with 5-10 ml of saline 3. Wash hands thoroughly, put on disposable gloves 12. Remove the tourniquet 4. Select vein 13. Inject the drug 5. Place tourniquet 3-4” above the site 14. Unless otherwise instructed, remove the needle Check for 6. Localize the vein access point visual concerns, and apply gentle 7. Clean it with an alcohol prep pad using a circular pressure to the site with a gauze. motion while moving from the center to the outside. 15. Dispose of the syringe and needle 8. Allow the area to dry 30 sec. before inserting the or butterfly needle properly. needle. Do not blow or fan the area in an attempt to 16. Document all relevant dry the area. information. 64  INTRATHECAL Intrathecal administration is an injection into the spinal canal It is also called the Subarachnoid space so that it reaches the cerebrospinal fluid (CSF) Intrathecal refers to the space located between the arachnoid and the pia mater of the spinal cord, which contains cerebrospinal fluid, spinal nerves, and blood vessels. Myelogram 01/14/25 s RAD 271 - Patient Care 65 Standard Precautions  Standard Precautions Guidelines 1. Always wear gloves when any chance of being in con- tact with body substances exists 2. Protect clothing by wearing a protective gown or plastic apron, if a chance of coming in contact with body substances exists 3. Masks or eye protection must be worn if a chance of body-substances splashing exists 4. Handwashing is the most effective method to prevent the spread of infection 5. Uncapped needle syringe units and all sharps must be discarded in biohazard containers 6. If any contact is made with body substances, the entire area contacted must be washed completely with bleach 7. Contaminated articles must be disposed of properly 8. Needles should never be recapped but should be placed with the syringe in a sharps container 9. Protective masks or mouthpieces should be used when performing cardiopulmonary resuscitation (CPR), if providing breaths in addition to chest compression.  Standard PPE Selection of PPE depends on the potential risk of exposure to a hazard. Examples of PPE by body areas include: a.Eyes (e.g., safety glasses, goggles, laser protective eyewear) b.Ears (e.g., ear plugs or muffs) c.Face (e.g., face shield) d.Hands (e.g., exam gloves, chemotherapy gloves) e.Feet (e.g., shoe coverings) f.Torso/body (e.g., fluid resistant gowns, impervious splash suit, laser protective clothing) g.Lungs/respiratory tract (e.g., N95 filtering 01/14/25 RAD 271 - Patient Care 69 01/14/25 RAD 271 - Patient Care 70 01/14/25 RAD 271 - Patient Care 71  Resident microbes live in or on our bodies and are even more difficult to remove because they are so firmly embedded in epidermis. Surgical scrubbing is needed for removal. Reduction is necessary before aseptic procedure. Ex: Staphylococcus Aureus lives on skin with out causing disease. Located in the deep layers of skin These organisms are not typically associated with the transmission of infection. Typically non-pathogenic. If they are disturbed, they will repopulate. Depending on the condition of the skin and the # of microbes present it could take as much as 7 to 8 minutes of handwashing remove the Transient microbes. Temporary organisms can live on skin for hours to months! Located in the superficial layers of skin Transient microbes are typically non-pathogen or opportunistic pathogen These organisms are typically associated with the transmission of infection. 01/14/25 RAD 271 - Patient Care 72  The Microbial World Pathogenic microorganisms are divided into 4 basic infectious agents: A. Bacteria B. Viruses C. Fungi D. Protozoan Parasites  CYCLE OF INFECTION Cycle of infection = All factors are involved in the spread of disease Susceptible host: Person at risk for Infectious infection organism: Pathogen Portal of entry: Reservoir of Any avenue infection: Place available to enter where organisms the body can thrive Mode of Portal of exit: transportation: Any avenue Route taken by available to exit pathogens from the body reservoir to  Pathogen: Infectious agents producing disease or illness Examples: Virus, parasite, fungus, bacterium, prion Varies on virulence (quantifies term for producing power of disease), pathogenicity (qualitative term “all or none” to produce disease), ability to enter host Reservoir/Source: Environment/habitat where a pathogen can live and multiply Environmental surfaces/equipment, body fluids (blood, saliva), urine/fecal material, food/water, soil, skin, respiratory tract Portal of Exit: How the pathogen exits or leaves reservoir Skin to skin, skin to surface, blood, mucous membranes, oral cavity, fecal Other potentially infectious material (OPIM): Seminal fluid, joint fluid, saliva, urine/fecal material, any body fluid