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CHAPTER

3 Patient Care
and Safety

STUDENT LEARNING OUTCOMES KEY TERMS

Ambulatory: Walking, or able to walk
After studying this chapter, the student will be able to:
Atrophy: Decrease in the size of the organ, tissue, or muscle
1. Give clear verbal instructions to an ambulatory
Decubitus ulcer: A pressure sore or ulcer
patient concerning the correct manner of dressing
Dyspnea: Labored or difficult breathing
and undressing for a radiographic procedure.
2. Correctly assess a patient’s need for assistance Immobilizer: Velcro straps that are used on a patient’s
to complete a radiographic procedure safely. limbs or waist to prevent a patient from injuring him or
herself or others
3. Demonstrate the correct method of moving and
positioning a patient to prevent injury to the Ischemia: Deficiency of blood in a body part due to
patient or the radiographer. functional constriction or actual obstruction of a blood
vessel
4. Demonstrate the correct method of assisting a
disabled patient with dressing or undressing for a Tissue necrosis: Localized death of tissue due to injury or
radiographic procedure. lack of oxygen
5. List the safety measures that must be taken Ulceration: An area of tissue necrosis that penetrates below
when transferring a patient from a hospital the epidermis; excavation of the surface of any body
room to the radiographic imaging department. organ
6. Describe steps that must be taken as the
radiographer to protect the patient’s
integumentary system from injury.
7. Explain the criteria to be used when
immobilization of a patient is necessary.
8. List the types of immobilizers available, and demon-
strate the correct method of applying each one.
9. List the precautions to be taken if a patient is in
traction or wearing a cast.
10. Demonstrate the correct manner of assisting a
patient with a bedpan or urinal.
11. Explain the responsibilities of a radiographer
concerning radiation safety.
12. List the departmental safety measures that must
be taken to prevent and control fires, patient
falls, poisoning or injury from hazardous
materials, and burns as well as the measures to
evacuate patients in case of a disaster.

47
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48 Patient Care in Imaging Technology

pproaching the profession and patients in a cour- patient and determines which items of clothing are to
A teous and tactful manner can put the patients at
ease and decrease their level of embarrassment so that
be removed. The patient’s discomfort or embarrass-
ment can be decreased if the situation is approached in
the procedure can be performed in a smooth and timely a courteous and professional manner.
manner. The radiographer sets the tone for the entire The patient should be taken to the specific dressing
exchange when a patient arrives as an outpatient. The area and shown how to close the dressing room door or
radiographer is responsible for protecting him of her- draw the curtain of the cubicle while undressing. Clearly
self and the patient from injury in every way possible. explain that he or she is to put on the examining gown
Health care workers are often injured while moving and point out where to go for the examination once pre-
and lifting patients, but almost all of these injuries are pared. (Remember that not everyone knows that some
preventable if the correct body mechanics and rules of types of examining gowns open at the back rather than
safety are used. Patients are also victims of injuries at the front; this information should be part of the expla-
caused by being improperly moved or lifted. Most of nation.) Doing this takes only a few moments, and it will
these injuries can also be prevented. make the patient feel more comfortable.
Moving patients from the radiographic table to a The patient should be given hangers for clothing. If
gurney or wheelchair, or from a hospital bed to a gur- it is permissible to leave clothing in the dressing room,
ney or wheelchair, requires some forethought regard- explain this to the patient. If the patient cannot leave
ing the safety of the patient as well as to the body the clothing, show him or her what to do with it.
mechanics used. Special care with the ancillary equip- Purses, jewelry, and other valuables should be treated
ment must be taken when moving it with a patient dur- with special care so that they will not be lost or stolen.
ing transport. A patient’s integumentary system must Many patients wear jewelry or carry a purse or
be protected from damage. This is of particular con- other valuable items to the radiology department. The
cern when the patient is unable to move by his or her dressing rooms in most departments are not safe places
own power. to leave these items, and the patient may feel justifiably
Occasionally, a patient may have to be immobilized uneasy about leaving them there. Again, consider the
for his or her own safety during a radiographic proce- patient’s concern and explain what must be done with
dure. Not only must the institution-specific rules con- personal items to keep them safe.
cerning immobilizers be learned, but also the correct Metal items such as necklaces, rings, and watches
use of these devices must be carefully learned to pro- are not to be worn for many diagnostic procedures and
tect the patient from harm. must be removed before the procedure can begin. An
The need for a bedpan or urinal may be a require- envelope or other container large enough to accommo-
ment that a patient may find embarrassing but date all such items should be offered to the patient.
unavoidable. As a professional, the radiographer will Identifying information should be written on a receipt,
be able to put the patient at ease and proceed with tact and all items should be tagged and placed in the desig-
and confidence that will facilitate the procedure to a nated safety area. This procedure will prevent losses
swift conclusion. The different styles of bedpans that may result in inconvenience and expense to both
require some knowledge as to the correct placement the patient and the department.
under the patient. An understanding of how a bedpan Do not place value on a patient’s belongings. An
feels underneath a patient and the embarrassment that item that may seem insignificant to others may be the
the patient experiences will help the radiographer patient’s most treasured belonging. Every article of
empathize with the patient. clothing or jewelry and the personal effects that a
Adhering to rules of radiation safety, preventing patient brings to the diagnostic imaging department
and controlling fires, using and disposing of hazardous should be treated with care.
chemicals correctly, and observing other rules of
patient and departmental safety are important parts of
the radiographer’s education. BODY MECHANICS

Constant abuse of the spine from moving and lifting

CARE OF PATIENT’S patients is the leading cause of injury to health care
BELONGINGS personnel in all health care institutions. Following the
correct rules of body mechanics will reduce the amount
A patient who comes to the radiology department as an of fatigue and chance of injury. Rules of body mechan-
outpatient is frequently required to remove all or some ics are based on the laws of gravity.
items of clothing and to put on a patient gown before Gravity is the force that pulls objects toward the
an examination procedure or treatment can be per- center of the earth. Any movement requires an expen-
formed. It is usually the radiographer who receives the diture of energy to overcome the force of gravity. When
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CHAPTER 3: Patient Care and Safety 49

an object is balanced, it is firm and stable. If it is off • When picking up an object from the floor, bend
balance, it will fall because of the pull of gravity. The the knees and lower the body. Do not bend from
center of gravity is the point at which the mass of any the waist (Fig. 3-1)
body is centered. When a person is standing, the center • The biceps are the strongest arm muscles and
of gravity is at the center of the pelvis. are effective when pulling; therefore, pull heavy
Safe body mechanics require good posture. Good items or patients rather than push them.
posture means that the body is in alignment with all the • When assisting a patient to move, balance the
parts in balance. This permits the musculoskeletal sys- weight over both feet. Stand close to the patient,
tem (the bones and joints) to work at maximal effi- flex the gluteal muscles, and bend the knees to
ciency with minimal amount of strain on joints, ten- support the load. Use arm and leg muscles to
dons, ligaments, and muscles. Good posture also aids assist in the move.
other body systems to work efficiently. For instance, if • Always protect the spine. Rather than twisting
the chest is held up and out (the musculoskeletal sys- the body to move a load, change the foot posi-
tem), then the lungs (the respiratory system) can work tion instead. Always keep the body balanced
at maximal efficiency. over the feet, which should be spread to provide
Rules for correct upright posture are as follows: a firm base of support.
• Make certain the floor area is clear of all objects.
• Hold chest up and slightly forward with the
waist extended. This allows the lungs to expand
CALL OUT!
properly and fill to capacity.
• Hold head erect with the chin held in. This puts To prevent lower back injury, always keep the center
the spine in proper alignment, and there is no of gravity, the knees flexed, and the weight over both
curve in the neck. feet. Do not bend at the waist or twist with the body.
• Stand with the feet parallel and at right angles
to the lower legs. The feet should be 4 to 8
inches apart. Keep body weight equally distrib- MOVING AND TRANSFERRING
uted on both feet. PATIENTS
• Keep the knees slightly bent; they act as shock
absorbers for the body. The radiographer may be called upon to transfer or
• Keep the buttocks in and the abdomen up and assist in transferring a patient from a hospital room to
in. This prevents strain on the back and abdom- the diagnostic imaging department. Several precautions
inal muscles. must be taken when moving a patient from the hospital
room to the imaging department. They are as follows:
The forces of weight and friction must be overcome
when moving and lifting objects. Keep the heaviest 1. Establish the correct identity of the patient.
part of the object close to the body. If this is not possi- Approach the patient and identify yourself and the
ble, one or more persons should assist with moving or reason for being there. Ask to see their identification
lifting the load. wristband. This is extremely important, as many
The force of friction opposes movement. When times the patient has been transferred to another
moving or transferring a patient, reduce friction to the room since the radiology request was submitted.
minimum to facilitate movement. This can be done by 2. Request pertinent information concerning the
reducing the surface area to be moved or, in the case of patient’s ability to comply with the physical demands
a patient, by using some of the patient’s own strength of the procedure while at the nurses’ station.
to assist with the move, if possible. If the patient is 3. Request information concerning the patient’s abil-
unable to assist, reduce friction by placing the patient’s ity to ambulate and any restriction or precautions
arms across the chest to reduce the surface area. The to be taken concerning the patient’s mobility.
surface over which the patient must be moved must be 4. Move the patient to the imaging department accord-
dry and smooth. Pulling rather than pushing also ing to the necessary restrictions after greeting and
reduces friction when moving a heavy object or person. identifying him or her and providing an explana-
A sliding board or pull sheet placed under an immobile tion of what is to occur.
patient also reduces friction. Directions for the use of
these items are presented later in this chapter.
To avoid self-injury when moving heavy objects, CALL OUT!
remember to keep the body’s line of balance closest to
Never move a patient without enough assistance to
the center of the load. Rules for picking up or lifting
prevent injury to yourself and/or the patient.
heavy objects are:
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50 Patient Care in Imaging Technology

