NON-ASEPCTIC TECHNIQUE Flashcards
1
Q
What are NON-ASEPTIC TECHNIQUE?
A
- Requires special nonsterile procedures
-Involves tubes and lines into the digestive tract
-Body wastes
-Enemas for contrast exams
2
Q
Which Asepsis IS FOLLOWED FOR NON-ASPETIC TECHNNIQUE?
A
Radiographic procedures that require medical asepsis to be followed but not surgical asepsis
3
Q
What are Nasogastric Tubes?
A
Tube inserted through the nasopharynx into the stomach for decompression or the removal of flatus (gas) and fluids from the stomach.
-NG tubes are also used to provide nutrients to the stomach (feeding tube).
4
Q
What is the nasogastric tube used for?
A
Used to feed the patient or to conduct gastric suction (removal of flatus call gas) and FLUIDS and provide nutrients by feeding tube (AFTER INTESTINAL OBSTRUCTION OR MAJOR TRAUMA)
5
Q
Can patients with NG TUBES DRINK AND EAT?
A
Patients with NG tubes cannot eat or drink fluids.
6
Q
What type of care must be taken for a patient with a nasogastric tube?
A
The radiographer must be careful that the NG is not dislodged.
-not to pull on the NG (NOT DISLODGED) tube while moving patient or performing
the examination
7
Q
WHO IS RESPONSIBLE FOR THE INSERTION AND REMOVAL OF THE NG TUBE?
A
Physicians and nurses are responsible for the insertion and removal of NG tubes however,
the Radiographer must be able to assist in the procedure and should be comfortable performing radiographs on patients that have NG tubes in place.
8
Q
Ng tubes may be used to insert?
A
NG tubes may be used to insert Barium or other contrast materials during radiographic procedures such as Upper GI examinations.
9
Q
What position should the patient be in when NG TUBS ARE INSERTED?
A
NG tubes are inserted while the patient is in a high Fowler’s position.
10
Q
What is used for lubrication for insertion?
A
The NG tube is lubricated for insertion with a water-soluble lubricating jelly.
The NG tube is secured to the outer nares of the patient with tape.
11
Q
What is the NG TUBE CONNECTED TO?
A
NG tubes may be connected to a gastric suctioning device to remove or decompress the stomach contents.
12
Q
WHY NG TUBES MAY BE INSERTED?
A
Remove flatus (gas) from the stomach
Remove fluids from the stomach
Provide nutrients into the stomach (feeding tube)
13
Q
TYPES OF NG TUBES?
A
LEVIN- SINGLE LUMEN
Salem-sump tube – double lumen type
Cantor
Keofeed
Miller – Abbott
Sengstaken – Blakemore
14
Q
The two most popular types of NG tubes are?
A
the Levin and the Salem-sump tubes.
15
Q
MOST COMMAN NASOGASTRIC TUBE IS?
A
Levin tube – single-lumen type
Levin tubes have black markings on the surface which indicates -how far the tube has been inserted
16
Q
SINGLE LUMEN ARE COMMONLY USED IN?
A
IV, urological and drainage catheters.(DRAIN FLUID FROM BODY)
Single Lumen - When a catheter has a single hole through the center of it, it is referred to as a single lumen. Single lumens are most commonly used in IV, urological and drainage catheters.
The single-lumen tubes are best for decompression
17
Q
What is the SALEM sump tube?
A
IS A DOUBLE LUMEN TUBE
double-lumen sump tube is best for continuous lavage or irrigation of the stomach.
18
Q
A tube used to feed a patient or to perform gastric suction is called a:
A
Nasogastric tube
19
Q
An item that is used to feed the patient or to suction gastric contents is a:
A
Nasogastric tube
20
Q
How can you check to see PLACEMENT OF the tip of the NG was correctly placed?
A
By taking an ABX (ABDOMINAL XRAY), OR ‘
USING FLUROSCOPY
OR LISTENING TO THE ABDOMEN WITH A STETHOSCOPE (10-20ML AIR IS INSERTED) (WHOOSING SOUND)
a syringe to remove gastric contents as proof.
Another check is to gently aspirate gastric secretions from the stomach
21
Q
HOW DO YOU TOUCH NG PATIENTS?
A
WITH A CLEAN GLOVES
22
Q
How can you withdraw the tube from the patient?
