Presentation on theme: "PATIENT CARE Eduardo D Campuzano BS,RT (R,MR,CT)"— Presentation transcript:
1PATIENT CARE Eduardo D Campuzano BS,RT (R,MR,CT) Images property of Siemens Medical.
2ETHICAL & LEGAL PRINCIPLES PATIENT CAREETHICAL & LEGAL PRINCIPLESPATIENT’S BILL OF RIGHTSEvery human being of adult years and sound mind has a right to determine what shall be done with his/her own body.Privacy- Patient has the right to receive notice of privacy practices.Extend of Care- A patient has the right to consent to or refuse treatment (e.g. DNR)Access Information- A patient has the right to review his medical recordsLiving will- These documents express a patient’s choices about his future care.Research participation- The patient has the right to consent or decline to take part in research.
3ETHICAL & LEGAL PRINCIPLES PATIENT CAREETHICAL & LEGAL PRINCIPLESLEGAL ASPECTS OF RADIOLOGYWho is authorized to order an examination?MD,DO,PA,ARNP with valid credentials. No Medical Students,Residents,Fellows or Nurses can order an examination.
4ETHICAL & LEGAL ASPECTS PATIENT CAREETHICAL & LEGAL ASPECTSREQUEST FORMThe patient’s name to be examineThe exact region to be image (Knee, Liver)The patient’s diagnosisThe ordering physician (MD)The date of requisition
5ETHICAL & LEGAL PRINCIPLES PATIENT CAREETHICAL & LEGAL PRINCIPLESINFORMED CONSENT (WRITTEN OR VERBAL)The patient has a right to informationA written consent is required for any procedure that involves substantial riskConsent forms may be signed by the legal guardian in the case of minors or incompetent patientsThe patient maintains the right to refuse an examination (At any time during the exam)
6PATIENT CAREExpressed Consent – Involves obtaining a patient’s permission to performed the procedure (can be given orally)Informed Consent – Is done for invasive procedure and includes the risk, benefits and alternative .They are clearly explained in a language patient fully understand.Patient or Legal Guardian (Alert & Oriented x 3) must sign the informed consent for an invasive procedureFor Minors ,Parents or Legal Guardian must sign the informed consent.Implied Consent – Occurs when the patient is in need of immediate medical services ,but is unconscious or unable to consent for treatment. Services are rendered with the assumption that the patient would consent if able.
7ETHICAL & LEGAL PRINCIPLES PATIENT CAREETHICAL & LEGAL PRINCIPLESCONFIDENTIALITY(HIPAA)HIPAA- Means Health Insurance Portability and Accountability ActHealth care provider must provide for the privacy and security of patient information in any forms (verbal, written, or electronic).
8ETHICAL & LEGAL PRINCIPLES PATIENT CAREETHICAL & LEGAL PRINCIPLESPROFESSIONAL LIABILITYASSAULT- The threat of touching in an injurious way.BATTERY- An unlawful touching of a person without consent.FALSE IMPRISONMENT- An unjustifiable detention of a person against his/her will.INVASION OF PRIVACY- When the confidentiality of a patient information is not maintained.NEGLIGENCE- The neglect or omission of reasonable care and caution.
9ETHICAL & LEGAL PRINCIPLES PATIENT CAREETHICAL & LEGAL PRINCIPLESPATIENT IDENTIFICATIONThe Technologist has the responsibility for proper patient identification.Wrist bandQuestioning patient (Name & date of birth)
10INTERPERSONAL COMMUNICATION PATIENT CAREINTERPERSONAL COMMUNICATIONCOMMUNICATION WITH PATIENTReview of patient historyExplanation of current procedureEmpathy, sensitivity to the needs of the patientAssertiveness, most productive when working with a reluctant patient.
11INTERPERSONAL COMMUNICATION PATIENT CAREINTERPERSONAL COMMUNICATIONEQUIPMENTAll MRI Equipment Inside the MRI Suite must be MR SafeIV’S- Check frequently, maintain solution bottle/bag 18-20” above the level of the vein.MONITORS- Check frequently, plug in units.URINARY CATHETERS,CHEST TUBES- Must be kept from superimposition and allowed to maintain operation ( check to see MRI compability ).