contaminated with blood Modes of Transmission: How a pathogen moves from reservoir to susceptible host Direct Transmission: Airborne, droplet, contact (e.g., skin), bite, needlestick or other sharps injury Indirect Transmission: Fomites – contaminated equipment or medication (multidose vials, single dose vials), vectors, food, water Portal of Entry: Opening where the pathogen may enter Body openings (ex. mouth, eyes, urinary tract, respiratory tract), incisions, wounds Susceptible Host: The person at-risk: patient or healthcare worker 01/14/25 RAD 271 - Patient Care 76  Mode of Transmission EXOGENOUS Infection- transmission from outside of the body – not normal flora FOMITE VECTOR Non-living object Living organism Object or material which is likely to Organism, typically a biting insect or carry an infection such as clothes, tick that transmits a disease or utensils, and furniture parasite from one animal or plant to another Takes part in indirect contact Takes part either indirect contact transmission transmission Examples: Contaminated clothing, Examples: Flies, mosquitos, fleas, doorknobs, table tops, chairs, etc. ENDOGENOUS infection – transmission from within equipment, food, etc. the body or normal flora enters the body through a cut.  Mode of Transmission VEHICLE – anything that can transport a microorganism. Could be blood, saliva, food, water, contaminated equipment. Indirect contact. EXOGENOUS Infection- transmission from outside of the body – not normal flora FOMITE VECTOR Non-living object Living organism Object or material which is likely to Organism, typically a biting insect or carry an infection such as clothes, tick that transmits a disease or utensils, and furniture parasite from one animal or plant to another Takes part in indirect contact Takes part either indirect contact transmission transmission Examples: Contaminated clothing, Examples: Flies, mosquitos, fleas, doorknobs, table tops, chairs, etc. equipment, food, etc. ENDOGENOUS infection – transmission from within the body or normal flora enters the body through a cut. Isolation techniques have been divided into three sets of guidelines:  AIRBORNE (Aerosol) Precautions Airborne transmission is expelled as smaller droplets and remain in air for a long period of time – can travel. These particles can be breathed in by another person. Protocol: Patient: Wears surgical string mask, private-negative pressure room. Limited to room if possible. Door should always remain closed. Radiographer: Wears N96 Particulate mask if patient cannot wear mask, gloves, gown for blatant contamination Includes TB, Varicella, Rubeola (measles), Shingles, Covid-also Droplet  Special ventilation (negative pressure) in room, door to remain closed Designed to prevent airborne microorganisms in the room from entering hallways and corridors. 01/14/25 RAD 271 - Patient Care 81  Patients with Neutropenia 1. Have a decrease in white blood cell count 2. Neutropenia may be caused by chemotherapy, immunotherapy, bone marrow transplant 3. Low immune system 4. Radiographers caring for patients with neutropenia must carefully follow hospital protocol so as not to transmit something to the patient 5. Techs should wear standard PPE, wash hands 6. Some institutions use a similar form of isolation 01/14/25 called Reverse Isolation or RAD 271 - Patient Care 82  Droplet Precautions Expelled through large droplets when coughing, sneezing or talking. These droplets land on the body surface and infect another person through contact with the mouth, conjunctiva, nasal mucosa. Protocol: Patient: Must wear a surgical string mask, regular private room Radiographer: Wears gown, gloves, and mask. Must use N95 for flu. Healthcare practitioners should protect themselves by wearing surgical masks when within 3 feet of the patient. Door may remain open, no special ventilation required. Door can remain open because large droplets typically travel 3 feet before dropping to the ground. Includes Rubella, Mumps, Influenza, Covid-also Airborne  Contact Precautions Always used in conjunction with Standard Precautions Private room, door may remain open Gloves when entering room, remove gown and then wash hands prior to leaving room. All equipment should be cleaned with antiseptic solution after leaving room. Two-radiographer team “clean vs dirty” All equipment must be disinfected thoroughly before using again Protocol: Patient: Wears a surgical string mask per protocol, regular private room Radiographer: Wears gown, gloves, and mask for MRSA. Must handwash used before entering and leaving room Includes: Mumps, MRSA, VRE, Staph, Herpes, Scabies, GI Infections, Conjunctivitis, Hepatitis A  Contact Precautions “Clean vs Dirty” 01/14/25 RAD 271 - Patient Care 85  Infection Control Terms