CALL OUT!
Never move a patient without assessing the patient’s
ability to assist.

When the procedure is completed, return the patient to

the hospital room using the following procedure:

1. Stop at the appropriate nurses’ station, return the

chart, and inform the unit personnel that the
patient is being returned to the room. Request help
if it is needed at this time.
2. Return the patient to the room, help the patient get
into bed, and make him or her comfortable and
safe. Place the patient’s bed in the position that is
closest to the floor with the side rails raised and the
call button within reach in case the patient needs
assistance.

! WARNING!
To prevent possible patient injury, always lower the bed to
the lowest position, and secure the rails in the upright posi-
tion when a patient is returned to bed.

Assessing the Patient’s Mobility

Before beginning to move a patient, critical thinking and
problem-solving skills must be used to plan the most
effective manner of accomplishing the task. The expected
outcome of this plan will be to accomplish the move
without causing additional pain or injury to the patient.
Use interviewing and assessment skills to complete this.
Look for the following during patient assessment:

1. Deviations from correct body alignment. Deviations

in normal physiologic body alignment may result
from the following: poor posture, trauma, muscle
damage, dysfunction of the nervous system, malnu-
trition, fatigue, or emotional disturbance. Support
blocks or pillows, which are used to assist the
patient during the procedure, must be available.
2. Immobility or limitations in range of joint motion.
Any stiffness, instability, swelling, inflammation,
pain, limitation of movement, or atrophy of muscle
mass surrounding each joint must be noted and
Incorrect Correct considered in the plan of care.
FIGURE 3-1 Keep the body balanced over the feet to provide 3. The ability to walk. Gait includes rhythm, speed,
a broad base of support. cadence, and any characteristic of walking that may
result in a problem with balance, posture, or inde-
pendence of movement. Before beginning the
move, the amount of assistance needed to safely
complete the move and procedure must be planned.
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CHAPTER 3: Patient Care and Safety 51

4. Respiratory, cardiovascular, metabolic, and mus- 4. Generally, it is better to move a patient toward his
culoskeletal problems. Obvious respiratory or car- or her stronger side while assisting on the patient’s
diovascular symptoms that impair circulation and weaker side.
signal potential problems in positioning must be 5. The patient should wear shoes for standing trans-
planned for. Metabolic problems such as diabetes fers, not slippery socks.
mellitus or rheumatoid arthritis may be discovered 6. Inform the patient of the plan for moving and
during the interview process and planned for as encourage him or her to help.
necessary (symptoms and care of patients with
7. Give the patient short, simple commands and help
medical problems are discussed in Chapter 8).
the patient to accomplish the move.
Other assessment considerations are:

1. The patient’s general condition. How well or how Methods of Moving Patients
poorly is he or she functioning? There are essentially three ways of transferring
2. Range of motion and weight-bearing ability. Has patients: by gurney, by wheelchair, and by ambulation.
the patient had a surgical procedure that restricts
motion or limits weight bearing until it is healed? By Gurney
3. The patient’s strength and endurance. Will the When a patient is moved from a gurney to a radi-
patient become fatigued and be unable to complete ographic table, or the reverse, great care must be
the transfer with only stand-by assistance? taken to prevent injury. If the patient is unconscious
4. The patient’s ability to maintain balance. Can the or unable to cooperate in the move, the patient’s
patient sit or stand for as long as the procedure spine, head, and extremities must be well supported.
requires? Convenient and safe ways to do this are by using a
5. The patient’s ability to understand what is expected sliding board or a sheet to slide the patient from one
during the transfer. Is he or she responsive and surface to another.
alert?
6. The patient’s acceptance of the move. Does the Sheet Transfer
patient fear or resent the transfer? Will the trans- To place a sheet under a patient, use a heavy draw
fer increase the pain? Does the patient feel that the sheet or a full bed sheet that is folded in half. Have one
move is unnecessary? person stand on each side of the table or bed at the
7. The patient’s medication history. Has the patient patient’s side. Turn the patient onto his or her side
received a sedative, hypnotic, or other psychoac- toward the distal side of the bed or table. Place the
tive drug in the past 2 or 3 hours? Will any med- sheet on the table or bed with the fold against the
ication that he or she has taken affect the ability to patient’s back (Fig. 3-2A). Roll the top half of the
move safely? sheet as close to the patient’s back as possible (Fig.
3-2B). Inform the patient that he or she will be turned
Before going to the patient, a consultation with the onto the side toward the opposite side and will be
nurse in charge of the patient is recommended so that moving over the rolled sheet. Then turn the patient
the patient’s condition and limitations can be under- across the sheet roll and have the assistant straighten
stood. If assistants are needed, they must be on hand. the sheet on the distal side (Fig. 3-2C). Return the
A patient must never be moved without adequate assis- patient to a supine position, and the transfer may
tance; to do so may cause injury to the patient or the begin.
radiographer. The radiographer must decide how the If the patient is an adult, three or four people
patient can be transferred safely and comfortably, should participate in the maneuver. One person stands
whether by gurney or by wheelchair. Hospital patients at the patient’s head to guide and support it during the
are seldom allowed to walk to and from the diagnostic move, with another at the side of the surface to which
imaging department for reasons of safety. Someone the patient will be moved, and a third person at the side
must always be at the patient’s side as he or she moves. of the surface on which the patient is lying. If there are
The following rules should be observed during a move: four people, two may stand at each side. The sheet is
rolled at the side of the patient so that it can easily be
1. Give only the assistance that the patient needs for grasped, close to the patient’s body. In unison (usually
comfort and safety. on the count of three), the team transfers the patient to
2. Always transfer a patient across the shortest dis- the other surface. Extra care over the metal parts of the
tance. radiographic table’s metal edges should be taken as
3. Lock all wheels on beds, gurneys, and wheelchairs well as assuring that the tube housing is positioned out
before the move begins. of the way.
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52 Patient Care in Imaging Technology

A B

FIGURE 3-2 (A) Place the sheet on the table with the fold
against the patient’s back. (B) Take the top half of the sheet and
roll it against the patient. (C) After the patient is rolled to the
C
opposite side, the rolled half of the sheet is straightened out.

Sliding Board Transfer 5. Assist the patient to turn onto his or her side, away
The sliding board (also called a smooth mover and a from the radiographic table, and place the sliding
“smoothie”) is a glossy, plasticized board approxi- board under the sheet upon which the patient was
mately 5 feet 10 inches in length and about 2 feet 6 lying.
inches wide. This item facilitates moving patients from 6. Create a bridge with the board between the edge of
one surface to another, usually from a gurney to an the radiographic table and the edge of the gurney
examining table. The sliding board usually requires (Fig. 3-3A).
fewer personnel to make the move than the sheet trans- 7. Place the sheet over the board, and allow the
fer because it creates a firm bridge between the two patient to roll back onto the board.
surfaces over which the patient can be easily moved. 8. With one person at the side of the radiographic
The sliding board transfer procedure is as follows: table and the other at the side of the gurney, slide
the patient over the board and onto the radi-
1. Obtain the sliding board and spray it with antista- ographic table (Fig. 3-3B).
tic spray if necessary. 9. Assist the patient to roll toward the distal side of
2. Obtain the assistance of one other person if the the radiographic table, keeping the patient secure
patient is of average size and weight; if the patient by holding onto the sheet on which he or she was
is large, three people may be necessary to move the lying. The person standing on the side of the gur-
patient safely. ney should remove the sliding board from under
3. Move the patient to the edge of the gurney. One the patient (Fig. 3-3C).
person should hold the sheet that the patient is lay- 10. Remove the gurney and perform the radiographic
ing on over the top of the patient to keep the procedure.
patient from possibly rolling off the gurney. 11. When the procedure is completed, the patient can
4. Move the gurney up against the radiographic table be transferred back to the gurney by repeating the
and lock the wheels of the gurney. steps above.
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CHAPTER 3: Patient Care and Safety 53

A B

FIGURE 3-3 (A) Create a bridge with the board between the
table and the gurney. (B) Roll the sheet close to the patient and
slide the patient onto the table. (C) Remove the sliding board
C
while safely securing the patient.

