Mobile and NICU

what does MICU stand for

medical intensive care unit

reasons as to why we would go see a NICU patient

• indications for imaging- including but not limited to:

  • prematurity

  • line and/or tube placements

  • respiratory distress

  • congenital heart disease

  • lung lesions

  • abdominal pathologies

  • birth related injuries- fractures

what type of patients are MICU used for?

critically ill patients

what does SICU stand for?

surgical intensive care

what types of patients are in SICU

post surgery for long stay patients

what does IMU stand for

intermediate unit

what type of patients are in IMU

pt is closely monitored; step down unit from ICU

what type of patients are in PACU

after anesthesia

what type of patients are in NICU

neonates with life threatening issues or premature infants

what is the ED

emergency department (trauma bay or other ED imaging)

what is A

column

what is B

telescoping arm

what is C

kVp/mAs settings

what is D

tube

what is E

light box & collimators

what is F

touchscreen computer

what is G

exposure switch

what is H

cassette or wireless image receptor

portable techniques

• RH portables have flip book technique chart located in the bin with the detectors

variable kVp charts for portables!

• use calipers!!

  • change kVp by 2 for every 1cm in body thickness

portable considerations

• proper positioning

• central ray alignment

• shape distortion

• grid

• beam restriction

• SID

• artifacts

Beam restriction

• 1M- 39.4”

• 1.5M- 59”

• 2M- 78.7”

grid use for digital portable

• RH: chest- greater than or equal to 30cm

• extremities- greater than or equal to 10 cm (min 60 kVp)

• abdomen (unless peds)- always use grid

information about portables

• high frequency generators

• technical factors utilized in radiographic room can be applied to mobile imaging

radiation safety

• mobile radiography produces some of the highest occupational radiation exposures for radiographers

radiation safety- Time:

• use proper techniques; limit repeat exposures

radiation safety- Distance:

• occupational protection

• patient protection

• shielding

radiation safety- distance- occupational protection:

• most effective means of protection (inverse square law)

• stand min 6ft (2m); when possible right angle to pt/primary beam away from tube

radiation safety- distance- patient protection:

• min SSD 12” (30cm) for mobile imaging (CFR21)

radiation safety- shielding- occupational protection:

-policy requires technologists and students to wear lead apron

• lead apron/ thyroid shields min 0.5 mm Pb (NCRP 102)

-dosimeter outside of lead apron

-if contact isolation don lead apron before gown

radiation safety- shielding- patient protection:

-patient chielding: not required at RH

-others:

• ask vistors and staff to temporarily leave the room

• if they cannot leave then they need to be shielded

• yell “x-ray” prior to breathing instruction

HIPPA

• be mindful of others viewing request or computer screen on portable

• don’t leave portable unattended

• ask visitors to leave before asking hx and explaining procedures

portable maintenance

• portable equipment should be cleaned at least every day

  • use gloves and Fresh Breeze TB

• charge the portable when not in use

• always log off when not in use

• keep the portable stocked with IR covers

special considerations

• isolation precautions

• varying levels of consciousness

• limited mobility or painful range of motion

• spinal precautions on trauma patients

• tubes, wires, lines and leads

what to do with isolation precautions:

• follow precautions as indicated on the patient’s door

• place the IR in a bag for isolation patients and anyone who is wet in bodily fluids

what to do with limited mobility or painful range of motion

• ask MD/RN before ever removing any splints or immobilizers

• if fracture present, use two people to hold/lift part and place IR carefully

• use blankets, pillows or x-ray sponges to support the limb and/or IR (beware: artifacts)

what to do with spinal precautions on trauma patients

• Never move collared patient without a nurse or physician present to hold the patient’s head

• log roll

what to do with tubes, wires, lines and leads other devices

• pull all lines away from the area of interest but do no disconnect i=or remove any

• make notes in EPIC if there are IVs, name bracelets or other artifacts that you cannot remove or move away enough

