RT, that's me!
Operating Room
What type of exam is top priority? What happens to the other exams?
OR exams are top priority since patients are usually intubated or under anesthesia
other exams must wait!
Who are the staff in the room?
- Doctors/Residents
- Anesthesiologist
- Circulator RN
- Scrub Tech RN
- Instrument Rep
How is the cassette/IR placement for a Portable X-ray Machine?
under the patient, in slot on the bed
How can you be prepared?
know exam type, room #, pt age and info, have proper equipment, keep talk to a minimum
When did Johns Hopkins open?
1889
How do you monitor radiation for yourself?
1) OSL badge on the lead apron at collar level
2) stand as far away from X-ray source as possible while still able to do your job
What does the doctor/resident do?
performs the surgery
What should you do if you are unsure of what the surgeon wants for images of the anatomy?
Center over the area of interest and be quick about it.
How can you be vocal?
announce presence, get more patient info from circulating nurse and anesthesiologist, confirm anatomy, announce when ready for x-ray
What are the three duties of the radiographer in the OR?
1) provide imaging needs of surgeons
2) monitor radiation safety within the case
3) maintain sterility of C-arm throughout case
How do you monitor radiation safety for the patient?
COLLIMATE!!!
keeps the patient under anesthesia and knows the patient's height and weight
What should you do about artifacts in the way?
How can you be aware of the surroundings?
leads in anatomy, surgical instruments, table supports, body parts
What is it like imaging in the OR? (5 things)
1) requires operating imaging equipment with little understanding of the case
2) usually demands a quick pace
3) always be prepared; identify scheduled cases that use imaging
4) work with portable machine and C-arm
5) always pay attention to the case, be aware of changes that could affect imaging
1) ensure that all staff are wearing lead or have some form of radiation protection
2) monitor new entries into the room to make sure they have lead
3) inform the surgeon that there is someone in the room without lead and do not expose until they leave or put on lead
What does the Circulator RN do?
keeps track of information and gets any needed supplies and provides patient information
Does the portable X-ray machine need to be sterile?
No, it doesn't need to be sterile because it's not touching anything
What are we considered in the OR?
the eyes of the OR
What is the goal of imaging in the OR?
to give the surgeon the best possible images while also using ALARA
What is the definition of sterile?
free from living organisms including microorganisms
What does the Scrub Tech RN do?
manages sterile tables and instruments and drapes the C-arm
What should you take into consideration when thinking about technique on a Portable X-ray Machine?
patient weight, body type, and build
remember: talk to Circulating RN!
What should we be looking for in the OR?
tube/line placement, contrast studies, localization, foreign bodies
What are some challenges of the OR? (5 things)
1) working in and around a sterile field
2) anatomy is often obstructed
3) short notice
4) different surgeons often have different preferences
5) having to work around blood and bodily substances
Why do you need a sterile environment?
For patient safety! It reduces the risk of infection.
What does the Instrument Rep do?
they give the correct instruments to the surgeon performing the surgery, they are the experts on the instruments being used (no real specific interaction)
What are the parts of the C-arm machine?
set up, drape, brake, controls, monitor, center locks
What are some examples of tube/line placement?
central lines, ET/airway, scope localization
What should you be wearing when entering the OR?
Scrubs and Hats (booties are optional/as needed) (isolation precautions as needed)
What does the saying "if it's clear or blue, it's not for you" mean?
If something or someone is covered in a blue or clear plastic covering, do not touch it! It is sterile!
Who should be the first person you go to about finding out about patient information?
Circulator RN
How are the C-arm and monitor connected?
connected by a cord, and then plug into the wall
What are some examples of contrast studies?
cholangiogram (liver), cystogram (bladder), arteriogram (artery)
What is the indicator before entering the OR?
A red line on the floor, to make sure you are dressed appropriately before entering. Make sure you have OR scrubs, hats, botties (if needed), and mask.
JHH was the first school to use ______ _______ during ______ in _________, and they were developed by ___ __________.
rubber gloves during surgery in 1894, and they were developed by Dr. Halstead.
How should sterile and non-sterile professionals move in the OR?
2 sterile people: face-to-face
1 sterile person/1 non-sterile person: back-to-back
Sterile staff have right of way
NEVER move in between fieldsWhat should you do once everything is set up?
lock equipment
What are some examples of localization?
spine level, screw placement, stimulator placement
How and when should your mask be worn?
Properly fitted and before entering the room
Non-sterile!
What part of sterile staff is considered sterile?
How should the C-arm be set up in the OR?
perpendicular to the table, wires and catheters under the table, watch the doctor's head and arms
what are some examples of foreign bodies?
sponges, surgical tools, packing material
What are the tips for OR?
be prepared, be vocal, be aware of surroundings
How do you maintain sterility?
1) watch out for lights, monitors, and anything above the patient that the C-arm could contact
2) monitor staff working or walking near C-arm to ensure contact is not made that would break sterility
If you need to place a cassette under a patient for imaging, how should it be done?
in the non-sterile area and out of people's way! if that means you have to crawl on the floor to get the cassette underneath and have the sterile people lift the blue and clear sheets for you, so be it!
How should the C-arm be moved in the OR?
slow and steady, keep to a minimum, watch the doctor's head and arms
How do you have success in the OR?
be vigilant, know what the doctor wants, ask questions, remain calm