Chapter 14 Immobilization Techniques PDF

Chapter 14 Immobilization Techniques 1 Objectives (1 of 2) ˜ ˜ ˜ ˜ Demonstrate a range of immobilization techniques. Explain the importance of high-quality communication with the patient. Describe reduction of patient radiation exposure by using proper immobilization methods. Apply immobilization te...

Chapter 14 Immobilization Techniques 1 Objectives (1 of 2) ˜ ˜ ˜ ˜ Demonstrate a range of immobilization techniques. Explain the importance of high-quality communication with the patient. Describe reduction of patient radiation exposure by using proper immobilization methods. Apply immobilization techniques in routine situations. 2 Objectives (2 of 2) ˜ ˜ ˜ ˜ ˜ Use immobilization devices effectively. Describe trauma immobilization techniques as they pertain to specific anatomic involvement. Explain the importance of establishing rapport with pediatric patients. Use various methods of pediatric immobilization. Describe appropriate application of immobilization techniques pertinent to geriatric patients. 3 Immobilization Goals ˜ Decrease likelihood of motion distortion Ø Improved spatial resolution ˜ Improves patient positioning accuracy Ø Desired projections can be obtained ˜ ˜ ˜ Ensures radiation exposures are at a minimum. Increases optimum timing of x-ray exposure with patient motion. Safer patient experience See Figure 14.6 in the textbook for more information 4 Immobilization Principles (1 of 2) ˜ ˜ ˜ ˜ Motion distortion is one of the most significant contributing factors to unacceptable image quality. Positioning inaccuracies also contribute to suboptimum image quality. Motion distortion can result from involuntary and voluntary patient motion and position. Patient restraint can be simple and complex. 5 Immobilization Principles (2 of 2) ˜ ˜ ˜ ˜ ˜ Communication with the patient is critical to effective immobilization. Use the shortest exposure time possible. Use immobilization aids when possible. Empathy with the patient’s condition can be effective in facilitating good immobilization. Be aware that some immobilization devices can leave artifacts on images. Ø Indicate the use of a device if shown on the image. 6 Immobilization Devices (1 of 2) ˜ ˜ ˜ ˜ Positioning sponges Sheets Sandbags Velcro strap restraints ˜ ˜ ˜ Head clamps Support bars Patient comfort devices Ø Ø ˜ Table pads Pillows (featherless) Commercial devices In some cases, improvising and using your own creativity can be effective when using immobilization techniques. 7 Immobilization Devices (2 of 2) ˜ ˜ ˜ ˜ ˜ ˜ ˜ ˜ Cervical collar Spine board Splints Sheet restraints Commercial restraint devices Stockinettes Tape Velcro straps See Figure 14.2 in the textbook for more information 8 Positioning Sponges ˜ ˜ ˜ A common method of reducing patient motion involves the use of positioning sponges. Positioning sponges reserved. allow for increased accuracy by supporting the patient or anatomic area of interest. Make sure sponges are free of artifacts. See Figure 14.1 C in the textbook for more information Fig. 14.1 (C) Hand in fan lateral position on sponge. 9 Sandbags See Figure 14.6 in the textbook for more information Fig. 14.6 Hand in oblique position on sponge with sandbag across forearm. See Figure 14.7 in the textbook for more information Fig. 14.7 Elbow in anteroposterior position with sandbag on palm. 10 Tape See Figure 14.8 A in the textbook for more information See Figure 14.8 B in the textbook for more information When using tape as an immobilization tool, take care to protect the patient’s skin from adhesive tissue damage 11 Stockinette ˜ ˜ ˜ Stretchable cotton fabric in the shape of a sleeve. Effective as a restraint when pulled over the upper or lower extremities of a child and secured with tape. Good for immobilizing the upper limbs above and behind the child’s head. See Figure 14.19 in the textbook for more information 12 Stability Bar ˜ ˜ ˜ ˜ Commercially available. Attaches to upright holder. Provides patient support for upright procedures. Improves patient positioning. See Figure 8.13 in the textbook for more information Commercially available devices such as a stability bar are effective in controlling many degrees of motion. 