Patient Care Test 3 PDF

Topic 13-14 Vital Signs Vital signs are critical indicators of a patient's physiological status and include: 1. Body Temperature 2. Pulse (Heart Rate) 3. Respirations 4. Blood Pressure → TPR They are essential for detecting changes in a patient’s baseline health and can indicate life-threatening co...

Topic 13-14 Vital Signs Vital signs are critical indicators of a patient's physiological status and include: 1. Body Temperature 2. Pulse (Heart Rate) 3. Respirations 4. Blood Pressure → TPR They are essential for detecting changes in a patient’s baseline health and can indicate life-threatening conditions. - Vital signs must be measured if the patient is having an interventional/invasive procedure and the department does not have a radiology nurse available. - The vitals should also be taken before and after a patient receives medication in the Imaging department. A patient may also have vitals taken if they are not feeling well while in the department. - A physician’s order is not required for the MIT to take vital signs Changes in baseline vital signs can be an indicative of a problem. - The MIT must always ensure that the sphygmomanometer, a stethoscope, and the equipment necessary for vital signs are functional. Homeostasis: - Stable or state of equilibrium of the internal environment of the body. - Vitals signs TPR → Vary within certain limits (of what is considered normal) ▪ → Measured to detect changes in baseline (of normal body function) → Indicates a patient’s response to treatment → Indicative of life-threatening circumstances → Are part of the assessment steps to obtain the patient's baseline There are four vital signs which are standard in most medical settings: TPR A. Body temperature – requires a thermometer B. Pulse rate (or heart rate) – requires a watch or timer C. Respiratory rate -- requires a watch or timer D. Blood pressure – requires sphygmomanometer 1. Body Temperature (T°) - Temperature (T): Physiologic balance between the temperatures produced in the body tissues and heat loss by the body. → The amount of heat in the body: The balance between the amount of heat produced and the amount of heat lost by the body to the environment. - Body temperature is regulated by the hypothalamus in the diencephalon of the brain. Humans are homeothermic, meaning they are warm-blooded and maintain a stable body temperature regardless of environmental changes. - F.U.O.: fever of unknown origin - P.U.O.: pyrexia of unknown origin Metabolic activity produces heat and increases body temperature: → usually lower in the morning → higher after exercise → higher after eating → higher during stressful events (psychogenic fever) - As body temperature increases, the body’s need for oxygen increases. Normal Range: - Adults: 36.7°C–37.4°C - Children (3 months to 3 years): 37.2°C–37.7°C - Hypothalamus Regulation: - Anterior hypothalamus: Controls heat dissipation. - Posterior hypothalamus: Controls heat conservation. Temperature Measurement Methods - Oral (Normal: 37°C, 98.6°F): → convenient, and accurate because the thermometer is in contact with the blood vessels under the tongue. → a few seconds for digital reading; 3 – 5 mins mercury glass thermometer - Rectal (Normal: 37.5°C, 99.6°F): → most accurate method because there is no outside interference (for infants and children) → also called the "core" temperature. (2 - 3mins; seconds digitally) - Axillary (Normal: 36.4°C–36.7°C, 97.5° to 98°F):  → less accurate than by mouth. It is the safest method because it is non-invasive. → seconds digitally; 5 - 10 mins with glass reading; Add 0.5 °C - Tympanic (Normal: 37.5°C, 99.6° F): → (aural) measures T° of the tympanic membrane vessels; fairly accurate reading close to core temperature, if placed properly → 1 – 3 sec. Reading Convert Celsius to Fahrenheit : - T(°F) = T(°C) × 1.8 + 32 Convert Fahrenheit to Celsius: - T(°C) = (T(°F) - 32) / 1.8 Abnormal Temperatures - Hyperpyrexia: >41°C → Is considered a medical emergency that can result in organ damage and death (41° C) if temperature is not lowered. The body Body absorbs more heat than it dissipates. This can also be caused by heat stroke or adverse reactions to drugs. - Hypothermia: 20 breaths/minute). - Bradypnea: abnormally slow breathing (< 10 breaths/minute).  - Hyperventilation: breathing too deeply and too fast (results in excessive O2 intake & excessive loss of CO2 =↓BP). - Stertorous: noisy breathing/deep snoring sound due to partial obstruction of the upper airway. Cheyne-Stokes (rhythmic alterations of intensity): - Respirations increase in rate and force, gradually decreasing until they stop - a short period of apnea; 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. - MORIBUND = approaching death/ near death Causes: - Brain damage - Brain tumours - CHF - Heart failure Blood comes into the right atrium from the body, moves into the right ventricle and is pushed into the pulmonary arteries in the lungs. After picking up oxygen, the blood travels back to the heart through the pulmonary veins into the left atrium, to the left ventricle and out to the body's tissues through the aorta. 4. Blood Pressure (B.P.) - Definition: This is the force/pressure exerted by the blood against an arterial wall. SYSTOLIC blood pressure is the degree of force (maximum) when the heart is pumping (contracting). - Systolic: is the pressure of the blood ejected from the left ventricle (contraction) at the height of the wave and blood is pumped into the aorta. - The DIASTOLIC blood pressure is the degree of force (minimum) when the heart is relaxed. - Diastolic: is the pressure of the blood at the low point in the wave when the ventricles relax and there is minimal pressure exerted against the arterial walls. - The difference between the two is known as the Pulse Pressure. B.P. is an index to: - Elasticity of arterial walls/allows for arteries to stretch  - Efficiency of the heart as a pump (to receive increased amounts of blood pumped into the arteries) - Blood volume - When the walls of the arteries are diseased, the walls will thicken and there is less space for the blood to flow which will increase the blood pressure (the walls will distend= increase B.P.) A ↓ in blood volume will also ↓ blood pressure because there is a ↓ in fluid within the arteries. Normal Ranges: - Adult Systolic: 90–120 mmHg. - Adult Diastolic: 60–80 mmHg. Key Points - Hypertension: greater than 140/90mmHg - Hypotension: less than 90/60mmHg. - The average blood pressure for a healthy adult is: 120/70 mm Hg - Measured with a sphygmomanometer (mercury or aneroid manometer) and stethoscope (for auscultation). - Sphygmomanometer: is a pressure-measuring device Factors Affecting B.P. - exercise (BP rises with physical activity) - age (BP increases with age - arterioles walls are less elastic and are unable to stretch and dilate) - shock (sepsis—response to an infection) will decrease your BP significantly and blood flow) - hemorrhage (causes a severe drop in BP) - time of day (BP is low in the morning and rises in the afternoon) - anxiety (increase) - after a meal (increase) Facts: - Years ago, Europe adopted the practice of taking blood pressure from both arms as part of heart disease screening and it can be used because there may be differences in blood pressure readings taken from the left and right arms. - This may be a sign of heart and blood vessel disease and death risk, according to research. - Researchers found that a difference of 15 points or more in the readings between the left and right arms raised the risk of peripheral vascular disease, a narrowing or blockage of the arteries, by two-and-a-half times. - That same 15 point-difference in systolic readings (the top number in a blood pressure reading) also increased the risk of cerebrovascular disease by 60%. Cerebrovascular disease is associated with thinking problems, such as dementia, and an increased risk of stroke. - Researchers say the results suggest that doctors should routinely compare blood pressure readings from both arms to prevent unnecessary deaths. 