• MRI screening exceptions

• stone protocol exceptions

during a code…

• NEVER leave the detector under the patient during cardiac arrest

  • the charge of the defibrillator will cause malfunctions in the IR and possibly redirect the charge from the patient

chest tube placement is confirmed by:

portable chest x-ray performed to confirm placement

another name for chest tubes

thoracostomy (intrapleural) tubes

ET tube placement is confirmed by:

portable chest x-ray performed to confirm placement

PICC line placement is confirmed by:

portable chest x-ray performed to confirm placement

PICC line X-ray

-RH

• patients are RPO 15 degrees, mark side down

• must include should of insertion site and at least all of the mediastinum

• SID 45”

  • angle of the RPO allows visualization of tip of PICC line away from spine

central line placement is confirmed by:

portable chest x-ray performed to confirm placement

NG tube placement (keofeed) is confirmed by:

portable chest x-ray or portable abdomen performed to confirm placement

for large bore NG tube:

• most of the image should be chest with feeding tube visualized

  • top of IR at the level of the shoulders (Not higher)

• if a portable abdomen is ordered include more of the abdomen with feeding tube visualized

  • CR at level 2” above crest

RH protocols line/tube placement

• with any line or tube placement, if the line or tube needs to be advanced or pulled back, a new x-ray order is required to take another image to show the line or tube position

• automatic verbal reports

automatic verbal reports are needed for…

1. PICC line placement

2. Feeding tube placement

3. NICU new central line placement

4. if the doctor request a verbal report on the order or at bedside

a neonate is a

newborn

premature is

born before the 37 week gestation

RH NICU mobile imaging

• scrub hands for 30 second before entering

• use hand sanitizer

• use hand sanitizer between multiple patients

NICU precautions/preparation

• equipment: #9 and #10 to obtain images (wipe them down)

• digital detector: 9×11 housed in NICU

• lead markers: disposable markers

• make sure to shield nearby babies and NICU nurses

NICU IR placement

• will be dependents on type of bed/isolette

  • IR placed in tray or directly under the patient

  • some beds have side measurements to air in centering the IR in the tray below

isolette

• imaging is possible through the plastic

• RN may lift the lid and tube would go under the lid (however- short SID)

open bed warmer

• arm of heater may be moved for imaging

  • important to remember to place arm of heater back over baby immediately when finished exposure

Portable NICU chest positioning

• IR portrait (9×11)

• AP supine, nurse holds

• CR at nipple line

• tight collimation

• 40” SID

• all surroundings shielded

• yell “x-ray”

• watch breathing for inspiration

portable NICU “babygram” positioning

• IR (11×12 portrait)

• AP supine0 nurse holds

• CR at region of diaphragm

• tight collimation

• 40” SID
  ensure all surrounding are shielded

• yell “x-ray”

• watch breathing for inspiration

RH NICU PROTOCOL

NEVER REPEAT A NICU EXAM WITHOUT AUTHORIZATION FROM THE ORDERING PHYSICIAN

What is the no grid GCF

1

what is the 5:1 GCF

2

what is the 6:1 GCF

3

what is the 8:1 GCF

4

what is the 10:1 and 12:1 GCF

5

what is the 16:1 GCF

6

Grid rules

• the tube must be perpendicular and centered to the grid in order to prevent

  • grid cutoff

  • elongation/distortion

• the technique must be increased when using a grid

what type of tube is this?

chest tube

what type of tube is this?

ET tube

what type of tube is this?

PICC line

what type of tube is this?

central line

what type of tube is this?

NG tube

why is a chest tube placed?

to relieve air or fluid in pleural cavity space

what is a pneumothorax?

air (seen higher)

what is pleural effusion?

fluid in the lungs (seen lower)

what is a hemothorax?

blood in the lungs (seen lower)

how much fluid has to be in the lungs to see it on an x-ray?

300mL

how much fluid needs to be in the lungs to see it on a lateral decub chest?

150mL

location on an ET tube

about 1-2 inch superior to the carina (not in esophagus)

most common mistake when placing an ET tube?

goes into the right bronchus because it is straighter and wider

where is a PICC line placed?

• peripheral line that goes in through right or left arm and goes into the heart

• Distal tip ends at the SVC

  • can go into the cephalic, basilic or brachial

why do we oblique the pt for a PICC line x-ray?

to shift the mediastinum away to be able to visual the line

most common insertion site for a central line?

subclavian

• central venous catheter

insertion of an NG tube

through the nose and end into the stomach junction