13 Spinal Trauma Immobilization (1 of 2) ˜ ˜ ˜ The most common spinal trauma traction device is the cervical collar. All projections can be produced with the cervical collar in place. Often these patients are also on a spinal backboard. See Figure 14.9 in the textbook for more information 14 Spinal Trauma Immobilization (2 of 2) See Figure 14.9 in the textbook for more information Patient positioned for recumbent lateral cervical spine image with a cervical collar in place... Cervical collars should not be removed until a qualified practitioner has assessed images, and determined it is safe to move the patient. 15 Spine Trauma See Figure 14.11 in the textbook for more information The use of a trauma spine backboard is common and typically radiolucent, to some degree. They are effective in helping to immobilize patients in a variety of situations. 16 Pediatric Immobilization ˜ ˜ ˜ ˜ ˜ Effective communication techniques and development of a rapport with the patient are critical. Kindness, patience, honesty, and understanding, conveyed to children on their level. Threats and force must be avoided at all times, and restraints applied gently. Work with parents. Follow department policies and procedures. See Figure 11.7 in the textbook for more information Bending down and getting to their eye level is effective in establishing rapport 17 Infant Sheet Restraints ˜ Effective, simple, inexpensive, and reliable method of restraining or immobilizing a child. See Figures 14.12 A, B, C, D, E in the textbook for more information Sheet restraint (mummification technique) sequence. (A) The child is placed in the center of a triangular folded sheet as shown so that the shoulders are just above the top fold. (B) The left corner of the sheet is brought over the left arm and under the body so that approximately 2 feet of the sheet extends beyond the right side of the body. Make sure the child is not lying on the left arm. (C) Tuck the 2 feet of sheet over the right arm and under the body. Again, make sure the child is not lying on the arm. (D) Bring the remaining sheet over the body. (E) Tuck the sheet securely under the left side of the body. Remember that this technique restrains most movement but is not satisfactory as a complete immobilization procedure. Restraint bands are still required, and the child should not be left alone, even for the amount of time needed to make a radiographic exposure. 18 Commercial Restraints ˜ Upright restraint devices: Pigg-O-Stat Infant Immobilizer Ø Pedia-Poser Ø ˜ Restraint board: See Figure 14.13 B in the textbook for more information Contour-fitting pad, mold, or sponge with attached Velcro straps for securing the patient Ø Papoose Board Ø 19 Pigg-O-Stat Infant Immobilizer ˜ ˜ ˜ ˜ ˜ ˜ Very common in many departments. Upright exams. Rotates for lateral and obliques. Creates minimal image artifacts. Easy to clean. Restraint position typically initiates crying. See Figure 14.13 A in the textbook for more information Fig. 14.13 Patient positioned in Pigg-O-Stat for posteroanterior chest image. 20 Octostop Restraint Board ˜ ˜ ˜ ˜ Patient can be rotated 360° into eight different positions. Radiolucent material. Durable. Limited to pediatric patients up to 1 year old. See Figure 14.16 in the textbook for more information Fig. 14.16 Child on an Octostop restraint board in oblique position.. 21 Geriatric Patients (1 of 2) ˜ ˜ ˜ ˜ Greatest fear is falling! Communication is critical to effective immobilization of older patients. Take extra care to make a geriatric patient feel secure. Ensure their exam comfort: Ø Ø Ø Radiolucent table pad Pillows (featherless) Blankets 22 Geriatric Patients (2 of 2) ˜ ˜ ˜ Keep patient warm. Work smoothly and avoid working quickly so as not to disorient the patient. Reassure the patient with particular attention to their comfort, particularly during positioning. 23 Conclusion (1 of 2) ˜ ˜ ˜ ˜ Motion distortion is a key factor in final image quality. Use very short exposure times in order to lessen the chances of motion distortion. Communication is an essential skill in effective immobilization techniques. Use your creativity 24 Conclusion (2 of 2) ˜ ˜ ˜ ˜ Pediatric immobilization requires creativity and adaptability. Deal with parents according to department policy. Use immobilization devices when appropriate. Be aware of image artifacts from immobilization devices. Inform radiologist. Ø Annotate on image to indicate presence. Ø 25