12PATIENT CARE INFECTION CONTROL TERMINOLOGY Cleanliness- Avoid transmitting organism by using proper cleaning, dusting, and hand washing techniques.Disinfectants (Germicides)- Refers to the used of hand washing to kill microorganism.Medical Asepsis- Refers to destruction of bacteria through the use of disinfectant/antiseptics.Sterilization (Surgical Asepsis)- The third level of medical asepsis, involves treating items with heat, gas, or chemicals to make them germ free. Destroyed all microorganism and their spores.
13PATIENT CARE INFECTION CONTROL ASEPTIC TECHNIQUES Cleanliness- Is our only defense against infection.Hand Washing- Should be performed after every patient, hand washing should last 20 seconds.Alcohol Based is approved by Joint CommissionPatient Prepping- Betadine destroy microorganism, Alcohol prevents the growth of microorganism.
14PATIENT CAREMedical Asepsis – Microorganism are eliminated through soap, water, or alcohol based products.Reduces the number or spread of microorganismSurgical Asepsis – Microorganism and their pores have been destroyed by heat, or chemical process.Sterile Technique – Only the front and above the waist is considered sterile area.
15PATIENT CARE PATIENT MONITORING VITAL SIGNS Blood Pressure Temperature Systolic range- Represents the pressure created during contraction of the left ventricle ( Normal)Diastolic range- Represent the pressure within the vascular system with the heart at rest (60-80 Normal)TemperatureOral 98.6, Rectal 99.6, Axillary 97.6RespirationAdults per minutes, Children per minutesPulseNormal Range beats/minute for adults, for infants/children.
16INDICATIONS & CONTRAINDICATIONS PATIENT CARECONTRAST MEDIAINDICATIONS & CONTRAINDICATIONSThe best predictor of possible reaction to contrast media is a history of a previous reaction.About 5% of patient experience some reaction; of this population only 5% experience a severe or life-threatening reaction (5% Rule)
17Pre-Meds for allergy are anti-histamine(Benadryl) and Steroids(Medrol) CONTRAST AGENTSIdiosyncratic ReactionsAdverse Reaction - Can be caused by anything other than contrast.It happens with the release of Histatmine due to injection, anxiety.Histamine- Can cause muscle constraction,accelarated heart rate,lower blood pressure,localized edema.Pre-Meds for allergy are anti-histamine(Benadryl) and Steroids(Medrol)
18Use for those at risk of reactions PREMEDICATIONUse for those at risk of reactions90% of reactions are associated with the release of histaminePrednisone is used to reduce the release of histamine (high osmality contrast stimulates release of histamine).Breakthrough reactionsMost likely similar to initial ,however there is a chance it could be more severe.No Premedication could replace state of being ready to treat a reaction
19CONTRAST AGENTS PATIENT PREPARATION SIGNED INFORMED CONSENT AllergiesPregnancyKidney FunctionsSELECTION OF VEINSAnticubital Veins (Best)TYPE & SIZE OF NEEDLE18/20 Angiocatheter Gauge for MRA ,Perfusion, Dynamic Studies
20SAFETY CONSIDERATIONS CONTRAST AGENTSSAFETY CONSIDERATIONSAlways wear gloves.Follow OSHA standard precaution and dispose of all materials.Place needle and syringe in sharp containers (DO NOT RECAP NEEDLES).Use new needle, and site for second attempt.Document injection and all complication. Also time and amount of contrast injected
21CONTRAST AGENTS VENIPUNCTURE Wash hands and put on gloves. Select site and apply tourniquet.Confirm puncture site and cleanse(Surgical Asepsis.Initiate puncture (35-45 degrees angle).Secure needle and confirm access (drawback blood)Flush line and confirm no pain or extravasation.Proceed with injection.
22INTRAVENOUS INJECTION PATIENT CARECONTRAST MEDIAINTRAVENOUS INJECTIONIV drugs are injected directly into the circulatory system, reaction can be instantaneous.Technologist must not leave the patient receiving a contrast agent alone.Patient pulse rate and blood pressure should be taken before and after exam (Depending on the Hospital Policy).If patient experiences any changes in their vital signs contact physician immediately.
23CONTRAST AGENTSIs used to improve the sensitivity and specificity of clinical diagnoses.Reactions to IV Contrast AgentsHigher injection rates,larger total volume are all associated with increase of adverse reactionsMinorModerateSevereNauseaHivesAnaphalaxysVomitingWheezingCardiac ArrestHeadachesBronchospasmRespiratory ArrestItchingFacial EdemaModerate reactions may require treatment and close observationSevere reactions are rare ,but are required immediate attention.