A
By putting a clean glove one and let patient take a deep breath as tube is gently withdrawn (WRAP IN A PAPER TOWEL AND DISCARD)
23
Q
Why should portable xrays be labelled?
A
To include the position
24
Q
What are MALE URINALS?
A
Male urinal is plastic or metal and shaped so that it can be used by a patient who is supine, lying on his right or left side, or in the Fowler’s position.
-Disposable or reusable
25
What type of male patient is it typically used for?
Typically used for ambulatory male patients
26
If the patient can help themselves, what type urinal may be given to them?
An aseptic urinal may be given to the patient after privacy for the patient has been assured.
27
THE MALE UNRINAL
Confirm urine volume if urinary output is being tracked.
.
28
What should we do after patient is finish using urinal?
Wash your hands and provide for patient hand washing
29
What position do you insert a NG TUBE?
HIGH FOWLERS POSITION
30
PROCEDURE FOR PLA
Procedure:
* Find a private area such as an empty radiographic room and secure the patient’s privacy.
* The radiographer should put on disposable gloves.
* Cover the patient with a sheet.
* If the patient needs assistance a male radiographer may assist the patient.
* Give the patient toilet paper or a washcloth to use after urinating.
*
31
After completion of voiding?
After completion of voiding, the urinal should be rinsed and the re-sterilized.
32
When are Plastic made urinals discarded?
Urinals in uses in hospitals today are made of plastic that are discarded after a single use.
33
Procedure for placing a URINAL?
The radiographer should wear disposable gloves and should wash their hands before and after assisting with the procedure.
If it is indicated on the patient’s chart the contents of the urinal should not be discarded but the urinal and the contents will be returned with the patient with a note for the nursing staff.
If it is not necessary to record the output of urine the contents of the urinal should be emptied into the toilet, flushed, and the urinal should be rinsed and then discarded as per hospital protocol.
34
BEDPANS
males-defecation
female-urination and defecation
BEDPANS
* Used for defecation and urination
* Hand washing is extremely important and should be performed both before and after assisting the patient with a bedpan.
* Respect patient privacy and comfort.
* Two designs- wide and narrow
35
2 types of bedpans
Standard bedpan – has wide sides that the patient’s buttocks rests on.
Fracture bedpan – the sides are very narrow so that the bedpan can more easily be slid under the patient.
36
How do you place the bedpan?
Slide the bedpan under the patient by asking the patient to turn slightly on their side and then gently roll the patient onto the bedpan. Or if possible, the patient may raise their buttocks (hips) as the bedpan is slid under them, with a convenient handle for placement and removal.
Stay nearby but allow the patient to be alone and have them call you when they are finished
37
Procedure of bedpan
Give the patient toilet paper or a washcloth to use after.
Two people may be required to assist the patient.
When the patient is finished empty the contents of the bedpan into the toilet and flush. Rinse the bedpan and dispose of it according to hospital protocol.
Bedpans in use in hospitals today are made of plastic that are discarded after a single use.
The radiographer should wash their hands before and after assisting patients with bedpans.
38
What are CLEANSING ENEMAS?
is used to promote defecation and to prepare the large intestine for the introduction of Contrast Media.
If the patient follows the pre-procedural instructions most patients will arrive for the barium enema exam free of feces in the colon.
39
WHEN IS A SCOUNT FILM DONE?
A scout film is done before any contrast materials are introduced into the body.
It is done to check to see if the patient is prepared for the exam, if there are artifacts present, and to check the radiographic technique to be used before contrast is introduced.
40
What is BARIUM ENEMA?
A radiographic study of the large intestine or lower gastrointestinal tract.
41
How is Contrast media intrOduCED into the large Intestine/lower GI?
Contrast media of BaSO4 is introduced through a large catheter (either a straight tip or Foley type).
42
The radiographer must?
Obtain patient’s consent.
Explain the procedure.
Allergic sensitivity to Latex or Barium should be assessed.
Non-latex enema tips are available.
43
What are CONTRAST MEDIA? is it radiopaque?
A substance introduced in the body that is radiopaque and is used to outline organs and structures within the body.
44
What is the Contrast solution mixed with?
The contrast solution and water must be well mixed prior to use.
