Bedside radiography and patient care

PPt for patient care during bed side radiography

1. Bedside Radiography: Special condition and Environments

2. Mobile radiography. Mobile x-ray unit used primarily for bedside radiography and may also be used in the surgical suite. Study done with this equipment is generally termed as “portable examination / portable x-ray”. But this is not very accurate term. Two types of unit are generally used : the mobile radiographic unit and the C-arm mobile image intensifier ,a fluoroscopic unit. It is often more advantageous to perform bedside radiography for patient in special care unit , orthopedic traction and isolation. Mobile radiography has some limitation compared to departmental fixed X- ray unit.

3. Mobile Radiography Units. Portable Radiography Unit.

4. Cont.. Follow these guidelines: Check with the nurse in charge to inquire about patients condition. Confirm the order in the patient’s chart , if applicable . Always greet the patient (if applicable ) , check the name and D.O.B and identification band. Inspect and prepare room before bringing x-ray machine .

5. Special Care Units Intensive care Unit (ICU) Coronary care Unit (CCU) Neonatal Intensive Care Unit (NICU) Post anesthesia Care Unit/ Recovery (PACU) Emergency Department (ED) /Trauma Unit High Dependency Unit (HDU).

6. Treatment Situations Involving specialty Equipment Special Beds and Mattresses. Alternating pressure mattress / Rocking beds – needs to be turned off during exposure to avoid motion artifacts . Air mattress – must be fully inflated to firm up and level the bed before placing the IR under patient. Patient laying on an alcohol or water filled pad to raise or lower body temperature , it is important to place IR on the top of the pad to avoid artifacts. Must be careful while placing IR in between of patient and Mylar warming blanket.

7. Orthopedic Traction. Don’t attempt to alter a patient’s traction. Sudden release of traction may result in serious harm. Don’t bump against bed. Take help of nursing staff. Encourage patient to co-operate and use Trapeze bar to raise patient's torso.

8. Tracheostomies: Monitor patient closely. Never untie the tapes holding a tracheostomy tube in place.

9. Mechanical Ventilation: An endotracheal tube is passed through the mouth into the trachea. The tube is connected to ventilator. While performing radiograph don’t turn off ventilator to eliminate respiratory motion. Pay attention to breathing rhythm . Sense the breathing rhythm correctly and keep short exposure. Position patient carefully without applying tension to tubing . If patient is in AMBU bag , instruct nursing staff to stop squeezing while exposure is made.

10. Nasogastric and nasoenteric Tubes. Tubes passes through the nose and down into the stomach or small intestine. Has several purpose as feeding , decompression , radiographic examination. Levine and Salem-sump tubes are often sued. Don’t disturb the tube while taking radiograph . If it has to be disconnected from suction ,temporarily take permission from the nurse. While giving oral contrast through tube make sure not to displace tube from its location .

11. Correct placement of NG tube Incorrect placement of NG tube

12. Closed chest Drainage. Used to remove air or fluid accumulated in the pleural space. While taking radiograph: Ensure that chest suction and drainage apparatus is not disturbed. Take care that the chest tube is not dislodged when positioning the IR for the chest radiograph. Ensure that drainage unit remains below the level of the patient’s chest .

13. Pacemaker : You should not elevate or abduct the patient’s left arm for 24 hours after surgery to prevent dislodging the pacemaker and catheter.

14. Placement of central lines. Swan - Ganz catheter is correctly placed when its tip lies in the right or left pulmonary artery. Catheter measure cardiac output and heart pressure. Inserted through subclavian , jugular or femoral vein . Central venous catheter (CVC)- These is advanced into the venecava through veins . It facilitate the administration of long term drugs, dialysis ,blood transfusion , drawing blood and monitoring central venous pressure. Make sure to position patient and tube correctly in order to show correct placement of catheter in radiograph . Avoid patient rotation .

15. Swan - Ganz catheter

16. Central venous catheter

17. Thank you!!