5. Oxygen Saturation (SpO2) - Is used to measure the saturation of hemoglobin (SaO2) - Normal Range: 95%–100%. - A value of less than 85% indicates that the tissues are not receiving adequate O2 Measurement Tool - Pulse oximeter: Attached to fingertip 6. Neurovital Signs - Palpate major arteries, bilateral B.P. → Increased B.P., decreased pulse rate, irregular breathing (signs of increased intracranial pressure) Cushing Reflex--Triad – → This occurs when the ICP is too high the elevation of blood pressure is a reflex mechanism to maintain CPP (cerebral perfusion pressure). High blood pressure causes reflex bradycardia and brain stem compromise affecting respiration - Increased temperature (damage to hypothalamus or infection). - Depressed fracture  - Check nostrils, and ears for blood or spinal fluid drainage (fracture or subdural haematoma). - caused by stroke, trauma, hemorrhage, ischemia, meningitis, tumours etc Topic 15 1. Breathing Difficulties Key Terms - Eupnea: Normal, quiet breathing (at rest). - Apnea: Absence of breathing. - Orthopnea: Ability to breathe easily only in an upright position. - Dyspnea: laboured or difficult breathing. Dyspnea is a symptom of a variety of disorders and is primarily an indication of inadequate ventilation, or insufficient amounts of O2 in the circulating blood. Dyspnea can be symptomatic of a variety of disorders, both acute and chronic. Causes of Dyspnea - Acute: → conditions causing dyspnea such as pulmonary disorders including acute infections and inflammations of the respiratory tract, obstruction by an inhaled foreign object, anaphylactic swelling of the tracheal and bronchial mucosa. It also includes cardiovascular diseases or traumatic injury to the chest. - Chronic: → disorders causing dyspnea usually fall into the category C.O.P.D. or are associated with pulmonary edema and congestive heart failure (CHF). A fat embolism resulting from a fracture of a long bone can cause dyspnea. - Special Case: Treatment: - help relieve anxiety and improve ventilation. The patient should respond favorably to a calm, reassuring manner and an explanation of what is being done to relieve the shortness of breath. Positioning: - a High Fowler's position (head elevated 80°-90°)or orthopneic position with the arms resting on pillows on an overhead table will help improve chest expansion. ORTHOPNEA: - ability to breathe easily only in the upright position. 2. Fractures Types of Fractures 1. Simple: - A fracture of the bone with no piercing of the skin; therefore, no communication with the environment. 2. Compound (Open): - A fracture/break of the bone that pierces the skin (shattered ends forced through the skin) and communicates outside with the environment. It is considered an open wound - There is a very high risk of infection if external pathogens enter through the wound into the body. 3. Comminuted: - A fracture of the bone with no piercing of the skin; therefore, no communication with the environment. 4. Impacted: - one end of the fractured bone is wedged into other fractured end; considered stable 5. Compression: - the vertebral column is compressed, and the pressure exerted on the vertebral column will cause a fracture of one or more vertebrae; which usually occurs after a person falls. Higher prevalence with elderly, and history of osteoporosis 6. Greenstick: - A break on one side of the bone and a bend on the other side; common in children but considered a stable fracture. - Greenstick fractures occur when the young, soft bone bends and incompletely breaks (in half). One side of the bone is broken but the other side is bent. Greenstick fractures usually occur most often during childhood when bones are soft. 7. Depressed: - Fractured skull where the bone is pushed in (skull) 8. Spiral: - A torsion fracture where the bone has been twisted apart; Considered an unstable fracture. - Spiral fractures are complete fractures of long bones that result from a rotational force applied to the bone. Spiral fractures are usually the result of high energy trauma and are likely to be associated with displacement Signs and Symptoms - pain at or near site made worse by movement of injured part - swelling because of loss of blood pooling into tissues at the site - tenderness - loss of control -- unable to move part - deformity, angulation, shortening, depression, rotation - unnatural movement unless impacted - Crepitus (grating or cracking sound) - Shock: levels will vary depending on severity of injuries and will increase with loss of blood from circulation Treatment Principles - Support: → both ends of the injury (proximal and distal) - Immobilize: → To prevent further injury (pneumatic splints in ambulance) - Splint: → to support/immobilize injury Stable versus unstable fracture: - The ends of the fractured bone must be in correct alignment to be considered stable. Stable fractures typically require conservative treatment (reduction and cast); unstable fractures typically require surgery with internal fixation devices). 3. Wounds Types 1. Laceration: - is a deep flesh/skin/soft tissue cut or wound that may be irregular in shape and may become contaminated with bacteria and debris from the object that caused that wound. Example: stab and gunshot wounds 2. Abrasion: - is a scrape/wearing away of the outer/superficial layer of the skin. This may happen when one slips and scrapes a part of the body on a rough surface 3. Contusion (Bruise): - is a bruise/injured capillary vessel. The small blood vessels below your skin rupture and blood leaks into the surrounding tissue. The outer layer of the skin is not affected. To control pain, bleeding, and inflammation, keep the muscle in a gentle stretch position. → Rest: Protect the injured area and keep off of it/avoid activity. Could use protective devices such as crutches, splints, slings → Cold compress/Ice to decrease inflammation 20-30 min : (Remove ice compress for 20- min) → Compression: Wrap the injured area in a soft compression bandage for 48 hours → Elevate the injured site to reduce swelling; elevate higher than the heart → See physician/physio → For pain relief over-the-counter meds--Acetaminophen 4. Avulsion: - A part/fragment of bone is detached or pulled/separated by a ligament/tendon. Large avulsion may require surgery due to ligament tear. Smaller avulsion requires resting the extremity and icing. Ex: trauma or sports-related injury 5. Edema: - is another word for abnormal swelling or puffiness of soft tissues due to leaking fluid from blood vessels. The swelling can occur due to an inflammation, infection or injury. - Swelling of the lower limbs is referred to as peripheral edema. Pregnant women and elderly people often get edema. CHF, liver and kidney disease can also cause edema. → Avoid: sitting or standing for long periods of time; Elevate legs when possible → Flying: stretch your legs often walk as much as possible/wear support stockings → Driving: stop to stretch your legs and walk → Medication: most common diuretic is furosemide (Lasix) 6. Ecchymosis: - is an escape/seepage/extravasation of blood into soft tissues/skin from ruptured blood vessels. 4. Bandages and Splints - Bandages promote healing by preventing damage to a patient’s wounds and skin by: → holding dressings on a wound → offering the patient comfort, support and security → Provides needed compression → Provides immobilization with splints → Corrects any deformities The following principles guide the technologist’s actions when applying bandages: - Medical asepsis is observed when applying bandages. - The body part to be covered should be cleaned and dried thoroughly before applying a bandage. - Placing and supporting the body part to be bandaged in the normal functioning position prevents deformities and discomfort and enhances circulation to the body part. The bandage is applied with sufficient & even pressure to provide the amount of immobilization or support desired, to remain in place, and to secure a dressing if one is present. To help prevent undue and uneven pressure on tissues, the tension of each bandage turn should be equal; unnecessary and uneven overlapping of turns should be avoided. Bony prominences must be padded. Leaving a small portion of a bandaged extremity exposed, such as the fingers or toes, allows the technologist to assess the extremity for proper circulation. An extremity should be bandaged toward the trunk to promote venous return and impaired circulation in the distal part. A well-applied bandage is comfortable, durable, neat, and clean. This is important for the patient’s emotional security as well as for promoting the best possible physiologic functioning of the body. Bandaging Types 1. Roller Bandages: - A roller bandage is a continuous strip of material that is wound on itself to form a cylinder or roll. Plain gauze, elastic webbing, and stretchable (Ace) roller bandages are made in various widths (1" to 8") and lengths. - Roller bandages provide one of the simplest forms of immobilization and support. They are used to support and protect an injured body part and to secure an improvised splint. 