BARIUM ENEMA MUST BE MIXED WITH WARM WATER
100-105 DEGREE FAHRENHEIT (HELPS REDUCE CRAMPS
45
Contrast agents used for upper and lower GI exams may be either positive or negative or a combination of both.
Such as?
Positive – i.e., barium (BaSO4), Gastrographin
Negative – i.e., air
46
What gives optimum contrast?
Most patients will be given a solution containing barium BsSO4 and water.
-The high atomic number for optimum contrast.
47
CONTRAST MEDIA MAY BE MIXED WITH?
May be premixed or powder.
48
If there is any reason to suspect that the patient may have a perforation of the bowel, THEN?
Barium is contraindicated and cannot be used.
49
IF BaSO4 is contraindicated, WHAT CAN BE USED INSTEAD?
If BaSO4 is contraindicated,
then a water-soluble contrast material such as
Gastrographin a water-soluble iodine compound is used in place of the barium. (iodine is a aqueous compound)
50
What is a BE SERIES ?
A BE series will include fluoroscopy and several radiographs taken before, during, and after the introduction of the contrast material – the exact number of radiographs and projections taken for the series will depend on the protocol of the institution
51
What are the ENEMA TYPES?
Enema Types
* Tap water (hypotonic)
* Hypertonic (Fleet enema)
* Saline (safest used on infants)
* Oil retention
* Soapsuds solution
52
SALINE ENEMA?
IS THE SAFEST USED IN INFANTS
53
Patient Preparation for a Barium Enema
The preparation will vary for each institution, but the following are basic Barium Enema instructions given to the patient to follow before the exam. If the patient is not adequately prepared the colon may contain feces and the enema exam will need to be rescheduled.
54
Dietary Restrictions
patients are instructed to follow a low-residue diet. No milk products, meat products, or eggs. Fruits and vegetables are also avoided.
55
Purgation
the patient is prescribed a variety of laxatives to promote emptying of the colon.
i.e., castor oil, magnesium citrate or bisacodyl.
56
Over-hydration
– patients are instructed to follow a clear liquid diet for 24 hours prior to the exam. Liquid or clear diets include clear broth, clear gelatin, coffee, tea, and carbonated beverages are allowed.
57
Cleansing enemas
– are prescribed as per the institution’s protocol and may include as many as three cleaning enemas before the morning of the exam.
58
WHAT DEGREE OF WATER IS MIXED WITH CONTRAST MATERIAL?
If water is mixed with the contrast material, warm water should be used: 105 degrees F (41 degrees C).
59
If cramping occurs, what should we do?
Cramping may occur as the enema solution is introduced.
If cramping occurs as the patients should be told to inhale and exhale slowly and deeply, try to relax and the cramping should pass.
The radiographer must work quickly to reduce the patient’s discomfort.
60
STEP 1
Most patients will have a strong feeling that they need to defecate but the radiographer must talk the patient through the exam explaining the importance of having the barium or solution remain in the colon until all x-rays have been completed.
61
STEP 2
The enema bag is filled: with 30ml of fluid but inform the patient that the entire content will not be used
62
STEP 3
If using a retention balloon tip (Foley), inflate the balloon to hold the tip in place in the rectum with 30 to 90 ml of air.
63
What position is the PATIENT PLACED IN WHEN THE ENEMA TIP IS INSERTED?
SIMS POSITION
64
HOW TO PLACE THE TIP INSIDE?
-SIMS POSITION
-Wear gloves
-Lubricate tip
-Place a drape sheet over the patient to maintain privacy.
-Have the patient slowly exhale while inserting the tip into the rectum.
-The tip should move anteriorly and superiorly approximately 3 to 4 inches into the rectum
65
How much inches should the Tip be inserted into a rectum when putting in barium enema?
-The tip should move anteriorly and superiorly approximately 3 to 4 inches into the rectum
66
Preparing for Barium enema continue
Balloon tips are contra-indicated in cases of rectal narrowing and hemorrhoids. In those situations, narrower straight tips are used.
Barium solutions are prepackaged powder that is missed prior to the exam with warm water (106 degrees F 41 degrees C). Once the bag is mixed it should be used. If not, the Barium that remains in the water will separate and clog the tubing.
The enema bag is suspended above the table at least 30 inches so that gravity allows the BaSO4 to flow.
67
What type of solution is BARIUM ENEMA?
