myelogram, lumbar puncture, epidural injection, arthrogram, steroid injection, joint aspiration

clean asepsis is aka what

medical asepsis

what is the definition of clean asepsis

the reduction in microorganisms using water, soap, friction, and chemical disinfectants

clean asepsis would be used prior to what?

administering medications

enemas

tube feedings

interactions with patients

daily hygiene

what are two examples of clean asepsis

hand washing with soap and water

using an alcohol-based hand rub

surgical asepsis is aka

sterilization

what is the definition of surgical asepsis

the complete removal of microorganisms and their spores by using a heat or chemical process

what does surgical asepsis eliminate

eliminates all pathogens

where is the sterilized equipment that is used during invasive procedures in radiology obtained from?

obtained from the central supply department

what is the definition of disinfection

used when articles or surfaces cannot be sterilized (like countertops)

what are 2 examples of disinfection

sani wipes

bleach

lysol wipes

what is the definition of antiseptic

used to cleanse the skin

what are two examples of antiseptic

hand sanitizer

hydrogen peroxide

iodine

rubbing alcohol

when does the CDC require a mask to be worn

when a catheter is being placed or material injected into the spinal canal or subdural space

what two anatomic features must a mask fully cover

mouth

nose

how should a mask be removed

remove by handling the ties only

what is a sterile field

the area that has been prepared for the use of sterile equipment and supplies and a microorganism free area

items are considered sterile when they are:

clean

dry

unopened/not punctured

the expiration date has not passed

the sterility indicators have changed to the predetermined color that indicates the package is sterile

what are 4 things you should not do over a sterile field

sneeze

cough

laugh

talk over

once a sterile field is prepared, should it be left unattended

no

what type of contamination is just as serious as a break in the sterile technique

airborne contamination

what are the steps for opening a sterile package

wash your hands

remove tape and open the corner away from you

open next 2 corners to the left and right

pull last corner towards your body

if you need to add any items to the sterile field, how would you do so

while holding the edges of the wrapper, drop the item onto the sterile field

why must a small amount of solution be poured out prior to it being placed on the sterile field

to “wash” the containers lip and avoid the possibility of contaminating the tray

describe how you would add a sterile solution to a sterile field

discard a small amount of solution

place container at the edge of the sterile field

pour from a distance to prevent contamination pour away from the label

pour away from the label

what are the two types of gloving techniques used

open gloving

closed gloving

describe how you would put gloves on utilizing the open gloving technique

glove dominant hand first

pick up right glove with left hand at folded cuff

slide the right hand into the glove, do not unfold the cuff

pick up left glove with the gloved right hand under the fold

pull glove on over the hand and cuff of gown, then place fingers of gloved left hand under the cuff of the right glove, pull it over the cuff of the gown, then adjust

describe how you would put gloves on utilizing the closed gloving technique

glove package needs to be opened before the scrub procedure

cover both hands with sterile gown sleeves

pick up right glove with the left hand

place fingers of glove towards elbow

grasp cuff of glove through the gown

pull glove over the fingers and cuff of gown

with gloved hand pick up left glove

place fingers pointing towards the elbow

grasp cuff and pull second glove into place

which of the two techniques described would you utilize when setting up a sterile field in radiology

open gloving

the sterile field ends at what level

at the level of the tabletop or the waist of the sterile persons gown on the front side only

what abbreviation does CNS stand for

central nervous system

what two parts of the central nervous system divided into

the brain that occupies the cranial cavity

the spinal cord that is suspended within the vertebral column

where does the spinal cord begin and end

beings at the brain and ends at L1-L2

what is the name for the terminal end of the spinal cord

cauda equina

what is the function of the meninges

cover and protect the brain and spinal cord

what are the 3 layers of the meninges

dura mater (outer layer)

arachnoid mater (middle layer)

pia mater (inner layer)

what color is the cerebral spinal fluid

clear and colorless

at a given time, how much CSF is present in the body

150 mL

what is a cistern

expanded areas of the subarachnoid space

what is the most common site for lumbar punctures to be performed

lumbar cistern

what is the purpose of preparing the skin prior to beginning a procedure

to remove as many microorganisms as possible from the skin to reduce the risk of infection

what are the 2 ways to prepare the skin prior to a procedure

mechanical

chemical

when should hair be removed for a procedure

if it interferes with the procedure

describe the procedure when shaving a patient

hold the skin tight (taut)

shave in the direction of hair growth

dont nick or cut the skin

shave with short, firm strokes

wet sterile sponge with alcohol, removing all of the hair

when is chemical skip prep performed

after mechanical preparation

describe the steps for performing a chemical skip prep

get out gloves and a prep set

always ask if the patient is allergic to iodine before starting to cleanse the area

put on sterile gloves using the open gloving technique

prep 6-12” around the operation site

rub antiseptic solution in a circular motion (inside to outside)

repeat with a new sponge and watch for signs of irritation

allow skin to dry

what action is needed to remove microorganisms

friction

how would you know the proper amount of dry time is used using iodine to prepare the skin

the manufacturer has a stated amount of time

what does the informed consent discuss

risks and benefits of the procedure

alternative treatment options

who must sign the informed consent

patient

provider performing the procedure

when is the pre-procedure time out performed

done prior to the exam beginning

what is confirmed with the pre-procedure time out

the correct patient

the correct procedure

the correct site (lumbar, extremity)

who must agree to the time out before the procedure can begin

everyone in the room

where is the specific time the time out was performed documented?

