Patient_Care_and_Management_in_Computed_Tomography_(CT).pptx

Learn best practice for patient care and management in computed tomography (CT) imaging, including pre-examination preparation, patient position, contrast media, radiation dose reduction and post examination care.

1. Patient care and Management in CT University of Benin Teaching Hospital Dept. of Radiology Rad. Ugwumba O.J B.Rad , P.G.Cert Ct & Uss , mARN

2. PATIENT CARE AND MANAGEMENT IN CT WILL BE DISCUSSED FROM THE FOLLOWING POINTS OF VIEW General aspects of patient care Factors affecting patient care Factors influencing patient care Aspects of care specific to CT

3. GENERAL ASPECTS OF PATIENT CARE Patient Environment – Patients should be examined in a pleasant and conducive environment suited to their state of undress and their general state of mind. Hence, attention should be paid to hygiene, ventilation, lighting, temperature, humidity and noise control of the diagnostic room e.g., the CT suit. Patient R ights – of privacy, comfort, safety, personal belongings, hygiene, risk versus benefits of procedure, refusal, confidentiality, respect and courtesy, right to know and right to treatment. The patients’ general well-being, both physically and emotionally must be protected.

4. Clinical Responsibility Involves taking care of the patient’s physical, psychological, and physiological complaints using a combination of the appropriate imaging techniques, procedures and nursing care to provide pertinent information related to diagnosis and treatment management of the patient with minimum level of radiation dose and with economy. It is therefore, necessary for the Radiographer to acquire requisite knowledge and skills that will help in the accomplishment of this goal. These include: Knowledge of procedures Knowledge of pathology Understanding of the patient’s psychological state Interpersonal and communication skills Professional image .

5. Ethical Responsibility It is related to the mode of conduct and behaviour . Ethical rules are guides to moral behaviour . Ethics focus on people’s social behaviour in relation to circumstances surrounding the social actor at the time each action is contemplated or taken. Professional ethics are governed by self control and by regulations in the code of practice. In medical radiography, ethical rules are in regards of: The confidentiality of patient’s information Equality of care for all patients Hygiene Observation and communication Radiation protection Conduct and attitudes .

6. Legal Responsibility Legal responsibility deals with patient’s right to good professional service and protection. The law demands that we protect the patients well-being, both physically and emotionally. The Radiographer is expected to be conversant with the legal positions that provide protection to the patient. The legal position that provides protection to the patient may be found in: Identification of the patient Accuracy of documentation Consent form Recording of accident Negligence Litigation in breach of professional confidence.

7. FACTORS AFFECTING PATIENT CARE The factors affecting patient care can be considered as those relating to the way in which man, machine and environment interact in the process of conducting the radiographic procedure. The patient’s well-being and physical safety must be protected from: Electrical shock Mechanical malfunction Environmental factors Unnecessary radiation Accidental injury

8. FACTORS INFLUENCING PATIENT CARE These are frameworks and/or regulations imposed by organizations external to the health care organization to ensure that patients’ right and safety are protected. These factors can be found in the working document of such organizations as: Radiographers Registration Board of Nigeria (RRBN) Nigerian Nuclear Regulatory Authority (NNRA) Legislation (health and safety at work Act) International organizations e.g. ICRP, IAEA, etc.

9. ASPECTS OF CARE SPECIFIC TO CT In this section, our focus will be to review: Indications and justification for CT P atient preparation for CT Communication and patient protection V enipuncture , and injection techniques Patient care in emergency CT Patient care in special CT procedures (e.g. CT myelogram, CT angiogram, CT guided biopsy etc.).

10. Indications and Justification for CT Check request form is fully completed and signed by the requesting physician. Ensure that patient identity is correct and that the correct patient is found or identified. Ensure examination request correlates to clinical history. Check details of any special projection asked. Check pregnancy question if required and have patient sign for pregnancy risk if appropriate (consent form). Ask if any previous examinations, review previous reports and or films. Take special care with details from elderly, handicapped, deaf, blind, very young, individuals with poor English, etc .

11. Sample of CT Scan Consent Form

12. Patient preparation for CT This may vary depending on the body part being examined. Escort patient to changing cubicle, give changing instruction relevant to examination. Instruct patients in the removal of artifacts relevant to the examination. i.e. jewelry, prostheses, etc. Use clean, starch free examination and dressing gowns. Nil by mouth for 2hours before scanning if intravenous contrast medium is to be given, in case the patient vomits. Nil by mouth for 4hours if oral contrast is to be given, as the patient needs to drink a large volume (800ml) of the oral contrast, which is difficult on a full stomach. When oral contrast is to be given, first give 600ml of the contrast 20mins. before, and the remaining 200ml should be given just before scanning commences. For the urinary bladder, 800ml of oral contrast should be given an hour before scanning, in fractionated doses of 200ml every 15mins with the last 200ml being given 15min before scanning .

13. Communication , and Patient Protection Greet patient and introduce yourself by stating your name and grade. Inform patient of basic procedure and briefly explain procedure. Be tactful in given out information to the patient. Instruct patient on breathing technique and/or required movement. Rehearse and visually check patient in respiratory manoeuvre or required movements. Reassure and inform patient to relax. Provide gonad shield, and use immobilization gadgets if necessary. Visually check all round to ensure it is safe to make exposure .

14. Venipuncture , and Injection Techniques Other than oral contrast to outline the bowel, intravenous contrast is often used in CT. When I.V. contrast is to be given, Precautions should be taken for allergies The use of non-ionic contrast medium is strongly advised The Radiographer should ensure that the trolley is set and the necessary resuscitation drugs are in place. 30 – 100ml of I.V. contrast may be given (for adults) depending on the body part being examined and body weight For dynamic studies, a rapid injection of a loading bolus of 25ml is given, followed by the remainder of the contrast injected while the scanning is going on for up to 120s depending on the machine Scanning should commence 20s after the start of the injection Observe patient and check vital signs in case the patient reacts to contrast medium.

15. Oral and Intravenous Contrasts

16. Patient Care in Emergency CT In emergency situation, Patient should be attended to promptly The scanning should be done quickly Observe patient and check vital sign Ensure that a clear airway is maintained and keep patient warm Make available suction machine and ensure that patient is sucked as the need arises Do not scan a patient on oxygen but, ensure that the patient is ventilated from time to time during the scanning Turn off oxygen cylinder and keep cylinder away from the radiation source/gantry room Get the Doctor or nurse to ventilate the patient with the AMBU bag.

17. Patient care in Special CT procedures Explain to the patient what is to be done. Ensure patient is comfortable. Aseptic technique must be used. For myelogram, patient should be scanned in prone position with the head raised. For angiogram and biopsy, check coagulation screening has been performed and is within normal limits. Ensure all clothing is out from underneath the patient before starting the localizing scan. Perform scans in arrested respiration when doing CT guided biopsy, and use skin marker to confirm/mark area if necessary. After scanning, inform patient the examination is completed. Escort patient to the changing cubicle to redress and instruct to wait if required. Check vital sign and give instruction on post scanning observations. Inform patient of side/after effects of any drug or medication.

18. Conclusion

19. References Macmillan Cancer Support Patient Care; PH CT Course; Dr. Aimen O.A GE Healthcare; Product: Contrast Media