Intraoperative Radiography DMI 63 Intraoperative Radiography

Intraoperative Radiography: Running the mobile image intensifier or taking radiographs with the portable x-ray unit in OR under sterile, intense, conditions

Mobile Image Intensifier Commonly referred to as? C-arm Is it sterile? No! Unless----

Portable X-ray Unit Sterile? No! Unless covered with sterile plastic covers after portable brought into OR (X-ray machine should be cleaned prior to entering each OR!)

OR table Sterile? No! Unless- Covered with sterile drapes!

Working in OR requires : Super awareness of sterile environment! Skill in use of portable machine and c-arm Skill in working OR table Using radiation protection appropriately Knowledge of anatomic landmarks- whether you can see them or not! Ability to work with surgery staff under high pressure circumstances

During surgery Technologist works under direction of surgeon not a radiologist Who will appear to hate you! You must be able to perform accurately and quickly! Repeat is no longer in your vocabulary! Remember: it’s a high stress situation for all –but success or failure rests on surgeon’s shoulders

Check your ego at the door! You no longer have a name- you are “X-ray” The only person lower than you is the guy who cleans the OR- at least they know him! Expect some abuse! Good part -if you screw up, they won’t recognize you outside the OR! You

You must be able to read minds! When running c-arm, when Dr. wants fluoro, he expects you to understand that: “X-ray”, “now”, “OK”, “uh huh” “ready”, and a grunt or a mumble mean hit the fluoro pedal even when used interchangeably Or maybe just a glance at the monitor

Areas of OR Unrestricted Semi-restricted Restricted

Unrestricted areas of OR Provides outside to inside access No traffic restrictions Street clothes permitted

Semi-restricted areas of OR Authorized personnel only Pts and staff Provides access from unrestricted area of OR to restricted area Proper OR attire required Scrubs, head and shoe covers

Examples of Semi-restricted area Hallways within OR rooms Instrument and supply processing area Non-sterile supply areas and utility rooms

Restricted Areas Where surgical procedures are carried out Proper OR attire and mask must be worn Examples: Scrub sink areas Sterile supply rooms Operating suites

Surgical Suite

The Surgical Suite Restricted area! Aseptic technique: the effort taken to keep patients as free from hospital micro-organisms as possible Know Who is sterile and who isn’t! Know What equipment is sterile and non-sterile No items should be moved without permission of circulating nurse or person in charge! Scrub clothes must be worn, and covered if leaving department

Operating Room Attire Clean, fresh attire, surgical “scrubs,” donned at beginning of each shift Are they sterile? no Change as necessary Should soiled scrubs be worn outside OR suite? -no!

What the surgery team wears!

Masks worn at all times in OR! Are they sterile? No!

Operating Room Attire Caps Worn in all areas of OR to contain hair Hoods available to cover any facial hair not contained by mask Are they sterile? No!

Surgical Shoe Covers Purpose: Top prevent you from tracking in contaminants To prevent contaminants from soiling your shoes Are they sterile? NO!

Operating Room Attire for Techs Gloves Worn to protect tech from body fluids –sterile? No! Radiation badge Proper ID

Lead attire

Take a bath now and then! Daily body and hair cleanliness very important to prevent transportation of microbes!

Person with known transmittable infection should not be permitted in OR suite! Cold Acute infection Open cold sore Sore throat Carrier of transmittable conditions

Aseptic Vs Sterile Aseptic is defined as: Aseptic technique is used to maintain a sterile field Aseptic is defined as: Free from pathogenic microorganisms Sterile is defined as: Free from all living microorganisms

Nosocomial infections Infections which are a result of treatment in a hospital or a healthcare service unit Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge

Nosocomial infections In United States, Centers for Disease Control and Prevention estimates that 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year Commonly transmitted when hospital officials become complacent and do not practice correct hygiene regularly Also, increased use of outpatient treatment means people who are hospitalized are more ill and have more weakened immune systems than may have been true in past.

Aseptic Technique (cont’d) Radiographers or other non-sterile personnel must maintain a safe margin from any sterile field- What is worse than contaminating a sterile field is bad? - not reporting it!

What is the sterile corridor? Area between instrument table and draped pt Must not be entered by any non-sterile personnel! Notify proper personnel immediately if a sterile field is contaminated!!

What parts of sterile gown are considered sterile? On sleeves- elbow to cuffs On body- shoulder to level of sterile field

Surgical Instrument Tray

If you are not sure, consider it sterile!

Loading A Cassette in Sterile Cover Tech OR staff Tech 2 person job!

Retrieving IR in Sterile Field Why must Radiographer be wearing gloves? in case IR cover is contaminated with blood or body fluids Surgical tech or nurse gives covered IR to radiographer OK to contaminate cover now, but not person handing you the film! Cover and gloves are disposed of properly before handling uncovered IR Hot foot it up to develop and return with image

Logistical Problems Getting c-arm or portable through jungle of equipment and people Getting cassette under pt without breaking sterile field Centering CR to pt and to cassette when you can’t see or touch either one! When x-ray is table top, covered with sterile cloth- you can’t see body part! Watch out for your lead apron hitting field

Take a 5 second break!

Common Surgical Procedures requiring our services

Cardiac Surgery Anything pertaining to heart and related major blood vessels Most common procedures: pacemaker and automatic internal cardiac defibrillator insertions (C-arm) Coronary artery bypass grafts What is generally required after above mentioned procedures? post-op CXR

Cholangiogram

Neurosurgery Laminectomies Shunt placements Transphenoidal cases Requires x-table lateral projections Shunt placements Transphenoidal cases Requires C-arm or skull films

Cross-Table Lateral Cervical Spine

Oncology Catheter placements Brachytherapy localization Usually by C-arm Requires a post-op CXR Brachytherapy localization Requires two views at right angle to each other Cesium Implant

Orthopedic Surgery ORIF What does it stand for? Open reduction internal fixation May require C-arm or plain film radiography Closed reduction is what? No surgical incision- just manipulation C-arm or plain films

Open Reduction -Internal Fixation

Joint Replacement

Orthopedic Surgery

Pain Management Usually in: Requires C-arm to locate injection site for facet block Usually in: Lumbar spine or SI joint or Cervical spine

Vascular Surgery Utilizes both plain film and mobile fluoroscopy AV fistulas, AV grafts are most common procedures What is an AV fistula? abnormal connection or passageway between artery and vein)

Urology Suite Retrograde Pyelograms IVU’s Kidney & gall stone extractions Percutaneous Nephrolithotomy (removal stones from kidney by small puncture wound (up to about 1 cm) through skin)

Radiation Protection Or else!! Shield patient if possible! The mobile unit should not be used as shield by you YOU must provide Lead aprons for all personnel! Monitoring badges should be worn by all personnel You are responsible for making sure all personnel who can or want to leave room prior to making an exposure are given a loud clear warning and have a chance to get at Or else!!

Fluroscopy When using the c-arm, the radiation source is generally under pt, so where should shielding should be placed? Under the pt! between source and pt Must be done before pt is put on table

Summation of Important Things To Remember in OR! Upon entering OR, alert all staff of your presence and purpose Be aware of sterile fields and personnel Enlist aid of circulating nurse to move equipment out of way Any cassettes placed in sterile field must be covered first by a sterile member of the team Allow team to clear room prior to making the exposure Do it right the first time!!!