2. Triangular Bandage (Sling): - A sling is used to support and immobilize an injured shoulder or arm. Most health care facilities use commercial strap slings or sleeve slings. In the home setting, a large piece of cloth (muslin) folded into a triangle can be used as a sling. Common and Basic Turns for Roller Bandage: - Circular Turns: → the bandage is wrapped around the body part with complete overlapping of the previous bandage turn; used primarily for anchoring a bandage where it is begun and where it is terminated. - Spiral Turns: → the bandage ascends in a spiral manner so that each turn overlaps the preceding one by half or two-thirds the width of the bandage; useful when the body part being bandaged is cylindrical (wrist, fingers, trunk, ankles). - Figure-8 Turns: → a series of oblique overlapping turns that ascend and descend alternately; each turn crosses the one preceding it so that it appears like the Figure 8; effective for use around joints (knee, elbow, ankle, wrist). Sling Application: - Position the longest side of the triangle approximately along the patient’s midline. Place the triangle’s point at the elbow. Then, cradle the injured arm between the triangle’s two halves. Interphalangeal joints should be exposed to ensure that there is no impairment of circulation. - To prevent nerve damage leading to wrist drop, make sure the sling’s midline edge extends to the proximal interphalangeal joints of the patient’s fingers. Also, to reduce swelling, arrange the sling so that the patient’s hand is elevated slightly above the elbow. - Knot the two ends of the sling loosely, but securely, around the patient’s neck. Never position the knot over the cervical vertebrae -- this can cause nerve damage! - A 4" X 4" gauze pad may be placed under the knot to protect the patient’s skin and to keep the knot securely positioned. - Use a safety pin to fasten the sling at the elbow. - When the sling is applied properly, the patient’s injured arm should be immobilized so that the elbow is at a 900 angle, as shown. Topic 16 Prévention des infections, Principes et Technique de Manipulation du Matériel Strérile 1. Core Principles of Surgical Asepsis Definition and Scope - Surgical Asepsis and Sterilization: → The procedure used to prevent contamination of microbes and endospores before, during, and after surgery using sterile technique. → The complete destruction of all organisms and spores. → The absolute killing of all life forms is termed sterilization. → If proper sterilization techniques are used, the probability of infection is theoretically zero. When Required: - Invasive medical procedures (e.g., surgeries, catheterization, sterile dressing changes). - Diagnostic imaging involves invasive techniques, such as angiography. - Use of interventional tools like C-arms in surgical suites. 2. Standards of Practice-OTIMROEPMQ - Cleaning is an essential step in achieving maximum efficiency during disinfection and sterilization processes. It removes foreign matter, such as dust, dirt and organic matter. Cleaning makes it possible to physically remove the microorganisms without destroying them. - Flat surfaces and fabric objects (e.g. cushions, covers, pressure cuffs, table examination or treatment) must be cleaned regularly, whenever they are soiled or between each patient. - Cleaning should be done with water and detergents and then be completed with a low level disinfectant, if there has been a spill of blood or any other biological material. 3. Sterile Field Management - Sterile Field: A contamination-free area where sterile instruments and materials are placed. Rules:  - Prepare the field just before use to minimize airborne contamination. - Always keep the field in view and never leave it unattended. - Avoid reaching over, leaning against, or turning your back on the sterile field. - Only sterile personnel may interact with the sterile field. Sterile Draping and Coverage - Drapes are used to isolate the sterile field and maintain asepsis. - Single-use, impermeable drapes are preferred. - When contamination occurs, cover affected areas with sterile towels or replace the drapes. 4. Standards of Practice-OTIMROEPMQ P.1 Classification System - Critical Instruments: → Critical instruments, such as bronchoscopes and probes, penetrate sterile tissues and pose a high infection risk if contaminated, particularly by spores. These items require meticulous cleaning followed by sterilization. Using agents that destroy all microorganisms before reuse. - Semi-Critical Instruments: → Semi-critical equipment, such as thermometers, speculums, and endovaginal or rectal transducers, contacts non-intact skin or mucous membranes without penetrating them. These items require meticulous cleaning followed by high-level disinfection. In some cases, intermediate-level disinfection may be acceptable based on the equipment's use and purpose. - Non-Critical Instruments: → Non-critical devices, such as examination tables, stethoscopes, pressure cuffs, and oxygen saturation monitors, contact intact skin but not mucous membranes. These items require low-level cleaning and disinfection using chemical agents effective against vegetative bacteria, enveloped viruses, and certain fungi. Equipment cleaning-Standards of Practice-OTIMROEPMQ - Materials should be soaked immediately to prevent organic matter from drying. Detergents, enzymatic products, or high temperatures, with or without mechanical aids, help eliminate organic matter. Afterward, equipment must be thoroughly rinsed to  remove dirt and cleaning agents, prevent stains, and ensure complete cleanliness. Distilled or deionized water may be required for rinsing in some cases. - Finally, drying is an important step. It prevents microbial proliferation. It is important to proceed to immediate drying. In addition, it is important to mention that bacteria proliferate on surfaces because that they are hydrophobic (insoluble in water). When non-sterile surfaces are damp or wet, they can become covered with a biofilm (a layer of bacteria trapped in an extracellular substance) which can protect bacteria against disinfection and sterilization. Cleaning of surfaces and fabric objects-Standards of Practice-OTIMROEPMQ - Regular cleaning of flat surfaces and fabric objects, such as covers and pressure armbands, prevents dirt, dust, and pathogens from accumulating and supporting microbial growth. Surfaces should be cleaned with water and detergents whenever soiled or between patients. Antiseptics should not be used on inanimate objects. For blood spills, gloves, and protective gear like gowns and goggles are necessary, with used towels disposed of in designated containers. After cleaning, surfaces must be sanitized with a low-level disinfectant. Disinfection: Standards of Practice-OTIMROEPMQ - Disinfection: is the de-activation of pathogenic microorganisms. However, it does not destroy the spores. Disinfection is generally performed using the three methods : chemicals, pasteurization (heat) or ultraviolet rays. - The level of disinfection depends on: → contact time → temperature → degree of soiling → type and concentration of active ingredients in the disinfectant → nature of the contamination - If a soaking solution is used, the expiration date should be indicated and the solution should be changed as soon as it expires. Disinfection Levels - High-Level Disinfection: → High-level disinfection is required for reusing semi-critical equipment. It eliminates most pathogenic microorganisms on inanimate objects, except bacterial spores. - Intermediate-Level Disinfection:  → Intermediate-level disinfection is used for some semi-critical items, destroying vegetative bacteria and most fungi but not resistant bacterial spores. - Low-Level Disinfection: → Low-level disinfection