12. Once the patient is back on the gurney, place a pil- physician in charge of the patient’s care and applied in
low under the patient’s head, if this is permitted, compliance with institutional policy.
and put the side rails of the gurney up. Place a soft The Joint Commission states that immobilizers
immobilizer over the patient. The patient may then should be used only after less restrictive measures
be transferred. have been attempted and have proved ineffective in
13. When the move is complete, discard the soiled protecting the patient. Remember this and use critical
linen that was used on the radiographic table, and thinking skills to avoid the use of immobilizers if at all
clean the sliding board and the table with a disin- possible. Immobilizers are defined as any manual
fectant spray. method or physical or mechanical device, material, or
14. After washing hands, place clean linen on the equipment attached or adjacent to the person’s body
table. that the person cannot remove easily that restricts
freedom of movement or normal access to one’s body
CALL OUT! (Omnibus Reconciliation Act, 1989).
The most effective method of avoiding the need to
Always obtain enough assistance to move a patient, restrain an adult patient is the use of therapeutic com-
even with a smooth mover. This is for the safety of munication to explore the patient’s fears. If a patient
both the patient and the radiographer. seems fearful or is striking out or moving in an unsafe
manner, assure the patient that the procedure will be
USE OF IMMOBILIZERS carried out quickly and in a manner that keeps him or
her as comfortable as possible. If this does not reassure
The ethical and legal restrictions concerning use of the patient, other less restrictive devices, such as soft,
immobilizers (often called restraints) in patient care Velcro straps (Fig. 3-5A), sandbags (Fig. 3-5B and 3-5C),
are discussed in Chapter 1. The radiographer must and sponges may be used to remind the patient to
remember that immobilizers must be ordered by the refrain from moving. If immobilizers are to be used, be
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54 Patient Care in Imaging Technology

PROCEDURE
Wheelchair Transfer

If a patient must be moved from a bed or radiographic

table to a wheelchair, or the reverse, he or she must be
helped. Never allow a patient to get off a table or onto a
6. The footrests on the wheelchair should then be put
down and the wheels unlocked. A safety belt should
be put across an unsteady patient.
wheelchair without some assistance. The patient is often
not as strong as he or she thinks. The sudden movement
may cause dizziness, and the patient may fall. CALL OUT!
If the patient has been in a supine position and is to be
When moving a patient from hospital bed to wheel-
helped to a sitting position, have the patient turn to the side
chair, always place nonskid slippers on the patient’s
with knees flexed. Then stand in front of the patient with
feet, provide assistance to prevent falls, and secure
one arm under the shoulder and the other across the knees.
the seatbelt on the wheelchair.

1. If the patient can assist, instruct him or her to push up

with the upper arm when told to do so (Fig. 3-4A).
2. On the count of three, move or help the patient to a sit- ! WARNING!
ting position at the edge of the table. Before helping the Before allowing a patient to get out of a wheelchair, raise
patient to stand, allow him or her to sit for a moment the foot supports out of the way. Many patients step on
and regain a sense of balance.While the patient is “dan- these, causing the wheelchair to flip over, which causes
gling,” place nonskid slippers on the patient’s feet. injury to the patient!
3. If the patient needs minimal assistance to get off the
table, stand at the patient’s side and take the patient’s
arm to help. Once placed on the radiographic table, cover the patient
with a protective sheet. Do not allow the patient to
4. If the radiographic table is high, never allow a patient
become chilled.
to step down without providing a secure stepping
A patient who has received a narcotic, hypnotic, or
stool. Always stay at the patient’s side to assist. A tele-
other type of psychoactive medication; a confused, disori-
scoping radiographic table must be placed in the
ented, unconscious, or head-injured person; or a child
lower position before a patient is assisted to move
must never be left alone on a radiographic table or gur-
off of it.
ney. If the patient’s behavior cannot be predicted or if the
5. The wheelchair must be close enough so that the patient is in a wheelchair; observe him or her carefully. A
patient can be seated in the chair with one pivot (Fig. soft immobilizer belt should be placed over any patient on
3-4B). Have the foot supports of the chair up and the a gurney or in a wheelchair. The side rails of the gurney
wheels locked. must always be up.

A B

FIGURE 3-4 (A) Stand in from of the patient and place an arm under her shoulders and over across her knees. Assist to a
sitting position. (B) Wheel the wheelchair close to the table pivot and help the patient sit in the chair.
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CHAPTER 3: Patient Care and Safety 55

A B

FIGURE 3-5 (A) A Velcro strap being placed snuggly but not
tightly. (B) Sandbags will help remind the adult patient to
C
remain still. (C) Sandbags will also assist in immobilizing the
infant while holding the shield in place.

certain that they are being used to protect the patient’s immobilizers are only temporary and that as soon as the
safety and that their use is the only alternative. procedure is finished, the immobilizer will be removed.
There are various types of immobilizing devices A calm, reassuring manner often soothes an agitated
that may be used for adult patients. Immobilizers for or confused patient who has been immobilized. A patient
use with children are discussed in Chapter 10. Reasons in this state needs repeated orientation as well as a quiet
for application of immobilizers in the care of an adult and quick explanation to complete the procedure. Return
patient include the following: the patient to the hospital room or wherever he or she is
to be taken on completion of the radiographs.
1. To control movement of an extremity when an intra- Always apply immobilizers carefully and in the
venous infusion or diagnostic catheter is in place manner prescribed by the manufacturer of the device.
2. To remind a patient who is sedated and having The type of immobilizer to be used is dictated by need.
difficulty remembering to remain in a particular As explained in Chapter 1, all radiographers must doc-
position ument application of immobilizers. The following are
3. To prevent a patient who is unconscious, delirious, rules for application of immobilizers:
cognitively impaired, or confused from falling from
a radiographic table or a gurney; from removing a 1. The patient must be allowed as much mobility as is
tube or dressing that may be life sustaining; or safely possible.
from injuring him or herself by impact with diag- 2. The areas of the body where immobilizers are
nostic imaging equipment applied must be padded to prevent injury to the
skin beneath the device.
When caring for a patient who has been immobilized,
explain the reason for using immobilizers to the patient 3. Normal anatomic position must be maintained.
and to anyone who may accompany the patient. After 4. Knots that will not become tighter with movement
immobilizers are applied, do not leave the patient unat- must be used (a half-knot is recommended; Fig. 3-6).
tended, and inform the patient that he or she is not 5. The immobilizer must be easy to remove quickly, if
alone and is not being punished. Also explain that the this is necessary.
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56 Patient Care in Imaging Technology

To immobilizer 6. Neither circulation nor respiration must be

impaired by the immobilizer.
7. If leg immobilizers are necessary, wrist immobiliz-
Immobilizer tie
ers must also be applied to prevent the patient
from either unfastening the device or, in an
Mattress Pull to tighten
attempt to leave the radiographic table or gurney,
accidentally hanging him or herself.
Frame
Springs Although the radiographer is not usually the health
care worker who monitors the patient in immobilizers
for long periods of time, it should be known that
immobilizers may need to be removed and the joints
affected by the immobilizer be put through range of
motion exercises. Only one immobilizer at a time
should be released, and then retied prior to releasing a
second immobilizer. Always tie the immobilizer to a
stationary object such as the gurney frame or side of
the radiographic table (if possible).
There are various types of immobilizers that may
be used, including the following:

Pull here to untie 1. Limb holders or four-point restrains (Fig. 3-7A)

2. Ankle or wrist immobilizers (Fig. 3-7B)
3. Immobilizing vest for keeping a patient in a wheel-
chair
FIGURE 3-6 Following this sequence will result in tying a half-
4. Waist immobilizer, which keeps the patient safe on
bow knot. The knot will remain secure until the free end is
pulled.
an examining table or in a bed, but allows the
patient to change position (Fig. 3-7C)