Barium solutions are prepackaged powder that is missed prior to the exam with warm water (106 degrees F 41 degrees C)
68
HOW MUCH DEGREE OF WATER IS MIXED WITH THE BARIUM POWDER?
(106 degrees F 41 degrees C)
69
HOW MANY INCHES ABOVE IS THE ENEMA BAG PLACED AND WHY?
The enema bag is suspended above the table at least 30 inches so that gravity allows the BaSO4 to flow
70
What types of Barium Enema Tip/kits are there?
1. SIngle contrast kit
2. Doublr contrast kit
71
What is the SINGLE-CONTRAST BARIUM ENEMA?
Solution of Barium (mixed with water).
If a perforation of the bowel is suspected water-soluble iodine compounds (i.e., Gastrographin) are used instead of Barium.
Uses large volumes of barium
Excess barium is drained back into the bag, the tip is removed, and the patient is sent to the toilet to evacuate as much of the barium as possible.
Post-evacuation images taken
72
What solution of Barium makes up the SINGLE CONTRAST BARIUM ENEMA?
Solution of Barium (mixed with water).
73
If a perforation of the bowel is suspected, WHAT WILL BE USED INSTEAD OF BARIUM?
water-soluble iodine compounds (i.e., Gastrographin) are THE ONLY ACCEPTABLE CONTRAST MEDIA used instead of Barium.
74
IN THE SINGLE CONTRAST BARIUM ENEMA, HOW MUCH BARIUM IS USED?
Uses large volumes of barium
75
When there is EXCESS AMOUNT OF BARUM WHAT IS DONE WITH IT?
Excess barium is drained back into the bag, the tip is removed, and the patient is sent to the toilet to evacuate as much of the barium as possible.
76
WHAT TYPE OF IMAGES ARE TAKEN WHEN USING SINGLE CONTRAST BARIUM?
Post-evacuation images taken
77
What is a POST EVACUATION FILM?
a radiograph that is taken after the patient has evacuated the barium or a contrast media.
78
On an XRAY BARIUM AND GASTROGRAPHIN WILL LOOK WHAT COLOR?
THEY WILL LOOK THE SAME, WHITE
79
WHAT IS VISCOSITY?
the physical property of liquids, how thick or thin they are. If a contrast material is thick it has viscosity.
80
NOW WHEN DO WE USE DOUBLE CONTRAST BARIUM ENEMA?
-Used for polyps
- History of colorectal cancer
-Rectal bleeding
-Anything where the colon mucosa needs to be visualized
81
What type of agent and what color is BARIUM AND AIR?
Barium = Positive agent (white)
Air = Negative agent (black)
82
What are some important patient concerns?
Please keep the tip firmly in the rectum.
Relax abdominal muscles to reduce intraabdominal pressure.
Use deep oral breathing to prevent spasms and cramps.
Cramping may cause a cessation of the procedure.
Try and take the patient’s attention away from the enema.
83
What reduces intraabdominal pressure?
Relax abdominal muscles to reduce intraabdominal pressure.
84
What should be done if cramping occurs during a BE?
DEEP ORAL BREATHING
Cramping may occur as the enema solution is introduced.
-If cramping occurs the patients should be told to inhale and exhale slowly and deeply, try to relax and the cramping should pass.
85
BARIUM ENEMA EXAM VOLUMES ARE DIMINISHING/GETTING LESS BECAUSE?
Exam volumes are diminishing because of colonoscopy and CT examinations.
86
What is IMPORTANT WHEN DOING A BARIUM ENEMA EXAM?
Patient education and communication are critical.
87
What should be done first when removing a RECTAL CATHETER THAT HAS AN INFLATABLE CUFF ATTACHED?
the cuff must be deflated before the catheter is removed.
88
NOW COLONOSTOMY BARIUM, WHAT IS COLONOSTOMY?
Formation of a stoma from the bowel to the outside of the body
89
How are PERMENENT COLONOSTOMIES PERFORMED?
Permanent colostomies are performed when a portion of the bowel is removed.
90
When is a TEMPORARY COLONOSTOMY PERFORMED?
A temporary colostomy is performed to heal or rest a portion of the bowel.
91
WHEN A PERSON HAS A COLONOSTOMY, HOW IS BARIUM ENEMA INTRODUCED INTO THE COLON?
