IMMOBILIZATION TECHNIQUES Flashcards
What is the primary goal of the Radiographer?
To produce the most diagnostic radiograph with the least amount of radiation exposure to the patient.
What is immobilization?
A method of applying restrictive measures to prevent patient/part movement.
How does immobilization affect motion on radiographs?
Immobilization, in addition to communication, will reduce motion on radiographs.
What can cause blurring on a radiograph?
The slightest movement from the patient.
IMMOBILIZATION PRINCIPLES
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 position
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.
What types of motion can affect radiographs?
Motion can be voluntary or involuntary
will cause motion on radiographs and will result in the need to repeat radiographs and increase the radiation exposure to the patient.
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Voluntary Motion
Can be controlled by the patient and occurs as a result of inadequate communication by the technologist.
Involuntary Motion
due to contributing factors such as temperature, shock, neurological disorders, and medication.
COMMUNICATION
The most effective means of reducing motion and ensuring that the patient cooperates during X-ray procedures is communication.
The technologist needs to give the patient instructions in simple terms that the patient understands.
Communication is not limited to verbal instructions. Patients respond well to demonstrations and other methods of communication.
What are the two types of immobilization methods?
Simple and involved immobilization.
COMMUNICATION -RAPPORT & EMPATHY
Communication also includes establishing a good rapport and showing empathy for the patient.
Rapport
Rapport – is a relationship of harmony and accord between two persons, this begins from the introduction and continues throughout the procedure.
Empathy
being able to enter the patients’ emotions. In a sense it means the technologist is able to see things from the patient’s perspective or emotional state. Having empathy for a patient is different from having sympathy or feeling sorry for the patient.
What is an example of simple immobilization?
Using sandbags and sponges to help a patient maintain a position.
What is an example of involved immobilization?
Using complex immobilization devices such as spinal trauma boards, that will hold a patient completely still
RESTRAINT
Restraining requires a physician’s order and is usually done to prevent them from injuring themselves.
Restraints for adults are usually applied before the patient arrives in the radiology department and may consist of wrist and ankle bands fastened to the bed or stretcher.
Immobilization and restraint devices must never interfere with the patient’s circulation or respiration.
What is required before restraining a patient?
A physician’s order.
immobilization
Ideal patient immobilization devices should possess the following features:
Radiolucency
Flexibility
Durability
Reproducibility
Safety and reliability
No image artifacts
Types of immobilization Devices
Positioning sponges
Sheets
Sandbags
Velcro straps
Head clamps
Commercial devices
Cervical collar
Spine board
Splints
Sheet restraints
Commercial restraint devices
Stockinettes
Tape
What should immobilization and restraint devices never interfere with?
The patient’s circulation or respiration.
What are some reasons for immobilizing patients?
To protect the patient from bodily harm, reduce the possibility of motion, reduce radiation exposure, and ensure proper positioning.
What is an effective method of immobilization?
Communication with the patient.
How does effective communication impact radiographic procedures?
It may avoid the need to immobilize or restrain a patient, reducing repeats and radiation exposure.
What should the technologist provide to the patient?
Instructions in simple terms that the patient understands.
What is empathy in the context of patient care?
Being able to enter into the patient’s emotions and see things from their perspective.
What should you never do with a patient who is unable to change position?
Never leave them unattended.
What are some simple immobilization devices?
ROUTINE APPLICATIONS INCLUDE:
Sponges-Make sure sponges are free of artifacts.
Sandbags
Plexiplate/ Plexiglas paddle
Velcro straps,
compression bands-waist immobilizers or safety straps
head clamps.
What are some complex immobilization techniques?
-Mummy wrap technique,
-securing a patient to a backboard
- commercial restraints.
Special Applications of Immobilization
Non-routine Situations’
1. Trauma Application
a)Spinal Trauma
b) Head trauma
c)Extremity Trauma
- Pediatric Applications
(infant sheet restraint)-Although this method can be used on children 4 or 5 years of age, it is beneficial for children who are still too young to understand cooperation.
Special Applications of Immobilization for infants
Commercial Restraints
1. Upright Restraints (Pig-o-stat, Pedia-Poser)
2. Restraint Boards (Circumcision Board, Brat Board, Octastop Board
Plexiglas (paddles) Velcro straps Tape Stockinette
Non-Routine Situations
Trauma Application
Usually, immobilization devices have already been applied before the patient arrives in the Radiology Department.
Radiographers never remove immobilization devices that have applied by emergency medical personnel (EMT’s) such as traction and cervical collars.
After the Radiologist reads the initial radiographs as negative or approval has been given by the attending physician the immobilization devices may be removed by the physician.
The Radiographer must know which devices are radiolucent vs. radiopaque.
It may be necessary to take the radiographs with radiopaque immobilization devices in place (which will produce artifacts on the films) rather than remove them and cause possible further injury to the patient.
If removed, immobilization devices should be removed slowly with the necessary assistance, sponges and padding may be used to ensure patient comfort.