is required for non-critical equipment or surfaces. It removes dirt, dust, and foreign material while destroying most vegetative bacteria, some fungi, and enveloped viruses, but does not eliminate mycobacteria or spores. Sterilization Standards of Practice-OTIMROEPMQ - Sterilization is the destruction of all forms of microbial life including bacteria, viruses, spores and fungi. For sterilization to be effective, the equipment must, before everything, be cleaned thoroughly. - The sterilization method is determined by the manufacturer's recommendations, the material being sterilized, and the available methods at the establishment, following the Infection Control Committee's standards. Responsibilities of the TECHNOLOGIST-SOP-OTIMROEPMQ - It is important to know the codes used in the establishment concerning the identification of equipment that has been subjected to sterilization or not. - For private clinics or other establishments that do not have a prevention committee infections, it is suggested to validate the practice with such a committee in an establishment located nearby, with the manufacturer or by referring to documents provided by Health Canada. Reuse of single-use equipment-Standards of Practice-OTIMROEPMQ - In general, the sanitization of single-use equipment is prohibited, as stipulated by the standards of manufacturers. At all times, the establishment is responsible. Recovery of reusable material and equipment SOP-OTIMROEPMQ - The cleaning of non-disposable equipment should be subject to procedures approved by the Committee of Infection Prevention in the establishment. Any reusable equipment or material that is recovered should be cleaned and sanitized (if applicable) before being stored again. Disassembly and cleaning of soiled equipment must be carried out in a room other than that used for the storage of clean equipment. Material Storage Standards of Practice-OTIMROEPMQ  - The packaging, the aeration time of the gas sterilized material, the handling of the sterile material and invasive monitoring equipment should comply with local policy. Sanitized equipment should be stored in a place protected from moisture, dirt and dust. They must be used before the expiration date. A program comprising a procedure and a register must be put in place to ensure a rotation of equipment and the possibility that it is used in a timely fashion. 5. Hand Hygiene: The Cornerstone of Infection Control Importance: - Hands are a major route for transmitting infections, with many microorganisms found under the fingernails, especially when hands are gloved. Therefore, handwashing is a crucial measure to prevent nosocomial infections. When to Wash Hands: - After any contact with the skin of a patient and before coming into contact with the next patient - Before an invasive procedure (eg: I.V. injection, catheterization, urinary catheter) - Before any contact with a patient in isolation or a patient from ICU - When the hands are visibly soiled - Between certain actions carried out on the same patient when there is a risk of hand contamination, in order to avoid cross-contamination - Following procedures where hands are at risk of being contaminated with microbes, body fluids, secretions, excretions or blood - After contact with items of known and probable contamination - After removing the gloves - Before preparing, handling or eating food - After using the bathroom or blowing your nose - Hand washing with ordinary soap is indicated to ensure current health care. However, it is not recommended to use a bar soap, as microorganisms can remain in suspension on the soap - Wearing jewelry at work is not recommended, it can harbor microorganisms that are not necessarily eliminated during washing Hand Lotion Standards of Practice-OTIMROEPMQ  - The lotion promotes adequate hydration of the skin and maintains its integrity. It must be checked whether the lotion is compatible with antiseptic products and what are its effects on integrity of gloves. The lotion container must be disposable to avoid colonization. Hand washing with soap or antiseptic solution is indicated: - In situations where there is a strong microbial contamination (infected wounds, faeces); - Before an invasive procedure - Before any contact with patients with an immune deficiency, integument (burns) or percutaneous implants - Before and after contact with patients infected with an organism resistant to antimicrobials. - When the hands are visibly soiled with dirt, blood or other matter, they should be washed with soap and water to remove visible dirt before using a antiseptic hand rinse. - The use of waterless antiseptic agents are an attractive alternative to hand washing when access to water is difficult. However, it is recommended to wash your hands with soap and water as soon as possible, as recommended by the maker. Antiseptic hand washes are more effective than soap and water in reducing contamination of hands. They should be favored if you want to have an antimicrobial action remanent on the hands (eg: installing a catheter or an intravascular device). 6. Personal Protective Equipment (PPE) - Wearing gloves is not intended to replace hand washing. It is considered as additional protection. Hands can be contaminated when gloves are removed or if they have a defect. It is therefore recommended to wash your hands after removing gloves and before touching a clean surface. - Gloves are not required to provide routine care, if contact is limited to intact skin Wearing non-sterile gloves is required: - exuding wounds or non-intact skin - When exposure to potentially infectious materials (pus, stool, respiratory secretions) - When handling items visibly soiled by blood, body fluids, secretions or excretions - When the technologist's skin is not intact - During an injection. Wearing sterile gloves is required: - For any procedure in which the hand or the instrument used enters a body cavity or sterile tissue Gloves must be changed: - From one patient to another - When the glove is torn - Between care given to the same patient after having been in contact with likely to contain high concentrations of microorganisms (e.g., installation of probe or other equipment). - Single-use gloves should not be washed or reused. Frequent wearing of gloves containing latex could be responsible for the increased contact allergies to latex. Vinyl gloves can then replace latex gloves in allergic subjects. However, one must make sure with the manufacturer that these constitute an adequate barrier to microorganisms of all kinds. Wearing non-sterile clothing or accessories - All measures that affect the wearing of non-sterile clothing or accessories (e.g.: gloves, mask, gown) and which provide a protective barrier between people and potential sources of contamination, including handling of contaminated material (guides, catheters), or piercing or cutting objects (needles, scalpels), are preferred during handling procedures. Wearing of mask, protective glasses and face shield - Mask, goggles and face shield should be worn when there is a risk of splashes or projections of droplets of blood, body fluids, secretions or excretions, to protect the mucous membranes of the nose, mouth and eyes. - In some situations, surgical masks may not be sufficient to prevent inhalation of droplets. In cases of airborne infections such as tuberculosis, it is recommended to wear masks with a higher filtration capacity and whose performance is recognized for this type of infection. (N95) Wearing the gown - Systematic wearing of the gown is not recommended except when specific measures indicate it. However, this must be worn to protect skin and clothing from splashes or projections of droplets of blood, body fluids, secretions or excretions. Wearing clothing or accessories in the presence of sterile material  1. Wearing shoe covers, cap, gown and mask is indicated and recommended, for all personnel having to enter an intervention room, and consequently, placed in the presence of sterile equipment, to wear clothes and accessories (e.g. shoe covers, gown, mask and cap) in order to maximize the asepsis of the premises and reduce the risk of contamination of sterile equipment. (Operating Room) This contamination can be caused by the projection of saliva, sneezing, falling dandruff or hair, soiling of shoes. On the other hand, wearing clothes and of accessories creates a protective barrier and avoids contact with blood or other body fluid from material or splash. 