Flora: The population of microbes inhabiting the outside or inside surfaces of people Endogenous Infection: Organisms derived from patient’s flora Exogenous Infection: Organisms are derived from outside the host 01/14/25 RAD 271 - Patient Care 86  Infection Control Terms Pathogen: Microbe or microorganism such as a virus, bacteria, fungus, or prion that causes disease in the animal or plant host. Opportunistic Pathogen: An infectious microorganism that is normally not harmful to the host but can cause disease when the host’s resistance is low. Ex: Pneumocystis Carinii – pneumonia in AIDS patients, E.Coli can cause UTI, meningitis, pneumonia, and abscesses and tooth decay/gum disease caused by normal mouth flora. Opportunistic Conditions: When the immune system is not working properly, normal flora can overpopulate or transition into other areas of the body they are not normally found. Opportunistic Infection: An opportunistic infection is an infection caused by pathogens, especially opportunistic pathogens. 01/14/25 RAD 271 - Patient Care 87  Infection Control Terms Community Acquired Infection (CAI): Infection that is present or incubating during admission to facility. CAIs are infections that are contracted outside of a healthcare setting. Patients can expose other patients to CAIs upon admission. Unless the chain of infection is broken, a healthcare facility can be put at risk of an infection outbreak. Hospital Acquired Infection (HAI): A nosocomial infection that can be defined as an infection acquired in the hospital or other care facility after admission to the facility. It does not originate from the original diagnosis for being admitted the facility. 2 million people acquire HAI per year! 90,000 deaths due to HAI per CDC Most common HAI is catheter-associated urinary tract infections. 5% patients will contract an HAI. 01/14/25  Handwashing The single most important component of any infection control system. Handwashing is both a chemical and a physical process. Many soaps and detergents are bactericidal, but their application during handwashing is not used long enough to kill microbes. Soaps are effective at removing some fragile bacteria, such as pneumococci and meningococci. An important and effective component of handwashing is the mechanical action of rubbing the hands together. Recommend minimum of 20 seconds of soap and friction followed by running water rinse  Handwashing Type Purpose Method Routine Removes dirt and transient Soap and water Handwashing microorganisms for minimum of 20 seconds Hand Antisepsis Removes soil and remove Antimicrobial or destroy transient soap and water microorganisms for at least 20 seconds Hand Destroy transient Alcohol based Rub/Degerming microorganisms on hand rub rubbed unsoiled hands in a limited vigorously until area. dry. Surgical Hand Removes or destroys Antimicrobial Scrub transient organisms and scrub solution reduces resident flora. Leaves and antimicrobial 01/14/25 RAD 271 - Patient Care 90 residual on the skin to  Medical Asepsis - “Disinfection” A reduction in the number of infectious agent, such as bacteria, but does not reduce it to zero. Reduces the likelihood of transferring pathogens to compromised person. Used in administration of medications, enemas, tube feedings, and daily hygiene Through the use of soap, water, friction and chemical disinfectants. I. ALCOHOL-based hand sanitizer I. Apply and rub correctly for 15 seconds. Must let completely dry without blowing on hands or fanning dry. II. WATER 1. Minimum time is 20 seconds but optimal time for handwashing is 30 -60 seconds 2. No artificial nails III. CHEMICAL METHODS  Medical Asepsis - “Disinfection” III. CHEMICAL METHODS: Disinfectants Also called Germicides Used to remove microorganisms from objects like x-ray tables and other types of radiographic equipment and accessories Chlorine (bleach) Antiseptics Bacteriostatic Applied topically used to remove Means that the agent prevents microorganisms from body surfaces. the growth of bacteria “Antisepsis” stops the growth of pathogenic microorganisms Bacteriostatic – stops bacterial Bactericidal growth Alcohol Kills bacteria Hydrogen peroxide Bacteria (bleach, chlorine, Ammonia iodine) Iodine (Betadine, Surgidine)  Surgical Asepsis - “Sterilization” Methods: Sterilization 1. Chemical Sterilization: when Absolute killing of all life forms objects are soaked in germicides. Also known as “sterile Commonly used are ethylene technique” oxide, formaldehyde, alcohol. 1.Completely removes all 2. Dry heat: achieved by placing microorganisms and items in dry oven >329 F reproductive cells (spores) 3. Boiling Sterilization: uses moist from affected skin, equipment heat and the environment. 