Non-Routine Situations
Spinal Trauma
Includes traction devices (i.e., backboards) and cervical collars.
All AP spine views from head to toe may be done without removing the patient from a radiolucent backboard by placing the cassette under the backboard.
A backboard may be used to keep the spine immobilized and support the body.
Most backboards are made of radiolucent materials (i.e. wood, plastic).
Backboards also facilitate easy transfer of the patient from the cart to the table.
To R/O a Cervical spine Fx a Cross-table Lateral view of the Cervical Spine is always done first. If the lateral view is questionable, additional views of the C-spine may be taken with the collar on.
A Radiographer NEVER removes a cervical collar or moves a patient from a backboard (Trauma board) until after the Radiologist has cleared the patient and R/O a spinal fracture.
HEAD TRAUMA- NON ROUTINE SITUATIONS
Head Trauma
Often cervical collars are in place are in place during radiographic skull examinations.
Since movement of the skull is restricted due to the immobilization of the collar, the equipment must be manipulated (i.e., move the tube and equipment without turning the patient).
With head trauma, bleeding may be evident from the nose or ears of patients with severe head traumas.
Extremity Trauma
Extremity Trauma
Traction devices may be present on extremities (i.e., traction and air splints).
Traction splints are not always radiolucent.
An anti-shock garment may be present in cases of trauma to the abdomen, pelvis and lower extremities to slow the rate of hemorrhage.
Anti-shock garments are always radiolucent.
Pediatric Applications- Non-Routine
Pediatric Applications
Good communication between the radiographer and the patient is always important regardless of age.
Use terminology the child will understand.
Trust and security must be established.
Departmental policy should be observed in allowing parents in the room and should be decided on an individual case basis.
The reasons for using immobilization devices should be explained to parents.
Never let a child think that immobilization is being used as a form of punishment.
Effective communication techniques and development of a rapport with the patient
Kindness, patience, honesty, and understanding conveyed to children on their level
Threats and force must be always avoided, and restraints applied gently.
Work with parents.
Follow department policies and procedures.
Infant Sheet Restraints
Mummification
Effective, simple, inexpensive, and reliable method of restraining or immobilizing a child.
Consists of gently wrapping the small child in a sheet which limits motion.
Commercial Restraints for babies
Commercial Restraints
1. Upright Restraints (Pig-o-stat, Pedia-Poser)
Allows the child to be rotated 360 degrees in the upright position.
Extremely useful for taking CXR and ABX in an upright position
Commercial Restraints
2. Restraint Boards (Circumcision Board, Brat Board, Octastop Board)
Allows for rotation of the child in the recumbent position.
Radiographs may be obtained in a variety of recumbent positions such as AP, Oblique, and Laterals.
Stockinette
Stretchable cotton fabric in the shape of a sleeve pulled over a fractured extremity before a plaster cast is applied
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
Special Applications of Immobilization
Non Routine:
Geriatric Applications
Aging involves the loss of a sense of mobility and sense of balance.
Special care should be taken to make the patient feel secure.
Often geriatric patients are frail and special attention should be given to elderly patients.
Blankets should be used to keep the patient warm.
Radiolucent table pads and pillows should be used for comfort.
A sponge placed beneath the knees reduces back strain.
What are key communication skills for radiographers?
Demonstrating empathy, fulfilling patient needs, directing patient actions, and obtaining cooperation.
What should radiographers do in trauma situations?
Never remove immobilization devices applied by emergency medical personnel.
What is the procedure for taking radiographs with radiopaque immobilization devices?
It may be necessary to take radiographs with devices in place rather than remove them and risk further injury.
What is the purpose of a backboard in spinal trauma?
To keep the spine immobilized and support the body.
What must be done before removing a cervical collar?
The patient must be cleared by the Radiologist.
What is the procedure for a cross-table lateral cervical spine view?
The patient remains supine and immobilized, with the x-ray tube lowered and turned for a horizontal CR.
What should be considered when dealing with head trauma?
Movement of the skull is restricted, and the equipment must be manipulated without turning the patient.
What should be done for pediatric applications?
Use terminology the child will understand and establish trust and security.
What is sheet restraint?
Mummification, which gently wraps a small child in a sheet to limit motion.
What are some commercial restraints for pediatric patients?
Upright restraints (pig-o-stat) and restraint boards (Circumcision Board, Brat Board, Octastop Board).
What should be done for geriatric patients?
Special care should be taken to make them feel secure, and blankets should be used to keep them warm.
What are some special tips for immobilizing patients?
Always explain to your patient, ensure immobilization is not too tight, and seek first aid if harm occurs.
Special Tips Immobilizing Patients
Always explain and talk to your patient.
Never cause harm by immobilizing.
Make sure immobilization is not too tight.
Immobilize for as short a period as possible.
Never use the sticky side of the adhesive tape directly on the skin.
Never rely on immobilization techniques alone to hold a patient.
If a patient is injured because of an immobilization technique, seek first aid and bring the incident to the supervisor’s attention.