2. Wearing a sterile gown: - The systematic wearing of the sterile long gown, worn over clothing, is indicated for the technologist who "brushes" himself against and who assists the specialist (internal), with on the one hand to ensure the total asepsis of the equipment and on the other hand, to ensure protection against splashes and splashes of blood. - Special care should be taken by the person wearing the sterile gown to avoid contamination by brushing nonsterile objects, instruments and devices the room. When in doubt, it is essential to remove the gown and put on another sterile one. Wearing a sterile gown does not apply to external staff (who do not assist the specialist) but special attention should be paid to avoiding brushing or touching people wearing sterile gowns. 7. Standards of Practice-OTIMROEPMQ P.2 Patient Care Equipment Standards of Practice-OTIMROEPMQ - Some equipment must be cleaned and disinfected from one patient to another, with a disinfectant solution, especially when there is suspicion of transmission of infection by contact or by droplets. Indeed, studies have shown that there can be contamination by microorganisms such as MRSA (methicillin resistant Staphylococcus aureus). Routine Practices, Additional Precautions & Biomedical Waste Management - The technologist must know and respect the procedures established by the Committee for the Infection Prevention of the establishment or an associated establishment, with regard to precautions, additional (isolation techniques, procedures in the event of  contamination) and the management of biomedical waste (body fluids, specimens, needles, catheters). Vaccination of Health Professionals SOP-OTIMROEPMQ - Annual influenza vaccination is recommended for all healthcare workers, especially those who have contact with members of high-risk groups. Prophylaxis Standards of Practice-OTIMROEPMQ - Prophylaxis is all the medical means implemented to prevent the onset, worsening or spreading illnesses. Prophylaxis encompasses all procedures established and implemented in the event of exposure to accidental pathogens or diseases transmitted by blood. - Protocols should be in place for accidental contamination. The technologist must be familiar with and follow the required sanitary and medical procedures, such as using specific cleaning products and taking prescribed medications, following any accidental exposure. - In the event of accidental contamination with pathogens, a rapid and appropriate prophylaxis reaction and provides a better chance of decontamination. Medical measures taken (through the health service, emergency) provide significant therapeutic and psychological support to the exposed person. Medical monitoring of exposed personnel should be carried out by the Health Service of the establishment. Principles and Handling Techniques of Sterile Material-- SOP-OTIMROEPMQ - Respect for the basic principles of asepsis is essential during an intervention in order to ensure patient safety. All sterile equipment (e.g. catheters, guides, syringes, needles, worktable, drape, screen cover, amplifier cover) required for the examination or procedure must be subject to special handling in order to '' avoid contamination”. - It is important to simplify the procedures in order to reduce the risk of contamination. Room spacing, adequate lighting and worker confidence are also factors to consider in reducing the risk of contamination. The principles and techniques for handling the following sterile material should be known and applied by the technologist who participates, directly or indirectly, in a sterile procedure: → Wearing a gown, cap, mask and shoe covers is required in the presence of a sterile table or sterile drape  → The gown is considered sterile in front of the shoulders to the level of the sterile field and sleeve length, from shoulders to wrists → Gloved people must handle sterile material or touch sterile areas → Open the trays so as to touch only the outside and place the sterile material on the sterile table by opening the packaging so as not to touch or brush this material → Open and present the instrumentation to the person wearing the gloves properly, avoiding the material touching the ground (e.g. catheter), brushing against a non-sterile object or droplets (e.g Proviodine, sterile water) sliding down the container when the technologist pours the liquid, which immediately contaminates the worktable) → Sterile equipment only should be used inside the sterile field → Actions performed inside or near the sterile field must be limited in order to not contaminate the area; → Touch the patient or adjust a non-sterile device, below the sterile drapes, if possible → Handle non-sterile material away from the sterile field or work table. The use of accessories (extension, tubing, adapter) must be encouraged in order to increase the distance between non-sterile equipment (e.g. automatic injector) and the sterile field → Avoid passing your arms over a sterile table or drape → Avoid walking between two sterile fields Avoid turning your back on sterile drapes in tight spaces → Keep the front of the sterile gown from all contact when it is necessary to be near the patient; → Apply strict control over the sterilization of equipment; → Questionable sterile material should be considered contaminated as well as sterile areas that may have been affected. 8. Sterilization Methods - MITs are not directly involved in all the processes of sterilization; most sterile instruments are typically obtained from the CSR (Central Sterile Supply). - Disposable syringes, needles, catheters, and intravenous devices are prepackaged sterile from the manufacturer. There are five methods for sterilizing radiology instruments and equipment, with some methods being more reliable than others. 1. Boiling:  - Boiling is a simple method of water disinfection using moist heat. Rarely used or non-disposable items that are needed quickly can be sterilized by immersing them in boiling water (212°F or 100°C) for 30 minutes to kill most pathogens. Adding sodium carbonate (NaCO3) in a 2% solution can make the process more effective, reducing the boiling time to 15 minutes. - This method has no indicator and several organisms are resistant to boiling and is, therefore, unacceptable in providing surgical asepsis. 2. Chemical Sterilization: - sterilization involves soaking clean instruments in a bath of germicidal solution. Sterilization depends on the solution strength, temperature, and immersion/soaking which are all difficult to control accurately. - Soaking time for thorough surgical asepsis is between 6 to 10 hours. Contamination of the solution or the object being sterilized may occur, therefore, chemical sterilization is one of the least suitable methods for providing surgical asepsis. 3. Autoclaving (Pressure Steam): - A device (autoclave) sterilizes items with steam under pressure in a non-toxic means. It is the most widely used, quickest, convenient and most dependable means of sterilization for instruments that can withstand heat. It has the ability to penetrate fabrics. Each item/instrument is exposed to direct steam at the required temperature and pressure for a specified time. - Higher temperatures can be achieved under pressure, making this an extremely effective method. Moist heat (121°C or 250°F) for 15 minutes effectively kills microbes AND spores. - One advantage is that indicators (tape) change colour when the required sterilizing conditions have been met. 4. Dry Heat: - : is used only when moist heat is not advisable; done in an oven. Requires higher temperature and longer time than wet heat. Time needed for sterilization varies; average of 2 hours at a temperature (320°F or 160°C). Exposure does not include the time to obtain the temperature required, (heating lag). - This method is rarely used in hospitals. It is used to sterilize bulk powders, and delicate cutting instruments. - Moist heat however is more effective and faster than dry heat - Advantage: penetrating power.  - Disadvantage: long time 5. Gas Sterilization: - sterilization is used primarily for instruments that will be damaged by high heat sterilization methods, (electrical, plastic, and rubber instruments, such as telephones, stethoscopes, B.P. cuffs , etc) - It can be an effective method but has one big disadvantage; the gases are poisonous and must be dissipated by aeration. It is thus recommended to send these items for gas sterilization in advance as the process is very slow and must be conducted in a controlled environment. Chemical identifiers are placed on a package containing items that have been sterilized by CSR with expiration dates. They change colour when the required sterilization conditions have been met. The MIT is responsible for ensuring the wrapped packages or trays are indeed sterile based on the indicators and integrity of the package. - Antiseptic: a topical agent that inhibits the growth of micro-organisms. It is a type of disinfectant which destroys or inhibits growth of microorganisms on living tissues such as skin; ie: hands (ex: iodine, hydrogen peroxide, alcohol) - Disinfectant: an agent that destroys as many as possible pathogenic organisms. Antimicrobial agents that are applied to non-living / inanimate objects (fomites, equipment, surfaces) to destroy or inhibit growth of pathogenic microorganisms; ie: ethanol alcohol, chlorine, dimethyl benzyl ammonium chloride. → An antiseptic is applied to the body, while disinfectants are applied to nonliving surfaces (fomites/inanimate objects). A Disinfectant can be used topically as an antiseptic. - Common chemical disinfectants in the radiology department include halogens like chlorine and iodine, which are bactericidal. Chlorine, found in bleach, is a strong oxidizing agent and is typically used on inanimate objects. - The effectiveness of chemical disinfectants is subject to concentration, temperature, time of exposure, types and numbers of microbes, and the nature of the object or person being treated. It is important to read all manufacturers’ labels carefully to ensure maximum effectiveness. - Sterilization: a process that destroys all micro-organisms and their spores.  - It is the responsibility of the technologist to familiarize himself/herself with the codes used in the institution to ID items that have been sterilized. - Responsibility of the technologist: be familiar with the codes used in the institution to identify items that have been sterilized or not. 9. Packaging and Storing Sterile Supplies - Please note expiration date on sterile packages. - If no date, consider unsterile and discard - Items wrapped in cloth or paper that are sterilized in hospital are considered sterile for 30 days if stored in a closed cupboard, and sterile for 21 days if kept on an open shelf. - Items sealed in plastic are considered sterile for 6-12 months. - Commercially sterilized articles considered sterile until seal is broken or until expiration date has passed. - CSR=Central Supply Room SOP, OTIMROEPMQ - Packaging, aeration time of gas sterilized equipment, handling of sterile equipment and of invasive monitoring equipment must comply with local policy. - Sanitized equipment should be stored in a place protected from moisture, dirt and dust. It must be used before the expiry date. - A program comprising a procedure and a register shall be put in place in order to ensure a rotation of the equipment and the possibility A program comprising a procedure and a register must be put in place to ensure a rotation of equipment and the possibility that it is used before the expiry date. Rules for Surgical Asepsis - Develop a "sterile conscience" - an awareness of sterile technique and the responsibility for telling the person in charge when you contaminate a field or observe its contamination by someone else. 10. Standard Principles Regarding Surgical Asepsis - Any sterile object or field touched by an unsterile object or person becomes contaminated. Never reach across a sterile field. Organisms may fall from arm into the field. Reaching also increases the chance of brushing the area with your uniform.  - If you suspect an item is contaminated, discard it. This includes items that are moist and items that have a broken seal or an indicator tape with the "wrong" colour. - Do not pass between the physician and the sterile field. - Never leave a sterile area unattended. - The outer 1 inch edge of a sterile field is considered contaminated. - Avoid talking, coughing, or sneezing. This will prevent droplets from the nose or mouth to contaminate the field. N.B. Technologists use the principles of medical and surgical asepsis to prevent nosocomial diseases and to protect themselves from infections. 11. Medical vs. Surgical Asepsis: - Medical asepsis reduces the spread of microorganisms. - Surgical asepsis involves the complete removal of microorganisms and spores. Surgical Asepsis Process: - Requires cleaning with medical asepsis followed by sterilization. Applications of Surgical Asepsis: - Used in invasive medical procedures such as: - Surgeries - Interventional procedures in DI departments - Parenteral medication administration - Catheterization - Tracheostomy care - Dressing changes MIT Responsibilities: - Skin preparation: Clean and shave the area before invasive procedures to prevent contamination. - C-arm use: Understand surgical asepsis to avoid contaminating the sterile field in the operating room. → Whether a C-arm or a mobile x-ray unit is used in the OR, the MIT must be aware of the corridor that he must travel to obtain the image(s). → The corridor is between the instrument table & sterile drapes on the operating table. They must take care not to come in contact with the sterile fields. 12. Infection Control Standards Three zones are found in the OR to decrease the risk of infection: - Zone 1 (Unrestricted): → No dress code; accessible to all hospital staff. - Zone 2 (Semi-Restricted): → Requires scrub suits, caps, and shoe covers. - Zone 3 (Restricted): → Strict PPE use, including masks and gloves. Sterile Drapes and Equipment: - Store sterile drapes and equipment in contamination-free areas. - Be aware of the sterile field and instruments during procedures. - Discard and replace any contaminated items. Operating Room (OR) Environment: - Special ventilation and filtration are required to prevent dust particles. - Airflow and humidity must be controlled. - OR traffic must be limited. Imaging Equipment: - Clean imaging equipment with disinfectant before entering the OR. 10. The Surgical Team: - Surgeon: The physician who plans and performs the surgical procedure and makes surgical decisions. - Surgical assistant: Usually, another surgeon or surgical resident; there may be several assistants - Anesthesiologist: A physician specializing in anesthesia who decides the type of anesthesia required. - Nurse anesthetist or technician: These specialists received education in anesthesia and administer anesthesia and monitors the anesthetized patient under the supervision of the anesthesiologist. - Circulating nurse: Oversees the safety of the patient and maintains the surgical environment; is dressed in scrub suit, cap, mask, and shoe covers, but is not clothed in sterile attire. - Scrub nurse or scrub technician: Dons sterile attire and sets up the sterile fields for the surgery. Assists the surgeon by presenting sterile instruments and sterile equipment needed during the procedure.  - Medical Imaging Technologist: Present at request of the surgeon to perform imaging procedures; is clothed in a scrub suit, cap, mask, and shoe covers. 