4. Autoclaving: Steam sterilization 2.Prevents contamination of under pressure. Moist heat at microbes before, during and 210 degrees for 15 minutes is after surgery required. It is the most 3.Used in dressing changes, catherization, and surgical convenient and efficient way to procedures sterilize materials. 5. Gas sterilization: items are  Handling and Disposal of Hazardous Waste 1.Material safety data sheets (MSDS) must be available, and radiographers should be familiar with their content and warnings 2.Contains information sheets for any chemical used in the department 3.MSDS provide direction for the following: A. Handling precautions B. Safe use of the product C. Cleanup and disposal 01/14/25 RAD 271 - Patient Care 94 01/14/25 RAD 271 - Patient Care 95 Handling & Disposal of Hazardous Waste Guidelines for handling chemicals Use only if container is clearly labeled Read container label several times before using contents to be certain of what is being handled Handle carefully to prevent contact with skin, eyes, and mucous membranes Wear personal protective equipment (PPE) – masks, gowns, gloves, and eye shields. May need respirator and dosimeter Use chemicals only as directed, never mix chemicals in other bottles Never mix chemicals unless compatibility can be verified Store chemicals only as directed on label Never pour toxic chemicals down the drain; this includes irritating or flammable materials Never induce vomiting, call 911 and poison control after referring to MSDS Isolate chemical from remainder of department, use good ventilation. Staff in areas with chemical should be rotated when working to reduce exoposure.  Handling and Disposal of Hazardous Waste INFECTIOUS WASTE 1. Anything that has the potential to transmit disease is infectious waste 2. Handle waste using US Centers for Disease Control and Prevention (CDC) guidelines for standard precautions 3. Place in containers or bags properly labeled with the type of waste (ex. linens, used sharps, disposable items) 4. Know the facility’s procedures for handling, containment, and disposal of all infectious waste 5. Exposure to infectious waste must be reported for medical follow-up and incident reports 6. Gloves must always be worn in the following activities: a. Handling used needles and syringes b. Handling bandages and dressing c. Assisting patients who use urinals or bedpans 7. Needles and syringes must be disposed of in special sharps containers 8. Needles should not be recapped 9. Used bandages and dressings must be placed into red plastic biohazard bags and sealed 10. Bedpans and urinals must be emptied immediately and rinsed  Handling and Disposal of Hazardous Waste BIOHAZARDOUS WASTE 1. Considered to be anything soiled with blood or other bodily fluids 2. Biohazardous waste is regulated by OSHA, EPA, and NRC 3. Must be properly identified on the outside of impermeable container and placed in special bin or area, then hauled off by approved agency. 4. Sharps have their own special container and box should not be filled completely. 5. Radioactive material must be allowed to decay before being disposed of. After Biohaz spill - The Radiographer can ensure the patient’s safety by: 1. Limiting access to the area 2. Evaluating the risks involved and determining other methods of completing task 3. Ensuring safe access to required equipment 4. Make sure spill is properly cleaned per protocol 5. Call supervisor when needed 01/14/25 RAD 271 - Patient Care 99  Equipment VENTILATOR Breathes for the patient by forcing oxygen 1. into the airway Never fixes the issue, just supports the 2. patient’s airway until recovery occurs (or long-term for critical patients) Mechanical respirators can be attached to 3. Tracheostomies and Endotracheal tubes Patient who has a ventilator has been 4. intubated Pay attention to how you move around 5. patient to not dislodge tubing  Equipment Endotracheal tube inserted in trachea between the vocal cords to be able to exchange air and gases. Used for admin. of oxygen and anesthesia. Will assist patients with respiratory illnesses - Pneumonia, heart failure, trauma, pneumothorax, etc. Days to weeks is the goals, long term ventilator needs would need Trach.  Equipment Endotracheal tube If properly positioned, the distal end of the Endotracheal tube will be 1-2” above the carina. Cuff is inflated with air and is positioned at midtrachea Equipm Tracheostomy is an artificial airway in ent trachea to help oxygen reach the lungs  Equipment CHEST TUBE Removes fluid or air from pleural space 1. Resolves 2. a. Pneumothorax b. Hemothorax c. Pneumothorax May be connected to a suction device 3. Pay attention to not hit the tubes or 4. suction device. Bottle or box must never be raised 5. above chest level Tubing must not be pinched 6.  