A B

FIGURE 3-7 (A) Limb holders (four-point restraints). (B)

C
Wrist immobilizer. (C) Waist immobilizer.
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CHAPTER 3: Patient Care and Safety 57

At times, a patient who is aggressive and delusional may prevent plantar flexion or footdrop. Pillows or
need to have waist as well as four-point immobilizers blocks under knees must be removed after a
that are stronger than those shown in Figures 3-7A and brief time (15 to 20 minutes) to prevent circu-
B. Immobilizers of this type also have locks. If this type latory impairment (Fig. 3-8E).
of immobilizer is necessary, one or more security officers Sims position: Patient lies on either left or right
should be called to assist with application. A radio- side with the forward arm flexed and the pos-
grapher, with only the assistance of one other radiogra- terior arm extended behind the body. The body
pher, must never attempt to apply immobilizers to an is inclined slightly forward with the top knee
extremely aggressive or combative patient. Persons who bent sharply and the bottom knee slightly bent.
have been trained to deal with this type of patient prob- This position is frequently used for diagnostic
lem must do this. When this type of immobilization is imaging of the lower bowel as an aid in insert-
necessary, the rules of immobilizer application still apply. ing the enema tip (Fig. 3-8F).
Trendelenburg position: The table or bed is inclined
with the patient’s head lower than the rest of
POSITIONING THE PATIENT FOR the body. Patients are occasionally placed in
DIAGNOSTIC IMAGING this position during diagnostic imaging proce-
EXAMINATIONS dures and for promotion of venous return in
patients with inadequate peripheral perfusion
When a patient must spend a long period of time in the caused by disease (Fig. 3-8G).
diagnostic imaging department, it is the radiographer’s Patients in respiratory distress or who have COPD
duty to assist the patient to maintain his or her body in must not be left in a prone, supine, or Sims’ position
normal alignment for comfort and to maintain normal for more than brief periods of time to avoid becoming
physiologic functioning. There are several protective increasingly dyspneic.
positions that the body may assume or be assisted to
assume for comfort. There are also several positions that
the patient may be requested to assume to facilitate diag- ASSISTING THE PATIENT TO
nosis or treatment. These positions are likely to be used DRESS AND UNDRESS
in the radiology department for various procedures:
The patient may arrive in the diagnostic imaging
Supine or dorsal recumbent position: Patient is flat department alone if he or she comes from outside the
on the back. The feet and the neck will need to hospital. The patient may need assistance in removing
be protected when the patient is lying in this clothing. This may be necessary if the patient is in a
position. A pillow may be placed under the cast or a brace, is very young, or is in too weakened a
head to tilt it forward. The feet should be sup- condition to help him or herself. The patient may
ported to prevent plantar flexion or footdrop have a contracture of an extremity or poor eyesight.
(Fig. 3-8A). Whatever the problem, if the radiographer senses
Lateral recumbent position: Patient is on the right that the patient will have difficulty undressing if left
or the left side with both knees flexed. This alone, then assistance should be offered and given as
position relieves pressure on most bony needed.
prominences. The patient may be supported If a trauma patient is brought to the diagnostic
with pillows or sandbags to maintain the posi- imaging department from the emergency unit, remov-
tion (Fig. 3-8B). ing the clothing in the conventional manner may cause
Prone position: Patient lies face down. A small pillow further injury or pain. It may be necessary to cut away
should support the head to prevent flexion of the garments that interfere with acceptable radiographs;
cervical spine. The patient maybe moved down however, clothing must not be cut without the patient’s
on the table so that the feet drop over the edge, consent except in extreme emergencies. If the patient is
or a pillow may be placed under the lower legs unable to give consent, a family member should do so
at the ankles to prevent footdrop (Fig. 3-8C). in writing for protection.
High Fowler position: Patient semi-sits with head If clothing must be cut off, try to cut into a seam if
raised at an angle of 45 to 90 degrees off the at all possible. The clothes should not be automatically
table. This position is used for patient in res- thrown in the trash. They should be offered to the
piratory distress (Fig. 3-8D). patient and placed with the patient’s other belongs.
Semi-Fowler position: Patient’s head is raised at an If the patient is very young and is accompanied by
angle of 15 to 30 degrees off the table. The a familiar adult, he or she will be more relaxed and
arms must be supported to prevent pull on the cooperative if the adult helps him to dress and undress.
shoulders, and the feet must be supported to Explain to the adult how the child should be dressed
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A B

C D

E F

FIGURE 3-8 (A) Supine position. (B) Lateral position. (C)

Prone position. (D) High Fowler position. (E) Semi-Fowler
G
position. (F) Sims position. (G) Trendelenburg position.
58
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CHAPTER 3: Patient Care and Safety 59

for the procedure, arrange a meeting place, and leave 2. Remove the clothing from the less affected side first
them alone. and then remove the clothing from the more
If a patient with a disability of the lower extremi- affected side and place the clean gown on that side,
ties must have assistance, the clothing should be making sure to keep the patient covered with the
removed from the top part of the body first. draw sheet.
3. Next place the clean gown on the unaffected side
1. Place a long examining gown on the patient.
and tie the gown at the back, if practical.
Instruct him to loosen belt buckles, buttons, or
hooks around the waist and slip the trousers over 4. If the patient is wearing an article of clothing that
the hips. If the patient cannot do this, reach under must be pulled over the head, roll the garment up
the gown and pull the trousers down over the hips. above the waist. Then remove the garment up
above the waist. Next, remove the patient’s arms
2. Have the patient sit down. Squat down in front of
from the clothing, first from the unaffected side
the patient and gently pull the clothing over the
and then from the affected side.
legs and feet to remove it. If the patient is not able
to help, call for an assistant. 5. Neatly, gently lift the clothing over the patient’s
head. One person alone should not attempt to
Some dresses may be removed in the same way. If this undress a disabled patient; to do so may cause fur-
method is not practical, however, and the dress must be ther injury or discomfort.
pulled over the woman’s head, proceed as follows: 6. To remove trousers, loosen buckles and buttons
and have the patient raise his buttocks as the
1. Place a draw sheet over the patient and then help
her to remove her slip and brassiere. trousers are slipped over his hips. If the patient is
unable to help, have an assistant stand at the
2. Help her to put on an examining gown and then opposite side of the table. After the trousers have
remove the draw sheet. been loosened, have the assistant pull the patient
The following are steps to re-dress a patient with a par- toward him or her, and then slide the trousers off
alyzed leg, a leg injury, a cast, or a brace: one side of the hip. Next, draw the patient toward
the opposite side and have the assistant slide the
1. Slide the clothing (pants or skirt) over the feet or trousers off the other hip.
legs as far as the hips while the patient is sitting 7. Slip the trousers below the knees and off.
and still wearing an examining gown. 8. Fold the clothing and place it in a paper bag on
2. Have the patient stand and pull the clothing over which the patient’s name has been printed. If a rel-
the hips if he or she can tolerate it. ative or a friend accompanies the patient, ask that
3. If the patient is not able to pull the clothing over person to keep the patient’s clothing. If the patient
the hips alone, have an assistant raise the patient is alone, the radiographer is responsible for caring
off the chair so that you may slip the clothing over for the clothing.
the hips and waist.
4. Remove the patient’s arms from the sleeves of the When a patient’s gown becomes wet or soiled in the
gown. Have the patient hold the gown over his or radiology department, it is the duty of the radiographer
her chest, and carefully pull the shirt over the head, to change it. If a patient is allowed to remain in a wet
or put it on one sleeve at a time. or soiled gown, the skin may become damaged, or he
or she may become chilled.
5. When the outside items of clothing are on the
When changing the gown of a patient who has an
patient, remove the gown from under the clothes.
injury or is paralyzed on one side, remove the gown
from the unaffected side first. Then, with the patient
covered by the soiled gown, place the clean gown first
THE DISABLED PATIENT on the affected side and then on the unaffected side.
Pull the soiled gown from under the clean one.
If the patient is on a gurney or the radiographic table
Always make sure that the patient is covered dur-
and the patient’s clothing must be changed, this can
ing the process.
most easily be accomplished with the patient in the
supine position.