11. Sterile Fields - Personnel must be clothed in a sterile gown and sterile gloves if they are to be considered sterile. - Any sterile instrument or sterile area that is touched by a nonsterile object or person is considered contaminated by microorganisms. - A contaminated area on a sterile field must be covered by a folded sterile towel or drape of double thickness. - If a sterile person’s gown or gloves become contaminated, they must be changed. - A sterile field must be created just prior to use. - Once a sterile field has been prepared, it must not be left unattended; it may become contaminated & presumed to be sterile. - An unsterile person does not reach across a sterile field. - A sterile person does not lean over an unsterile area. - A sterile field ends at the level of the tabletop or at the waist of the sterile person’s gown. - Anything that drops below the tabletop or sterile person’s waistline is no longer sterile and may not be brought up to the sterile tabletop. The only parts of the sterile gown considered sterile are the areas from the waist to the shoulders in front and the sleeves from 2 inches above the elbow to the cuffs. - The cuffs of the sterile gown are considered nonsterile because they collect moisture. Cuffs must always be covered by sterile gloves - The edges of a sterile wrapper are not considered sterile and must not touch a sterile object. - Sterile drapes are placed by a sterile person. The sterile person places the drapes on the area closest to him first to protect his sterile gown. - A sterile person must remain within the sterile area. He must not lean on tables or against the wall. - If one sterile person must pass another, they must pass back to back. The sterile person faces the sterile field and keeps sterile gloves above the waist in front of his chest. - The sterile person must avoid touching any area of his body. - Any sterile material or pack that becomes damp or wet is considered unsterile. - Any objects that are wet with disinfectant solution and are to be placed on a sterile field must be placed on a folded sterile towel for the moisture to be absorbed.  - A wet area on a sterile field must be covered with several thicknesses of sterile toweling or an impervious drape. - When pouring sterile solution, place the lid face upward and do not touch the inside of the lid or the lip of the flask. Pour off a small amount of solution before the remainder is poured into the sterile container. - When a sterile solution is to be poured into a container on a sterile field, the container is placed at the edge of the sterile field by the sterile person 12. Opening Sterile Packs - MIT must open commercially packaged sterile packs and place sterile objects on sterile fields without contamination. - Packs are usually wrapped in paper or plastic and sealed to maintain sterility. - Read the manufacturer's directions for opening to avoid contamination. - Never use sharp objects to cut or pierce the packs, and avoid tearing them or letting contents slide over the edges. - To open: Place the pack on a clean surface with the sealed end toward the radiographer, remove the outer plastic, and ensure the sealed end faces the MIT. - To move a sterile object to another sterile field or to pass a sterile object to a sterile person, grasp the underside of the wrapper and let the edges fall over the hand - Grasp the underside of the wrapper and let edges fall over hand. Take the item to the next sterile field and, from a distance, drop or flip it onto the field. Do not allow the edges of the wrapper to touch the sterile field  - Sterile forceps may be used to pick up a sterile object and move it to a second field. The forceps may be used for one transfer only - To pass a sterile object to a sterile person, grasp the underside of the wrapper as in and hold it forward to the sterile person so that he may take it. Do this away from the sterile field 13. Surgical Scrub Requirements for MIT: - MIT may need to perform the surgical scrub if required in the OR or special procedures rooms. Before entering the surgical suite: - Change into a scrub suit. - Cover hair with a cap, shoes with covers, and wear a mask. - Remove all jewelry, and cover ear studs with the cap. - If not scrubbing, perform handwashing for 3 minutes with antiseptic soap. - Surgical Scrub: Removes microorganisms from the hands and lower arms using mechanical and chemical methods with running water. - Anyone exposed to radiation must wear radiation-protective apparel before scrubbing. - Arms should be bare to at least 4 inches above the elbow. - Adjust water temperature and pressure, using foot or knee pedals if available. 14. Placing Image Receptors: - If the image receptor is needed after the procedure begins, the MIT may pass it to the scrub nurse in a sterile plastic bag, who then places it as directed by the MIT. - If the MIT places the receptor, the surgical team must clear space for them. - The MIT can place the receptor by raising the sterile drapes, touching only the inside of the drape, or the circulating nurse can assist by lifting the drapes. - If using a mobile C-arm, a sterile cover must be placed over it when positioned over the patient during fluoroscopy. 15. Radiation Safety during Imaging: - During multiple images or fluoroscopy, all non-scrubbed personnel should leave the OR if possible. - Scrubbed team members must wear radiation-protective apparel under sterile clothing and can step behind lead-lined shields.  - Leaded sterile gloves and other protective equipment must be worn if hands are exposed to radiation. - The MIT must wear a radiation detection monitor outside the lead apron and under the sterile gown, checking it at prescribed intervals. 16. Draping for a Sterile Procedure - Following the skin prep for a sterile procedure, sterile drapes may be applied. These are used to provide a barrier to infection and also to create a sterile field on which to place sterile instruments. - Usually, single-use, single-thickness, impermeable drapes are used; however, some cloth drapes may be chosen. Whatever the material is on hand, the process is the same. A fenestrated drape is often used, and, if so, the drape should be applied in such a way that the opening leaves only the operative site exposed. Topic 17 1. Skin Preparation for Sterile Procedures - The MIT may be asked to prep the patient's skin to remove microorganisms and reduce infection risks using both mechanical and chemical methods. - Shaving the hair in the area may be necessary to prevent microorganism growth. - A commercial skin prep pack is typically used for this process. Equipment: - Sterile gloves - Sterile prep tray that includes a sterile drape, two small basins, and a set of large sponges with handles to distance the operator’s hand from the site. The sponges are permeated with antiseptic soap - Basin of sterile water and basin of antiseptic solution - A sterile towel Procedure: - Allergies to antiseptic must be ruled out - Open the sterile pack and pour sterile water into one small basin and antiseptic solution into another.  - Don sterile gloves - An area approximately 6 to 10 inches in diameter should be prepped. - Dampen in sterile water one sponge or gauze with antiseptic soap - Begin by scrubbing in the center of the area to be prepared, cleaning outward in a circular motion with friction to remove microorganisms with the antiseptic soap; - Do not go back over the area of skin that has already been scrubbed - Drop the sponge off the sterile field once area is completed and repeat the procedure with a second sponge.prepped areas. - When scrub is done, the skin should be rinsed well with sterile water or lather wiped off without rinsing (institution’s procedure) - Blot the skin dry with the sterile towel or sterile gauze. - During the prep, if skin shows signs of irritation, stop the procedure and thoroughly rinse off the soap with sterile water and notify the physician. - Following the scrub, the skin around the area prepped area is often “painted” with an antiseptic solution to destroy some of the remaining microbes and acts as a deterrent to further microbial growth. - Agents commonly used for skin prep are chlorhexidine and hexachlorophene. Alcohol is not used on mucous membranes or on open wounds because it may cause harm. - If the skin is to be painted after the scrub, it is performed in a circular motion beginning in the center of the area to be prepped, working outward. Allow the skin to dry. - 4 × 4 sterile gauze is folded and picked up with sterile ring forceps and dipped into the basin of antiseptic solution. Note: chlorhexidine acetateis a disinfectant and antiseptic that is used for skin disinfection prior to surgery and to sterilize surgical instruments. 2. Bedpans and Urinals - When a patient makes a request to use the bathroom the technologist needs to respond quickly and in a matter-offact–manner. - If the patient is unable to use the bathroom the technologist will need to give the patient a bedpan/urinal on the table or in the bed. - Use gloves and make sure to wash your hands before and after handling the bedpans and or urinals. - Fracture bedpan: low wedge shape allowing easy in and out movement. 