Equipment Thoracentesis - Procedure to remove extra fluid from in the pleural cavity. 01/14/25 RAD 271 - Patient Care 105  Equipment A. NASOGASTRIC (NG) TUBES 1. For those who cannot swallow on own or open mouth. 2. Tube inserted through the nose, then down the esophagus into the stomach. Verified by fluoro or xray. 3. Used to: 1. Feed the patient 2. Suction liquid or air from stomach 3. Deliver medications 4. Admin. Contrast material 4. Must take care to not to pull on the NG tube while moving patient or performing the exams 01/14/25 RAD 271 - Patient Care 106  Equipme Patient Support Equipment nt NG TUBE Two common types: Short term use Levin tube – single-lumen tube with several holes near the tip. Purpose is primarily for feedings. Can take liquids out. Salem-sump – radiopaque end for placement, double-lumen tube (one for suction and one for ventilation/equalization). Purpose is decompression and taking things out of the stomach. Can provide nutrition as well.  AP or PA Chest is optimal image to check NG placement 1. X-ray 2. Aspiration of gastric contents 3. Auscultatio n 01/14/25 RAD 271 - Patient Care 108 NG Tube Properly placed NG Misplaced NG tube into stomach tube into left lung  Oh no 01/14/25 RAD 271 - Patient Care 111  These are more permanent placements of tubes through abdominal wall to access the stomach or small intestine directly. This is usually for tube feeding longer than four to six weeks. A.Gastric or gastrostomy tubes (G- tubes): The tube goes directly into your stomach. B.Jejunostomy tubes (J-tubes): The tube goes into the second part of your small intestine called the jejunum. C.Gastrostomy-jejunostomy tube (GJ- tube): The tube goes into your stomach and passes through into your jejunum. 01/14/25 These tubes have a G and a J port. The 112 RAD 271 - Patient Care G  Equipment Percutaneous Endoscopic Gastrostomy (PEG) PEG tubes allow nutrition through the stomach if not able to swallow or get all the nutrition needed by mouth for a semi to permanent timespan. 01/14/25 RAD 271 - Patient Care 113  Equipment URINARY CATHETERS (FOLEY AND SUPRAPUBIC) 1.Care must be taken during transfer and radiography of patients who have urinary catheters in place 2.Urinary catheter tubing must not be bent, pinched, or caught on other equipment and pulled out of the bladder 3.Bag attached to urinary catheters must always be kept below the level of the bladder 1. Allowing urine to flow retrograde into the urethra and bladder can cause urinary tract infections Uses aseptic technique to place Urinary tract infections are the number one cause of nosocomial infections (infections acquired in the hospital) Equipmen URINARY CATHETERS t Foley catheter uses a retention balloon with 1 ml of sterile water. uses Lithotomy position for placement Straight-type catheter. also called an intermittent catheter Usually used one time and discarded Needed for patients whoa are paraplegic, or nerve issues that affects the function of the bladder.  Equipment URINARY CATHETERS Suprapubic catheters A suprapubic catheter is left in place and has a balloon like the Foley Rather than being inserted through the urethra it is inserted through the abdomen. The surgery is completed under aseptic technique and needs to be done with some type of anesthesia. It is used when urethra or bladder damaged or blocked Or when someone is unable to use an intermittent catheter. 01/14/25 RAD 271 - Patient Care 116  Central venous line catheters are most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis. Types of Central venous line catheters: Subclavian: Hickman – a tunneled central venous catheter. Groshong - is very similar to the Hickman catheter, but has a valve at the tip of the catheter which makes it unnecessary to leave a high concentration of heparin in the catheter. Broviac catheter is also similar to the Hickman catheter, but is of smaller size. This catheter is mostly used for pediatric patients. Portacath – this catheter has an implantable port that lies completely under the skin. PICC – peripherally inserted central venous line. Usually at the elbow. Vascath – a specialized venous catheter used for dialysis.  Videos Tunneled CVC - hthttps://www.youtube.com/watch?v= zZ2_vha41wtps://www.youtube.com/watch?v=nhCuebd cTEI 01/14/25 RAD 271 - Patient Care 118 01/14/25 RAD 271 - Patient Care 119  Unlike non-tunneled central venous catheters (CVCs), tunneled CVCs travel under the skin and terminate away from the venous access site. As such, tunneled CVCs can be in place for weeks to months, while the non-tunneled catheters must be exchanged every few days to a week. 01/14/25 RAD 271 - Patient Care 120  TUNNELED Central Venous Catheters (CVC) Catheter examples Hickman Cook Broviac Groshong The catheter can be single, double, or triple lumen. Tunneled Central Venous Catheters (CVC) Tunneled CVC are used for:  Long-term use  Chemotherapy, Dialysis, IV medication or total parenteral nutrition (TPN) Sterile procedure Reduces risk of infection More secured than non-tunnel Placement during sterile procedure: Incision above nipple to tunnel catheter under skin towards the Subclavian Vein Then the catheter will advance towards the junction of the Internal Jugular Vein and Brachiocephalic Vein, then advance inferiorly into the lower 1/3rd of Superior Vena Cava or Upper Right Atrium. 