24PATIENT CARE CONTRAST MEDIA ADVERSE REACTIONS Assessment of Patient : How do they look,sound(voice),breathing ?If needed , stop exam immediately and remove patient from Zone 4Call for HelpCode or Radiologist/MD (Follow your Hospital Policy)Vital Signs: Get BaselineHeart Rate – Less than 40 bpm or greater than 130 bpm (except Pedi)Systolic Pressure – Less than 90Respiration Rate – Less than 8 per minuteOxygen Saturation – Less than 90
25PATIENT CARE CONTRAST MEDIA ADVERSE REACTIONS Mild Reaction- Nausea and vomiting, Hives, Itching, Sneezing.Monitor and comfort patient (Document reaction).Moderate Reaction- Excessive hives, tachycardia, excessive vomiting.Call for medical assistance, monitor & comfort patient (Document reaction)Severe Reaction (Anaphylactic)- Very low blood pressure, cardiac or respiratory arrest, convulsion, cyanosis.Call for immediate assistance, prepare for CPR, prepare for antihistamine (EPINEPHRINE).
26PATIENT MONITORING MEDICATIONS: Benadryl (Diphenhydramine)– Relieve allergic symptoms,can be given IV or PO.Epinephrine - Use for management of severe allergic reaction,can be given IM (Epi Pen) or IV(MD).Atropine Sulfate– Is use to increase heart rate (IV)Albuterol (Inhalers) – Is a bronchodilator, increases air flow to the lungsNitroglycerin – Use for chest pain , blood vessel dilator, increases blood flow.
27PATIENT MONITORING MEDICATIONS: Dextrose 5% - Is injected into a vein through an IV to replace lost fluids(helps increase BP) and provide carbohydrates to the body.Nifedipine – Is a type of calcium blockers,is use to decrease blood pressure.
28PATIENT MONITORING Cardiac Arrest Seizure Stroke Shock CPR should be started on any patient demonstrating cardiac failureSeizureCan cause a patient to demonstrate convulsive moments or period of unconsciousnessStrokeLack of blood flow to the brain. Could result in inability to speak, facial numbness,limb paralysis.ShockCan result due to blood loss(trauma) or massive vasodilation can occur due to allergy to iodine contrast
29LOCAL ADVERSE REACTIONS PATIENT CARECONTRAST MEDIALOCAL ADVERSE REACTIONSExtravasations- Escape contrast media into the interstitial tissues at the site of injectionSymptoms-Pain, swelling and redness. Care by applying warm/cold compress and elevating the effecting extremity.
30EXTRAVASATIONMost common experience is pain, swelling or tightness/burning at the siteMost Extravasation are limited to adjacent soft tissue(skin).Usually no permanent damage (Less than 100ml)All extravasation should have a close clinical follow.Always have a Radiologist examine patient and provide discharge instructionCompartment Syndrome – Is a severe injury from large amount of extravasation. Causing result of mechanical compression.Do not inject more than 20 ml saline flush with power injector.
31EXTRAVASATION TREATMENTS Elevation of affected extremity Keeping the extremity above the level of the Heart, decrease capillary pressure and promotes reabsorption of extravasated fluids.Apply Cold or Warm compressesNo evidence of favoring warm versus cold compress.Cold help relieved pain at the siteWarm/Heat helps improving absorption of extravasation, improving blood flow.Surgical ConsultationFor severe extravasation.Progressive swelling or painAltered tissue perfusion,blistered,and/or ulcer skinIncrease Patient RiskPatient who cannot communicate (Elderly/Pediatrics)Hand,Wrist,Foot and Ankle are more likely site for extravasationIV longer than 24 hours and multiple punctures in the same vein ,also increase risk for extravasation.
32Pregnancy Test is required for Child Bearing age female patients Need to be medically necessary and approved by ordering physician and OB-GYNContrast on Pregnancy – Placenta transfer contrast (Gad) to Fetal Circulation.Lactation– Recommended 24 – 48 hours after contrast injection, babies not to be fed.Excreted milk has shown very low levels of Iodine.Pregnancy Test is required for Child Bearing age female patients
33PATIENT CARE CONTRAST MEDIA LONG TERM EFFECTS Nephrogenic Systemic Fibrosis (NSF)- Mostly seen in patient with decrease renal function. It causes fibrosis over tissues, including joints,lungs,kidney,diaphragm.Symptoms-Swelling ,tighness,and redness of the skin. Patient must contact Referring physician if seen are seem.