3. IV Setup IV Fluids: - Normal Saline and Lactated Ringer's are commonly used IV fluids in hospitals and clinics. Both are isotonic, meaning they have the same osmotic pressure as blood. - Osmotic pressure measures the balance of solutes (e.g., sodium, calcium, chloride) and solvents (e.g., water). - Differences: Lactated Ringer's has a different composition from normal saline, which causes it to not stay in the body as long, helping to avoid fluid overload. - Lactated Ringer's (LR): Used to replace fluids and electrolytes in patients who are dehydrated, have low blood volume, low blood pressure, or are undergoing surgery or IV medication. It contains sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. - Medical Imaging Use: Saline is often used in the Medical Imaging Department to flush contrast media or keep veins open (KTVO). IV Components: - Bag, drop counter, tubing clip for flow regulation. - The use of IV fluid pumps is the safest and most accurate way to deliver fluids to a patient. If there are no IV fluid pumps, IV fluids can still be administered by using IV drip lines, either via micro-drips or macrodrips. → Macro-drip (10–20 gtts/ml) → Micro-drip (60 gtts/ml). Preparation of materials for IV set up: - butterfly needle (also called a scalp vein needle or a winged needle) - - over-the-needle catheter for a prolonged infusion - - a tourniquet - antimicrobial swabs - clean gloves - IV infusion set that includes IV tubing and a drip chamber (Fig. 16-14) - clear adhesive dressing or tape for infusion - Saline solution - infusion pump, if required. Open the outer packaging from the infusion set; remove the protective covering, the drip chamber, and the insertion tip keeping these sterile. Hang the solution and displace all air from the tubing to prevent air emboli. Recap the tip of the tubing to maintain sterility Materials Usually Needed in the X-ray Department for I.V. Injections - Alcohol swabs - Needle, and syringes - Tourniquet - Prescribed drug - Adhesive tape/Tegaderm - Latex gloves - Catheter(s) if necessary 4. IV Infusion Tubing/Administration Set: - The infusion tubing connects to the IV solution bag. - Primary IV tubing can be either a macro-drip set (delivers 10, 15, or 20 drops/ml) or a micro-drip set (delivers 60 drops/ml). - Macro-drip sets are used for routine primary infusions. - When a peripheral vein has a cannula, extension tubing is connected to the cannula hub and flushed with saline to maintain patency. - Most peripheral intravenous cannulas have extension tubing (20 cm) with a positive pressure cap attached to reduce manipulation of the catheter hub. - Extension tubing should be changed every 72-96 hours if complications such as blockage, infection, or phlebitis occur. - TKVO (To Keep Vein Open) infusion rate is usually 20 to 50 ml per hour. 5. Handling IV Complications - Infiltration: → Turn off IV, apply a cold compress, and notify the physician. - Extravasation: → Signs: Pain, swelling, redness. → Actions: Stop infusion, apply hot/cold compresses as needed, elevate limb. → Complete an incident report. - IV Overload: → Symptoms: Tight chest, flushing, syncope. → Action: Stop IV and notify the physician immediately. → Slow Flow: Risks dehydration or inadequate medication delivery. 6. Common Sites for I.V. Injection Sites for Injection: - Adults: → the amount to be injected is small; Antecubital vein and veins in the forearm → the back of the hand for prolonged I.V. infusions. - Infants: Scalp veins, feet. Contraindications: - patients with a side affected by stroke, mastectomy or renal fistula should avoid having blood pressure readings on this side. If a patient has an IV catheter in one arm, use the other arm to take the BP reading to prevent potential damage to the catheter and interruption of administration of medication. 7. Care and Handling of I.V.s - I.V.s should be placed 18 to 24" above the level of the vein, because the height of the solution affects the rate of flow. → If placed too low, blood will flow back into needle. → If placed too high, it may cause fluid to infiltrate into the surrounding tissues; site is cool and swollen. - In case of infiltration, turn off I.V. and notify/call nurse or M.D. and add a coldcompress. It is uncomfortable it may cause tissue damage. Standard I.V. Drip Rate: - The standard I.V. drip rate is 15 to 20 drops per minute, delivering approximately 60 ml per hour (as determined by the physician). Risks of Infusion: - Too Fast (IV Overload): Can lead to excess fluid in the body, accumulating in the lungs, causing pulmonary edema or fluid intoxication. - Symptoms of Overload: Itching, chest tightness, headache, syncope (fainting), drop in BP and heart rate, flushing of the face, shock, and cardiac arrest. - Actions: Stop the IV immediately and notify the physician. IV infusion can only be discontinued without physician orders in emergency situations. Inadequate I.V. Flow: - A slower drip may not replace fluids quickly enough, leading to dehydration. - If the I.V. contains medication, it may result in inadequate dosage. If used for contrast, it may prevent proper visualization of the medium.  - The IV flow rate can be controlled using the clamp below the drip chamber. The microdrip chamber is used for keeping a vein open (TKVO) and accessible without the infusion a unnecessary amount of saline. It is important to spike an IV bag and prime/flush your IV tubing before connecting to the patient’s catheter port (air bubbles will go into patient) - May cause pulmonary embolus 8. Disposal of Equipment Gloves and Safety: - Wear gloves when handling objects contaminated by blood, or when inserting/removing an IV and disposing of catheters, tubing, and bags in garbage bins. - Needles: Dispose of syringes with needles or needles alone directly into a puncture-proof "sharps" container without recapping. Do not recap needles. - Recapping (if necessary): Place the cover on a firm surface and use one hand to insert the needle. Medication Administration Guidelines: - Always follow aseptic technique rules. - Label Checks: Read the medication label three times—before drawing it up, after drawing it up, and with the physician or qualified MIT before administration. - Confirm patient identification before administering medication. - Monitor the patient for potential side effects. 9. Discontinuation of I.V. on M.D.'s instructions: - Wash hands - Inform patient - Drip control closed - Adhesive holding catheter removed - Needle or catheter removed in a long smooth pull - Pressure applied to site with cotton ball or 2x2 gauze until bleeding stops 10. Drop Factor Calculations Common drop factors are: - 10 drops/ml (blood set), - 15 drops / ml (regular set), - 60 drops / ml (microdrop). To measure the rate we must know: - the number of drops - time in minutes Formula: ( volume (ml) x drop factor (gtts/ml)) ÷ time (min) - Example: 1500 ml IV Saline is ordered over 12 hours. Using a drop factor of 15 drops / ml, how many drops per minute needs to be delivered? → ( 1500 ml x 15 gtts/ml) ÷ ( 12 x 60)= 31 gtts/ minutes 11. Extravasation - Contrast medium are irritating to the tissue if infiltration occurs. It may also cause tissue necrosis. It is very painful and must be treated immediately. Signs to look for: - Pain, burning sensation or stinging at the site - Redness, swelling and leaking of the contrast media at the site Action to take: - Explain to patient what has occurred - Stop the infusion & call the Radiologist - Remove the needle Ice (Cold Compress) Advantages: - Relieves pain at the injection site. - Constricts blood vessels, keeping the infiltrate localized. Heat (Hot Compress) Advantages: - Improves absorption of extravasation. - Increases blood circulation, especially downstream of the injection site. Raising the Affected Arm: - Facilitates the resorption of the liquid. Incident Report: - An Incident Report Form must be completed. 12. SOP: Techniques d’injection - When preparing the vein for IV needle insertion with an alcohol swab rub in a circular motion over the injection site (starting in the center and moving towards the periphery) - In an up and down motion over the injection site for approximately 30 seconds - The area to disinfect should extend 5 to 8 cm around the injection site.