01/14/25 RAD 271 - Patient Care 122  “Total Parenteral Nutrition” Medication or nutrition that is administered in the body other than the mouth and alimentary canal. TPN is needed when a patient is unable to use some or all of their Gastrointestinal. Can be short or long term 01/14/25 RAD 271 - Patient Care 123 01/14/25 RAD 271 - Patient Care 124 Tunneled Central Venous Catheters (CVC) Placement: Advance catheter towards the junction of the Internal Jugular Vein and Brachiocephalic Vein, then advance inferiorly into the lower 1/3rd of Superior Vena Cava or Upper Right Atrium. 01/14/25 RAD 271 - Patient Care 125 Tunneled Central Venous Catheters (CVC) 01/14/25 RAD 271 - Patient Care 126 01/14/25 RAD 271 - Patient Care 127 Tunneled Central Venous Catheters (CVC) 01/14/25 RAD 271 - Patient Care 128  Tunneled Femoral Vein Catherization for long term use 01/14/25 RAD 271 - Patient Care 129 The most common misplacement during subclavian vein (SCV) catheterization is into the internal jugular vein (IJV). Chest radiography is the gold standard for the confirmation of correct placement. Subclavian Central Venous Line Hickman Line Hickman lines may remain in place for extended periods and are used when long- term intravenous access is needed. The Hickman catheter comes in double-lumen and triple-lumen varieties.  VasCath Larger and sturdier than Hickman catheters. Pheresis (means withdraw) catheters can be used for hemodialysis and are often called "dialysis catheters". Placed in Jugular or femoral Vein A B 01/14/25 RAD 271 - Patient Care 133 Subclavian Central Venous Line Groshong Tunneled intravenous catheter used for central venous access. Groshongs may be left in place for extended periods and are used when long-term intravenous therapy is needed, such as for chemotherapy. Similar to the Hickman line, the tip of the catheter is in the superior vena cava, and the catheter is tunneled under the skin to an incision on the chest wall, where the distal end of the catheter exits the body. In contrast to the Hickman line, the tip of a Groshong line has a three-way valve. The valve opens outward during infusion, and opens inward during blood aspiration. When not being accessed, the valve remains closed, which reduces the risk of clotting, air embolism and blood reflux. Non-Tunneled Central Venous Catheters (CVC) Used for: Placement during non- Emergency use for quick sterile procedure: Jugular vein, femoral vein, delivery of medications and subclavian or other area in upper fluids. chest. Short-term (usually < 2 wks.) Chest area:  Catheter will advance towards lower More risk of infection 1/3rd of Superior Vena Cava or Upper Right Atrium. Less secured than tunneled Femoral area: Bedside or outpatient procedures Catheter The examples: catheter Hickman Cook can be Broviac single, Groshong 01/14/25 double, or RAD 271 - Patient Care 135 Non-Tunneled Femoral Central Venous Catheters (CVC) Used for short-term use Emergencies When original sites develop scar tissue Less risks due to no pneumothorax Still can cause infections and not as sectored as if tunneled. 01/14/25 RAD 271 - Patient Care 136 PICC Line  PICC Line Placement Insert Fig 15-35 A here Fig. 15-34 Tunneled catheter. Fig. 15-35 A, Posteroanterior projection of the chest shows double- lumen tunnel catheter in left subclavian vein with the tip in the superior vena cava at the right atrium.  PORTS Inplanted ports are also tunneled under the skin. The port itself is placed under the skin and accessed as needed. When not accessed, they only need an occasional flush but otherwise do not require care. They can be multilumen as 01/14/25 RAD 271 - Patient Care 139 well. They are also useful Portacat h  Swan-Ganz “Swan-Ganz catheterization involves the passage of a catheter into the right side of the heart to obtain diagnostic information about the heart and to provide continuous monitoring of heart function in critically ill patients.” Ideally, the catheter is positioned so that it lies within the right main pulmonary artery  Swan - Ganz 01/14/25 RAD 271 - Patient Care 142 Greenfield Filter 01/14/25 RAD 271 - Patient Care 143 Greenfield Filter Greenfield Filter To trap the clot before it leads to a Pulmonary Embolism Greenfield Filter