34CONSCIOUS SEDATIONChloral Hydrate– Is a sedative, is used in the short-term treatment of insomnia(oral).Usually given for pediatric cases in CT.Versed - Belongs to a class of drugs called benzodiazepines.Is given intravenous and has a short term effect.Morphine– Is a narcotic used for severe painValium – Is used as an anti-anxiety medication
35JOINT COMMISSIONJoint Commission (JC) – Accredits and certifies more than 20,500 health care organizations and programs in the United States.Every Three YearsImprove Patient SafetyImprove Health Care Quality
36JOINT COMMISSION MRI SAFETY MRI Safety Officer- Every department needs an MRI Safety Officer.Recommended a dedicated MRI Safety CommitteeYearly In-Service/Training for entire Hospital StaffDedicated In-Service for MRI TechnologistMeet Yearly with local Fire Department & Police DepartmentMRI Zones must be label throughout the departmentRestrict access to Zone III, Only MR Personnel Level 2 Zone IV5 Gauss Line ,must be marked/visible on the room/floor.
37JOINT COMMISSION MRI SAFETY(Cont…) MRI Safety Officer- Every department needs an MRI Safety Officer.Patient Identifiers(Two) ,name and date of birth or MR#MRI Screening forms to anyone entering the MRI SuiteHave two different MRI Personnel review the formsAll Equipment must be mark for MRI Safety within the department.Stickers with MR Safe or UnSafeFire Estiguisher,Wheelchairs,Stretchers,IV Pole,Vital Sign MachineHand Held Magnet (Exclusion Criteria Equipment)
38JOINT COMMISSION INFECTION CONTROL Hand Washing- Needs to be followed per guidelines below.Before touching patientsAfter touching patientAfter touching patient room equipmentAfter exposure to body fluidsAfter removal of glovesSoap & Water is required if exposure to body fluids(Blood).Alcohol Gel can be used if no soap & water available.(Unless Body Fluid Exposure)
39JOINT COMMISSION INFECTION CONTROL Infection Control Policy - Dedicated policy for MRI Department.Cleaning Pads and Coils after each useHave PPE ready in every room.Cleaning MRI Safety Equipment routinely(even if not used)MR Vital Signs, Anesthesia Machine,etcUsing correct cleaning solution for infection controlRequires two minutes(wet) to destroy microorganismCheck for specific brand for your HospitalHave sticker for date and check expiration datesInspect Pads routinely, replaced if neededMRSA can grow in old/tear pads
40Hospital Policies & Procedures JOINT COMMISSIONHospital Policies & ProceduresPolicies – Everyone should know where to locate Hospital and Departmental specific policies.Chemical Spills & Material Safety Data Sheet (MSDS)Code Red(FIRE)MRI Safe Fire ExtinguishersPull Station & Fire ExitsFire Evacuation Routes must be posted throughout the department.Hallways should be clear by at least 36 inchesInformed Consent Forms.Sedation (Claustrophobia) needs to provide patient/family with a copy.MR Conditional (Programmable Shunts,DBS,Pacemarker,etc)“Time Out” for Invasive Procedures (Biopsies,Wire Placement)
41Hospital Policies & Procedures JOINT COMMISSIONHospital Policies & ProceduresPolicies – Everyone should know where to locate Hospital and Departmental specific policy.Emergencies or Code Blue/Cardiac ArrestKnow the Policy & Who to contactKnow your ABCDNever performed in Zone IVMock Code should be performed every quarter with entire staff.Maintained Log/Inventory for AED,Refrigarator,Contrast Warmer,Eye Wash Station.Do not store anything in carton boxesNothing under sinks
42JOINT COMMISSION MEDICINE MEDICINES – All medicines need to be store and locked.Do monthly checks for expired medicationCheck biopsy supplies monthly for expirationKeep a logAll medications should be label ,including contrastPower Injector, label syringes with contrast and salineLabel needs to include medicine,dose,time,date,and initials
43JOINT COMMISSION PRIVACY HIPPA – Privacy must be maintained by all Hospital PersonnelEmployees should only have access to information needed.No cameras in Private Patient areasChanging rooms, BathroomsPatient Chart should have a cover/folder(No papers).All computers Screen must be close when not in used.Always log off medical records,PACS,RIS.All CPU must have a privacy protector screen.