1. Cover the patient with a draw sheet and have an CALL OUT!
examining gown ready. Explain what is to be done
When changing a disabled patient’s gown, allow enough
and ask the patient to help if he or she is able. If
material to work with by removing the unaffected side
the patient is paralyzed or unconscious, summon
first or by placing the gown on the affected side first.
help before beginning the procedure.
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60 Patient Care in Imaging Technology

diagnostic imaging department. Skin breakdown can

occur in a brief period of time (1 to 2 hours) and result
in a decubitus ulcer that may take weeks or months to
heal. Mechanical factors that may predispose the skin to
breakdown are immobility, pressure, and shearing force.
Immobilizing a patient in one position for an
extended period of time creates pressure on the skin that
bears the patient’s weight. This, in turn, restricts capillary
blood flow to that area and can result in tissue necrosis.
Moving a patient to or from a diagnostic imaging
table too rapidly or without adequately protecting the
patient’s skin may damage the external skin or underlying
tissues as they are pulled over each other creating a
shearing force. This, too, may lead to tissue necrosis.
Another factor that contributes to skin breakdown
FIGURE 3-9 Place the clean gown over the IV container. is friction caused by movement back and forth on a
rough or uneven surface such as a wrinkled bed sheet.
THE PATIENT WITH AN Allowing a patient to lie on a damp sheet or remain in a
INTRAVENOUS INFUSION wet gown may lead to skin damage. Similarly, urine and
fecal material that remain on the skin act as an irritant
Frequently, patients are taken to the diagnostic imaging and are damaging to the skin.
department with an IV infusion in place. Early signs that indicate imminent skin break-
down are blanching and a feeling of coldness over
1. If the patient’s gown must be changed, slip the pressure areas. This condition is called ischemia.
clothing off the unaffected side first. Ischemia is followed by heat and redness in the area
2. Carefully slide the sleeve of the unaffected side as the blood rushes to the traumatized spot in an
over the IV tubing and catheter, then over the con- attempt to provide nourishment to the skin. This
tainer of fluid. For this step, the container must be process is called reactive hyperemia. If, at the time of
removed from the stand. reactive hyperemia, the pressure on the threatened
area is not relieved, the tissues begin to necrose, and
3. When replacing the soiled gown with a clean one,
a small ulceration soon becomes visible. Ischemia and
first place the sleeve on the affected side over the con-
reactive hyperemia are difficult to observe in patients
tainer of fluid, then over the tubing and onto the arm
who are dark-skinned. In these cases, the skin must be
with the venous catheter in place (Fig. 3-9). Rehang
felt to assess any threat of damage. A shearing injury
the bottle of fluid and complete the change.
to the skin may cause it to appear bluish and bruised.
4. When moving the arm of a patient who has an IV If such an area is not cared for, necrosis and ulcera-
catheter in place, support the arm firmly so that the tion will occur.
catheter does not become dislodged. Remember to Persons who are most prone to skin breakdown are
keep the bottle of fluid above the infusion site to the malnourished, the elderly, and the chronically ill. A
prevent blood from flowing into the tubing. patient who is elderly and in poor health may have
If the intravenous infusion is being controlled by a dehydrated skin, an accumulation of fluid in the tissues
pump and the patient’s gown becomes wet or soiled (edema), increased or decreased skin temperature, or a
and must be changed, do not attempt to disengage the loss of subcutaneous fat that acts to protect the skin.
IV tubing from the pump. In this case: Any of these factors can contribute to skin breakdown,
and the radiographer must be particularly cautious
1. Remove the gown from the unaffected arm, and place when moving or caring for this type of patient.
the soiled gown to one side of the table until the nurse
in charge of monitoring the infusion can remove it. Preventing Decubitus Ulcers
2. Replace the soiled gown with a clean gown over
the unaffected side and the chest only. Protection of the integumentary system must always be
a consideration when caring for patients in the diag-
nostic imaging department. The tables on which the
SKIN CARE patients must be placed for care are hard, and often the
surface is unprotected. The areas most susceptible to
The radiographer is responsible for the care of the decubitus ulcers are the scapulae, the sacrum, the
patient’s skin or integumentary system while in the trochanters, the knees, and the heels of the feet.
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CHAPTER 3: Patient Care and Safety 61

The patient who is on the imaging table for a long

period of time should be allowed to change position
occasionally to keep pressure off the hips, knees, and
heels. This can be done by placing a pillow or soft
blanket under the patient or by turning him or her to a
different position whenever possible. This is done in
the usual hospital situation every 2 hours. If the patient
is lying on a hard surface, such as the radiographic
table, it should be done every 30 minutes. If a patient
is perspiring profusely or is incontinent of urine or
feces, make certain that he or she is kept clean and dry,
and take precautions when moving the patient to pre-
vent skin abrasions.
Special precautions should be taken to protect the
patient’s feet and lower legs during a position change
or transfer. Shoes should protect the feet, and care
should be taken to prevent bruising while the move is
made. Circulatory impairment in the lower extremities
is common, and the slightest bump may be the begin-
ning of ulceration.

CAST CARE AND TRACTION

Radiographic exposures of fractures that have been

casted are often needed to determine correct position- FIGURE 3-10 Support a casted or wrapped limb at both joints
when moving it.
ing of musculoskeletal tissues. Casts may be made of
plaster, fiberglass, plastic, or cast-tape materials. The
material used depends on the type of injury, the length sure on the skin in any area, it may impede circulation
of time needed for immobilization, and the physician’s or damage underlying nerves.
preference. A patient with a cast who is in the diagnostic imag-
The radiographer will often care for the patient who ing department for any length of time should be
has a newly applied cast. Some of the materials used, par- assessed for signs of impaired circulation or nerve com-
ticularly plaster, contain water and can accidentally be pression every 15 minutes. A cast applied to an arm
compressed. Compression of a cast may produce pres- may cause a circulatory disturbance in the hand; a leg
sure on the patient’s skin under the cast, and this, in turn, or body cast may affect circulation in the feet, toes, or
may lead to the formation of a decubitus ulcer at the site lower leg. Signs of impaired circulation or nerve com-
of cast compression. A cast that becomes too tight may pression that may be easily detected are as follows:
cause circulatory impairment or nerve compression. To
prevent these complications, the radiographer must be • Pain: Sudden pain or pain that increases with
able to assess the patient for circulatory or neurologic passive motion may indicate nerve damage.
impairment and must learn to move a cast with care. • Coldness: Fingers or toes distal to a cast should
When moving a patient who is wearing a cast, slide feel warm.
an opened, flattened hand under the cast. Avoid grasp- • Numbness: A cast that is too tight may cause
ing the cast with fingers, since this may cause indenta- numbness, another sign of nerve damage.
tions if the cast material is sill damp. A cast must be • Burning or tingling of fingers or toes: These
supported at the joints when it is moved. A casted symptoms may indicate circulatory impairment.
extremity must be moved as a unit with flat hands sup- • Swelling: Indicative of edema, swelling may result
porting it at the joints (Fig. 3-10). When moving a in circulatory impairment or nerve compression.
patient who has an abduction bar placed between the • Skin color changes (to a pale or bluish color):
legs of a spica cast, it is imperative that the abduction Skin should remain pink and warm. In dark-
bar not be used as a moving or turning device. skinned persons, temperature and comparison
To position a patient who is in a cast, positioning with the normal extremity are evaluated.
sponges or sandbags must be on hand so that the cast • Inability to move fingers or toes: All fingers and
can be well supported. A recently casted limb usually toes should be able to be moved and fully
should be kept elevated. If a cast is allowed to put pres- extended and flexed.
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62 Patient Care in Imaging Technology