Barium is introduced into the colon via the stoma through a soft flexible catheter connected to an enema bag.
92
What type of Catheter will be used to keep the Barium from flowing out of the stoma?
The Catheter will be a Foley type to keep the barium from flowing out of the stoma.
The Foley balloon is inflated with 3 to 5cc of water to hold it in place.
93
How much CC of water the foley balloon will inflate with to hold it in its place?
3 to 5 CC OF WATER
94
BE POST PROCEDURAL INSTRUCTIONS
Barium is naturally hygroscopic and can cause patient dehydration.
Patient stools are usually gray or white until the barium is fully defecated.
The patient should increase fluid intake and dietary fiber for several days unless medically contraindicated and should be instructed to rest after the examination.
The patient may be prescribed a laxative. Barium may cause constipation.
Post-examination instructions to patients are important!
95
LETS TALK ABOUT THE UPPER GI SERIES
WHAT IS UGI?
includes visualizing the terminal esophagus, stomach and proximal small bowel radiographically after the patient drinks a BaSO4 and water mixture.
96
AGAIN IF PERFORATION IS SUSPECTED?
If perforation is suspected a water-soluble iodine compound such as Gastrographin is used instead of Barium.
97
How and through what the mixture be introduced if the patient is unable to drink it?
The mixture may be introduced through a NG tube if the patient is unable to drink.
98
Pediatric patients may drink the mixture through a bottle with a nipple used for routine feeding.
Pediatric patients may drink the mixture through a bottle with a nipple used for routine feeding.
Extra holes may be placed in the nipple to allow the thicker solution to flow.
An upper GI series will include fluoroscopy and several radiographs taken before, during, and after the introduction of the contrast material- the exact number of radiographs and projections taken for the series will depend on the intuition
99
What is a ESOPHAGRAM?
Only the esophagus is visualized.
Radiographs are taken while the patient swallows the contrast mixture.
100
What is a SMALL BOWEL SERIES?
The small intestine is visualized.
The patient drinks two full GI cups of Barium and radiographs are taken at specified intervals i.e., every ½ hour until the barium reaches the ileocecal portion of the large intestine.
101
WHAT IS THE GALLBLADDER "GB" SERIES?
Radiographic examination of the gallbladder.
Iodinated contrast (tablets) are given to the patient the evening prior to the exam.
The day of the exam a series of radiographs are taken to visualize stones in the gall bladder or abnormalities.
Gall Bladder radiographic series are still done but have been widely replaced with Ultrasound studies that demonstrate the GB.
102
What is an INTRAVENOUS PYELOGRAM "IVP"?
A radiographic procedure in which contrast material is injected into a vein and travels to the kidneys. Radiographs are taken at certain time intervals showing the contrast material in the kidneys, ureters, bladder, and urethra.
An example of a contrast media used for an IVP exam is Renographin a water-soluble iodine compound.
103
WHAT IS A Post-voiding Film ?
a radiograph taken after the patient has urinated (voided) to demonstrate that the contrast material is no longer in the body.
104
WHAT IS THE SEQUENCE OF CONTRAST EXAMS?
If the patient is scheduled for more than one contrast radiographic exam they should be done in the following order:
1st IVP
2nd GB
3rd BE
4th GI
The order of the sequence will depend on how quickly the contrast can be eliminated from the body or whether the contrast will superimpose over the internal structures being demonstrated.
105
CONTRAST RADIOGRAPHIC EXAMS THAT MAY BE PERFORMED TOGETHER
-GB AND IVP
-IVP AND BE
-GB AND GI
2-1,
1-3,
2-4
106
PATIENT PREPARATION FOR CONTRAST STUDIES
The patient should be given pre-procedural instructions at the time that the appointment for the contrast radiographic exam is made.
107
IVP
NPO after midnight
Cleansing enema at home the morning of the exam
Empty bladder before scout film.
108
GB
Patient takes prescribed iodinated contrast(tablets) the evening before the scheduled exam.
Evening meal is fat-free to prevent gallbladder contraction.
Water only on the morning of the exam.
109
NPO
NOTHING BY MOUTH
110
BASO4
Barium Sulfate
111
BE SERIES
Barium enema series
112
UGI OR GI SERIES
Upper Gastrointestinal series
113
GB SERIES
GALL BLADDER SERIES
114
IVP
Intravenous Pyelogram