• Decrease in or absence of pulses: These changes 3. After the patient has finished using the lavatory,
may indicate circulatory impairment. help him or her to wash hands if unable to do so.
4. Accompany the patient back to the examination
If the last three changes are observed, the physician area and cover the patient to make him or her com-
should be notified and an attempt to relieve the pres- fortable.
sure must be made. 5. Return to the lavatory and make certain that it is
If the patient in a body cast or a spica cast reports clean.
difficult respirations or nausea or is vomiting, notify
6. The radiographer must wash his or her hands.
the physician because this may indicate abdominal dis-
tress that requires immediate treatment.
Radiographic images of patients who are in traction The Bedpan
will require the use of the portable unit. When working
The patient who is unable to get to the lavatory must be
with a patient in a traction device, the traction appara-
offered a bedpan or urinal. In the diagnostic imaging
tus must never be removed or pulled on. To do so may
department, clean bedpans and urinals are usually stored
cause a reduced fracture to become misaligned. Enlist
in a specific place. Most departments stock disposable
the help of another radiographer or a nurse to obtain the
units.
images without endangering the patient’s well-being.
There are two types of bedpans. The standard
bedpan is made of metal or plastic and is approxi-
mately 4 inches high. Most patients can use this type.
! WARNING! However, a patient may have a fracture or another
Never remove or move a traction bar from a patient while disability that makes it impossible to use a pan of this
performing radiographic procedures. height. For these patients, the fracture pan is used.
All diagnostic departments should have these pans
available (Fig. 3-11).
ASSISTING THE PATIENT WITH 1. Before assisting the patient, obtain tissue and a
A BEDPAN OR URINAL bedpan with a towel to cover it. Close the exam-
ining room door, or screen the patient to ensure
A patient may spend several hours in the diagnostic privacy. Always place a sheet over the patient
imaging department; often the patient is not able to while helping her onto the bedpan. Put on clean,
postpone urination or defecation. He or she may be disposable gloves.
embarrassed about making the request and will wait 2. Approach the patient and place the bedpan at the
until the last possible moment to do so. When a patient end of the table. If the patient is able to move,
makes such a request, the radiographer should respond place one hand under the lower back and ask the
quickly yet treat it in a matter-of-fact manner. patient to raise the hips.
1. If possible, help the patient to reach the lavatory 3. Place the pan under the hips (Fig. 3-12). Be sure
near the examining room; this is the most desirable the patient is covered with a sheet. If the patient
way to handle the situation. However, do not allow is unable to sit up, assist the patient to a sitting
the patient to go to the toilet without assistance.
Help the patient put on slippers or shoes, and wrap
the draw sheet around him or her if no robe is
available. Help the patient off the radiographic
table or out of the wheelchair and lead the patient
to the lavatory. The patient may have been fasting
or may have been given drugs that make him or her
very unsteady; therefore, it is not safe to leave the
patient unattended.
2. If the patient can help him or herself in the lava-
tory, close the door and tell the patient that assis-
tance is just outside the door waiting if help is
needed. Each lavatory should be equipped with an
emergency call button, and its use should be
explained to the patient. If there is no emergency
call button, check on the patient at frequent inter-
vals to be certain that his or her condition is stable. FIGURE 3-11 A fracture bedpan and a male urinal.
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CHAPTER 3: Patient Care and Safety 63

If the patient is not able to clean the perineal area,

the radiographer will have to do this. Wear clean dis-
posable gloves.

1. Take several thicknesses of tissue and fold them

into a pad. Wipe the patient’s perineum from front
to back and drop the tissue into the pan. If neces-
sary, repeat the procedure until the perineum is
clean and dry.
2. Cover the pan to take it to the bathroom and empty
it. If the bedpan is disposable, and the patient will
not be staying in the department long enough to
use it a second time, the pan may be discarded.
3. Remove the gloves and wash hands correctly.
FIGURE 3-12 Place one hand under the patient’s lower back, If a patient has difficulty in moving or adjusting to the
and ask the patient to raise the hips so that the bedpan may be height of a regular bedpan, follow the procedure using
placed under the patient. the fracture pan. The end with the lip is the back of the
pan and goes under the patient’s buttocks.
position. Do not leave a patient sitting on a bedpan—
he or she is poorly balanced and may fall. CALL OUT!
4. Place the toilet tissue where the patient can reach
it. Let the patient be alone as much as possible by Wipe the perineal area from front to back to prevent
turning around and facing away from the patient, a possible urinary tract infection.
or if the patient is able to sit by him or herself, step
away from the patient to provide privacy.
5. When the patient has finished using the bedpan, The Male Urinal
put on clean, disposable gloves and help the The male urinal is made of plastic and is shaped so it
patient off the pan. Have the patient lie back, place can be used by a patient who is supine, lying on the
one hand under the lumbar spine and have the right or left side, or in Fowler position. The urinal
patient raise the hips. may be offered to the male patient who is unable to
6. Remove the pan, cover it, and empty it in the lava- get off of the gurney or examining table to go to the
tory. Rinse it with clean cold water (dump the water lavatory.
into the toilet, not the sink) and then discard the
disposable bedpan in the trash receptacle. 1. If the patient is able to help himself, simply hand
7. Offer the patient a wet paper towel or washcloth to him an aseptic urinal and allow him to use it, pro-
wash the hands and a dry towel to dry them. viding privacy whenever possible.
8. The radiographer must then remove his or her 2. When he has finished, put on clean, disposable
gloves as described in Chapter 4 and wash the gloves, remove the urinal, empty it, and rinse it
hands thoroughly. with cold water. If the urinal is disposable and the
patient will not be staying in the diagnostic imag-
If a patient is unable to assist in getting onto and off a ing department long enough to use the urinal a sec-
bedpan, do not attempt to help him or her alone. Enlist ond time, the urinal may be discarded.
the aid of another team member. Have that person 3. Offer the patient a washcloth with which to
stand at the opposite side of the table. With the assis- cleanse his hands.
tance of the second radiographer, turn the patient to a 4. Remove the clean glove and wash hands.
side-lying position. Place the pan against the patient’s
hips, then turn the patient back to a supine position If a patient is unable to assist himself in using the uri-
while holding the pan in place. Be certain that the hips nal, the radiographer must position the urinal for him.
are in good alignment on the pan. Place pillows under
the patient’s shoulders and head and stay nearby. When 1. Put on clean, disposable gloves; raise the cover
the patient has finished using the pan, put on clean sheet sufficiently to permit adequate visibility, but
gloves and reverse the procedure to remove the pan. Be do not expose the patient unduly.
sure to secure the pan before rolling the patient as it will 2. Spread the patient’s legs and put the urinal
tip and spill the contents as the patient rolls to the side. between them.
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64 Patient Care in Imaging Technology

3. Put the penis into the urinal far enough so that it 10. Warning signs must be posted stating that, in case
does not slip out, and hold the urinal in place by of fire, elevators are not to be used and stairways
the handle until the patient finishes voiding. must be used instead.
4. Remove the urinal, empty it, discard it, remove the
If fire occurs, the correct procedure for patient safety
gloves, and wash the hands.
must be followed:

DEPARTMENTAL SAFETY 1. Persons in imminent danger are to be moved out of

the area first.
Prevention of patient and personnel injury is the respon- 2. Windows and doors are to be closed.
sibility of all health care workers. It is the responsibility 3. If oxygen is in use, it must be turned off.
of the radiographer to practice safety in all aspects of 4. Patient and staff evacuation procedures must be
work. This includes fire and electrical safety, prevention followed.
of patient or staff falls, prevention of poisoning, and safe
disposal of hazardous waste and toxic chemicals. General rules for the prevention of accidents involving
Institutional, local, state, and federal agencies regu- electrical equipment should include the following:
late safety in health care institutions, and there are safety
committees in all JCAHO-accredited health care agen- 1. Use only grounded electrical plugs (three pronged)
cies. Fire departments in all cities routinely evaluate the inserted into a ground outlet.
fire safety of health care and community institutions. Poi- 2. Do not use electrical equipment when hands or
son control centers advise health care institutions if poi- feet are wet or when standing in water because
soning is possible. The Nuclear Regulatory Commission water conducts electricity.
enforces radiation safety and nuclear medicine standards, 3. When removing an electrical plug from an outlet,
and the Environmental Protection Agency establishes grasp the plug at its base. Do not pull on the elec-
guidelines for the disposal of radioactive waste. trical cord.
4. Electrical cords must be unkinked and unfrayed; if
Fire Safety they are kinked or frayed, don’t use them.
5. Any electrical equipment must be in sound work-
The radiographer has an obligation to learn the fire
ing order to be used for patient care. If it is not, the
containment guidelines in any institution in which he
equipment must be returned to the manufacturer
or she is employed. The following are essential:
or to the area designated for repair service.
1. The telephone number of the institution for 6. All electrical equipment must be tested before it is
reporting a fire; the number must be posted in a used for patient care.
clearly visible location next to the telephone 7. Report any shock experienced; do not use equip-
2. The agency’s fire drill and fire evacuation plan ment if a patient reports that it gives a tingling feel-
3. The location of the fire alarms ing or a shock.
4. The routes of evacuation in case of fire 8. Do not use a piece of electrical equipment that has
5. The locations of fire extinguishers and the correct not been explained.
type of extinguisher for each type of fire 9. To prevent falls, do not use extension cords that
are not rounded and secured to the floor with elec-
Carbon dioxide extinguisher: grease or electrical fire tric tape.
Soda and acid water extinguisher: paper and wood
fire
Dry chemical extinguisher: rubbish or wood fire Prevention of Falls
Antifreeze or water: rubbish, wood, grease, or Patient falls are one of the most common hospital acci-
anesthetic fire dents. The radiographer must always be on guard to
prevent falls. No patients should be allowed to get out
6. A fire must be reported before an attempt is made
of a wheelchair or off a gurney or radiographic table
to extinguish it, regardless of the size.
without assistance from the radiographer or designee.
7. Hallways must be kept free of unnecessary equip- The patients most prone to falls are the frail elderly,
ment and furniture. persons with neurologic deficits, persons who are weak
8. Fire hoses must be kept clear at all times. and debilitated due to prolonged illness or lengthy
9. Fire extinguishers must be inspected at regular preparations for procedures, persons with head trauma,
intervals. Fire drills must be regularly scheduled persons with sensory deprivations, persons who have
for agency personnel. been medicated with sedating or psychoactive drugs,
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CHAPTER 3: Patient Care and Safety 65

and confused patients. Adhere to the following rules to If an accidental spill of a hazardous substance
prevent falls: occurs, first aid guidelines are as follows:

1. Learn the condition of the patient and determine Eye contact. Flush eyes with water for 15 minutes
whether he or she is safely able to enter, remain in, or until irritation subsides. Consult a physician
or leave the diagnostic imaging department without immediately.
assistance. Skin contact. Remove any affected clothing; wash
2. Keep floors clear of objects that may obstruct skin thoroughly with gentle soap and water.
pathways. Inhalation. Remove from exposure; if breathing
3. Keep equipment such as gurneys, portable radi- has stopped, begin CPR; call emergency num-
ographic machines, and wheelchairs in areas where ber and a physician.
they do not obstruct passageways. Ingestion. Do not induce vomiting; call emergency
number and Poison Control Center.
4. Side rails must always be up when a patient is on a
gurney. Diagnostic imaging personnel must understand the poten-
5. A wheelchair must be locked if a patient is in it; a tial hazards of scalds or burns that may occur in their
soft restraint may be needed if the patient is not department. Although the radiographer does not com-
reliable and may try to get up without assistance. monly deal with heating pads and hydrotherapy, they do
present potential hazards and must be handled safely.
Poisoning and Disposition of Hot beverages must be kept away from children.
Hazardous Waste Materials Coffee and tea equipment used in staff lounges must be
kept in safe working order and deactivated when empty
The number of the nearest Poison Control Center must or not in use. If a patient is offered a hot beverage, it
be posted near department telephones. As the radiog- should be at a temperature that will not scald him or
rapher, the following must be adhered to: her if it is accidentally spilled.
1. Any toxic chemical or agent that may poison
patients or staff must be clearly labeled as such. Radiation Safety
2. These substances must be stored in a safe area as
designated. It is the responsibility of a radiographer to protect
patients and personnel from radiation exposure. While
3. Emergency instructions to be followed in case of
the benefit of rapid medical diagnosis by exposure of the
poisoning must be conspicuously posted in the
patient to radiation outweighs the associated risks, radi-
diagnostic imaging department.
ation exposure must be kept to a consistently low level.
4. Chemicals must remain in their own containers Ionizing radiation in excessive amounts or in
and marked as toxic substances. amounts higher than the accepted level in a brief time
5. Chemical and toxic substances must be disposed period can result in either illness to the recipient or a
of according to federal mandates and institutional potential genetic disturbance to the descendants of the
policy. recipient. Other factors that can increase the risk of
6. Restrictions for disposal of hazardous materials suffering the adverse effects of ionizing radiation are
must be posted in a conspicuous area and followed the patient’s age at exposure, sensitivity of exposed
by all in the department. cells, and the size and area of the body exposed. The
7. Contrast agents and other drugs must be kept in a very young, the very old, and pregnant women are the
safe storage area where access to them is not avail- most vulnerable to adverse effects of radiation.
able to anyone not designated to use them. The goal of the radiographer must be to limit the
8. All containers of hazardous substances must be amount of ionizing radiation acceptable limits in the
clearly marked with the name of the substance, a patient, others in the vicinity, and personnel. To do this,
hazard warning, and the name and address of the the following precautions must be taken:
manufacturer.
1. Maintain exposure to a level as low as reasonably
9. Hazardous substances may be labeled with a color achievable (ALARA).
code that designates the hazard category, for instance
2. Minimize the length of time the patient or others in
health, flammability, or reactivity.
the vicinity are placed in the path of the x-ray beam.
The radiographer must read and fully understand all haz- 3. Maximize the distance between the source of the
ard warnings before using any product, and follow the ionizing radiation and the person exposed to it.
guidelines as stated on the label. If there is no label, or 4. Maximize the shielding from exposure of the
if the label is unclear, the product should not be used. patient and others in the vicinity of the radiation.
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66 Patient Care in Imaging Technology

Time. Use the shortest exposure time possible.

Remember that radiation dosage increases
with fluoroscopic imaging.
Distance. The closer a person is to the radiation
beam, the greater the exposure. The larger the
field of radiation, the greater the risks of scat-
tering the ionizing radiation and the greater
the exposure risk. Increasing distance from the
source greatly reduces the exposure risk of the
radiographer and others in the vicinity.
Shielding. Shielding persons who are unable to
reduce their exposure either by limiting time or
increasing distance is the third alternative for
protection from ionizing radiation. Shielding is
done by setting up a protective barrier, usually
lead or an equivalent, between the source of
the ionizing radiation and the subject involved,
whether the patient or others in the vicinity.
There are primary and secondary barriers. Pri-
mary barriers are usually made of lead or similar
material; they are designed to withstand being
struck by the beam exiting the x-ray tube with-
out allowing passage of ionizing radiation.
Secondary barriers are designed to prevent pas-
sage of scatter and leakage, rather than direct,
radiation. FIGURE 3-13 Lead apron, thyroid shield, lead goggles, and
radiation monitor should all be worn while in the room when
the beam is energized.
The radiographer’s obligation is to ascertain that
all persons who are involved in or in the vicinity of a
radiographic procedure are provided with appropriate proper technical factors to achieve a diagnostic radi-
protective apparel to shield them from ionizing radia- ograph on the first attempt.
tion. This includes the patient, the physician, nurses, Estimates of patient exposure to ionizing radiation
observers, and radiographer. Shielding can include a must be made available in the radiographic imaging
lead apron, lead gloves, a gonadal shield, a thyroid department. These estimates denote the amount of
shield, and lead goggles (Fig. 3-13). radiation an average patient undergoing a given proce-
Use of gonadal shielding to protect male and dure would expect based on standard technique
female reproductive organs (ovaries and testes) is of charts. The amount of exposure actually received is
vital importance. This is of particular importance when less than compared with these estimates. All radi-
the patient is a child or an adult of childbearing age. ographic imaging equipment must also be inspected
There are several types of gonadal shields, including for radiation safety at regularly scheduled times.
flat and molded contact shields. Lead aprons and other protective apparel must be
The radiographer must use his or her technical inspected periodically for quality control purposes.
expertise to minimize patient exposure to radiation. This This apparel must be hung carefully over a wide bar or
includes beam limitation, technique selection, filtration, on special hangers when not in use. To fold or drop
intensifying screens, and grids. Explanations of these them may jeopardize their integrity.
techniques are beyond the scope of this text; their use is The radiographer and any health care worker
discussed in detail in other radiologic technology courses. who works in constant contact with ionizing radia-
The radiographer has the responsibility to under- tion must be monitored to assess the amount of expo-
stand the technical aspects of the profession so that sure to it. This may be done by wearing a radiation-
the number of repeat radiographs necessary to monitoring badge sensitive to low radiation doses.
achieve the diagnostic purpose is minimized. The A specialized company processes the badge on a
need to frequently repeat exposures should be cause monthly or quarterly basis. The results are then
to put critical thinking skills to work to assess and returned to the institution and must be made avail-
solve the problems that are being encountered. Assess able to all occupational persons who wear the badge.
communication with the patient as well as the skills Special precautions must be taken to prevent
necessary to properly position the patient and set the exposing pregnant patients and pregnant health care
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CHAPTER 3: Patient Care and Safety 67

workers to ionizing radiation. This is particularly true dose limit for a fetus must not exceed 0.5 rem during
during the early weeks of pregnancy, when particular the entire gestation. The exposure must be limited to
fetal tissues are especially sensitive to radiation. This is no more than 0.05 rems in any month.
why it is critical to ask the female patient if there is any To minimize radiation exposure, the radiographer
possibility of her being pregnant and also when her last should not hold the patient during a procedure on a
menstrual period was. Pregnant workers who “declare” routine basis. Sand bags and positioning sponges
themselves to be pregnant are double badged, and rota- should be used if possible. If this is not feasible, then a
tions in the department are varied so as to limit the relative or a person who is not working regularly in
amount of exposure to radiation. The occupational radiography should be requested to assist.

SUMMARY

When an outpatient arrives in the diagnostic imaging her at all times and release the immobilizers at least
department, it is often necessary for that patient to every 2 hours. Follow the correct manner of docu-
undress entirely or partially for the diagnostic exami- menting immobilization use.
nation or treatment. Always show the patient where Take care to prevent the patient’s skin from being
and how to do so in a sensitive manner to spare the damaged while being cared for in the diagnostic imaging
patient embarrassment. department. This can be done by preventing injury that
It is the responsibility of the radiographer to pro- may come from immobility, pressure, shearing force, or
vide the patient with a safe place for personal belong- friction. Patients most susceptible to skin breakdown are
ings. Remember that the patient may treasure an arti- the malnourished, the elderly, and the chronically ill.
cle of clothing or jewelry that may not seem valuable. Take special care to protect these patients from injuries
Everything that belongs to the patient must be treated to their integumentary system, because they may result
as if it were of value. in a decubitus ulcer that can take months to heal. Also,
Correct body mechanics must always be used. take extra precautions when caring for a patient who is
When moving or lifting in the workplace, keep the wearing a cast or who is in traction. Observe the
weight close to the body and maintain a firm base of patient’s extremities for evidence of neurocirculatory
body support. This is accomplished by having the feet impairment, which may result from the pressure of a
slightly spread out and knees flexed. Twist or bend the cast on the skin. Some symptoms of neurocirculatory
body at the waist when lifting a heavy load. Weight impairment that are easily detected are pain, coldness,
should be pulled, not pushed. Use arm and leg muscles, numbness, burning or tingling of fingers or toes, swelling,
not the spine for lifting. color changes of the skin, and an inability to move fingers
The three ways of moving patients are by gurney, by or toes. If these symptoms are noted, change the patient’s
wheelchair, or by ambulation. When moving and lifting position and report the problem to the physician imme-
patients, assess the patient and resolve potential prob- diately. Do not release a traction apparatus while taking
lems before beginning the transfer. The plan for moving a radiographic image. If the procedure cannot be com-
the patient should be explained, and the patient’s help pleted because of the traction bar, request assistance
should be enlisted before beginning. Always notify the from the nurse in charge of the patient.
ward personnel when taking a patient to or from his or If a patient is unable to undress alone, offer assis-
her hospital room. The use of enough assistants and tance. Give assistance in a matter-of-fact manner that
equipment such as a smooth mover facilitates the move does not violate the patient’s privacy. Patients must be
and protects personnel and the patient from possible kept clean and dry while in the diagnostic imaging
injury. department. It is the radiographer’s duty to change the
When a patient is on the radiographic table or on a disabled patient’s gown and covering if they become
gurney in the diagnostic imaging department, his or her wet or soiled. Do this in a prescribed manner to ensure
body must be in good alignment. If the patient is privacy, safety, and comfort.
moved to a particular position for an examination, Some examinations in the imaging department are
restore correct body alignment as soon as possible. long and tedious. They often stimulate peristalsis and a
There are times when immobilizers must be used need to defecate or urinate. Meeting these needs can-
for the safety of the adult patient. When immobilizers not be postponed. Be prepared to assist with either the
are required, apply them according to the manufac- bedpan or urinal if necessary and do it in a way that
ture’s directions and the policy of the institution. Do ensures the patient as much privacy as possible. Infec-
not immobilize a patient without an order by a physi- tion control measures must be taken when assisting a
cian. When a patient is immobilized, attend to him or patient with a bedpan or urinal. These items must be
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68 Patient Care in Imaging Technology

used for one patient only and then disposed of in the rapher must understand the precautions to take rou-
proper waste receptacle. Put on clean, disposable gloves tinely to prevent fire and the correct procedures to fol-
when assisting with the patient’s elimination needs and low if a fire occurs. Prevention of accidents due to
wash thoroughly after removing the gloves. The patient faulty electrical equipment or poisoning and the correct
must not be left unattended while on a bedpan, gurney, use and disposal of hazardous materials are also the
or diagnostic imaging table. Patients must never be radiographer’s professional obligation.
allowed to get on or off an examining table or out of a Unnecessary exposure to radiation to the patient
wheelchair without assistance. They must also be care- and personnel is the responsibility of the radiographer.
fully attended on trips to the lavatory and in a dressing Excessive amounts of radiation from improper techni-
area after an examination or treatment. cal factors or from repeat exposures have an adverse
The radiographer must be constantly on guard to affect on living tissue. The very young, the very old,
protect patients and other staff members from acci- and pregnant women are particularly susceptible to
dents in hospitals. Most falls and injuries to patients adverse affects of ionizing radiation. Precautions to
can be prevented if the radiographer is knowledgeable prevent excessive exposure involve knowledge, techni-
about the patient’s condition and comfort. The radiog- cal expertise, and constant vigilance.

CHAPTER 3 TEST

1. When admitting a patient to the diagnostic imag-

ing department, what should be done? (Circle all a. Turning the patient every 1 to 2 hours
that apply) b. Friction and pressure
a. Take the patient to the dressing area and c. Frequent diagnostic imaging procedures
explain in some detail how he or she should d. A wet environment
dress for the procedure. 6. If a patient who has a cast in place complains of
b. Give the patient directions concerning how to pain that is sudden in onset and increases in inten-
care for valuables brought to the department. sity when the affected limb is moved, what should
c. Assist any patient who appears to need assis- be done? (Circle all that apply.)
tance with preparation for an examination. a. Complete the procedure and discharge the
2. The most effective means of reducing friction patient.
when moving a patient is by: b. Elevate the affected limb.
a. Placing the patient’s arms across the chest and c. Notify a physician immediately.
using a pull sheet d. Find a nurse to administer pain medication.
b. Pushing rather than pulling the patient 7. When caring for a patient who has a new cast
c. Rolling the patient to a prone position applied to an extremity, what must be remem-
d. Asking the patient to cooperate bered? (Circle all that apply.)
3. When transporting a patient back to the hospital a. Hold the cast firmly at a position between the
room, some safety measures to be used are (circle joints when moving it.
all that apply): b. Observe for signs of impaired circulation.
a. Place the side rails up, the bed in “low” position, c. Support the cast with bolsters and sandbags
and the call bell at hand. where needed.
b. Inform the nurse in charge of the patient that d. The extremity is now almost impervious to pain
the patient has been returned to the room. and can be twisted as needed for the image.
c. Give the patient something to eat or drink. 8. When caring for a patient who is disabled and is
d. Be sure that the TV is in place for the patient’s difficult to move, it is best to:
viewing. a. Keep the patient as quiet as possible.
4. Which procedures must be observed when assist- b. Work quickly.
ing a patient with a bedpan (circle all that apply): c. Obtain as much help as necessary to avoid
a. Respect the patient’s privacy. injury to the patient and to the radiographer.
b. Seek assistance for an immobile patient. d. Move the patient by gurney.
c. Wear clean gloves to remove the bedpan. 9. When moving a heavy object, you should
d. Make sure to offer tissue to the patient and a ___________ the weight, not ______________ it.
towel to clean his or her hands. 10. Patients most prone to falls are (circle all that apply):
5. Contributing factors to skin breakdown are (circle a. The frail elderly
all that apply): b. The person who is confused
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CHAPTER 3: Patient Care and Safety 69

c. Persons who have been given a psychoactive iv. Patient on back with head
drug lower than extremities
d. Persons with sensory deficits v. Patient on back with head
11. When moving a patient into an unnatural position raised 15 to 30 degrees
for a radiographic examination, the patient should 13. Name the two convenient and safe methods of mov-
maintain that position: ing a patient from a radiographic table to a gurney.
a. Until he or she asks to be moved 14. Describe three legitimate reasons for application
b. Until the radiograph has been processed and of immobilizers to an adult patient.
approved by the radiologist 15. List four signs of circulatory impairment if a
c. Only for the time it takes to make the patient is wearing a cast.
exposure 16. What are three methods of reducing a patient’s
12. Match the following: exposure to ionizing radiation?
a. Fowler i. Patient on side with for- 17. The leading cause of work-related injuries in the
position ward arm flexed and top field of health care is:
b. Supine position knee flexed a. Bumping into misplaced equipment
c. Semi-Fowler ii. Semi-sitting position with b. Overexposure to radiation
position head raised 45 to 60 c. Infection owing to poor hand-washing
d. Trendelenburg degrees techniques
position iii. Patient laying flat on d. Abuse of the spine when moving and lifting
e. Sims position back patients
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