documented on the computer with a specific time

what is a myelogram

a radiographic study of the CNS structures situated within the vertebral column

performed by introducing a non-ionic, water-soluble contrast medium into the subarachnoid space by spinal puncture

what are examples of why a myelogram would be performed

identifying CSF leaks

surgical planning

spinal tumors

cord swelling

herniated disks

narrowing of the canal due to spinal stenosis

what are the contraindication for a myelogram

blood in the CSF

arachnoiditis

increases intracranial pressure

recent lumbar puncture

what contrast is used for lumbar myelograms

isovue M 200

what contrast is used for cervical myelograms

isovue M 300

how many times must contrast be checked before it is able to be administered

3

how many people must check the contrast before it is able to be administered

2

what are radiographers expected to know about contrast

safe dosage

safe route (location) of administration

limitations of the drug

side effects

potential adverse and toxic reactions

indications

dont forget contrast media is considered a drug/medication

how should the radiographer prepare the examination room prior to a myelogram

using aseptic technique on table and equipment

place the padded shoulder supports and footboard on the table

why is the table tilted during a myelogram

facilitate positioning so the contrast medium will go to the desired region

what is the proper patient dress for a myelogram

in a gown with the back fully exposed

what are the procedure steps for a myelogram

1. get all necessary pre-procedure paperwork done and have pt in a comfortable prone position

2. the radiologist or PA will first fluoro to determine which level to access and mark the skin in that area

3. the radiologist or PA will perform chemical skin prep

4. a local anesthetic agent (lidocaine) is used to numb the skin prior to inserting spinal needle

5. radiographer (or student) will need to move the fluoro tube as the needle is advanced into the subarachnoid space

6. the correct location in the subarachnoid space is confirmed by the presence of CSF backflowing unobstructed into the spinal needle

7. contrast is hand injected through the spinal canal

8. after the injection is completed, the spinal needle is fully removed from the pt

9. the radiologist will tilt the table and instruct the patient to rotate in various positions as needed

10. be prepared to assist the pt in anyway they need and remind them about the table tilting prior

11. the radiologist will save spot images as the contrast reaches the desired location as well as when the patient is in the correct position

12. once the radiologist is finished, a band aid will be placed over the puncture site

13. the patient is then log-rolled onto a cart and taken to CT for post myelogram images

when completing the contrast screening tool, what must be documented regarding contrast

the time that contrast was administered

the type of contrast administered

the location where the contrast was administered

what procedure could be needed if a patient develops a severe headache following a myelogram

a blood patch procedure

where does the blood needed for a blood patch procedure come from

the patients own blood

what is the purpose of having an epidural blood patch procedure

used to patch a dural tear that is leaking CSF after the initial myelogram

what is a lumbar puncture

a diagnostic and therapeutic procedure performed to collect a sample of CSF for laboratory testing

what unit of measurement are opening pressures record in

mmH2O

what could higher than normal levels of CSF be an indicator for

meningitis

idiopathic intracranial hypertension

what type of contrast is used for a lumbar puncture

there is no contrast used

what type of infections could a lumbar puncture help diagnose

bacterial infections

viral infections

fungal meningitis

what type of neurological conditions could a lumbar puncture help dianose

multiple sclerosis

Guillain-Barre syndrome

how many tubes are typically collected during a lumbar puncture

4

what must be present on each tube collected

patients name and DOB

time and date of collection

tubing sequence (1,2,3,4)

initials of the person who received the tube and specimen from the performing provider

what is an arthrogram

a minimally invasive radiographic examination of the joint following the injection of a contrast medium into the joint space

what does an arthrogram aid in detecting

damage in soft tissues like ligaments, cartilage, and tendons that arent visible with regular x-ray

what are the steps for performing an arthrogram

place the patient in a supine position on fluoro table

radiologist/PA will prep the area with a cleaning agent

radiologist/PA will fluoro to determine area to access

radiologist/PA will numb the area with lidocaine

radiologist/PA will place needle (20-22g) into joint

radiologist/PA will have tech/student fluoro for needle placement

once the needle is placed, a small amount of omnipaque 300 (or whichever radiopaque contrast is used) will be injected to verify correct placement

once contrast placement is confirmed, the MRI specific contrast will be injected into the joint space

after the injection is complete, the needle will be removed and a bandaid will be placed over the puncture site

the rad tech/student will then assist the pt in dressing, so that they do not move their joint space more than necessary before they are taken to MRI or CT

what is a joint aspiration

a procedure to remove fluid from the space around a joint using a needle and syringe

why is a joint aspiration performed

to relieve swelling

obtain fluid for analysis to diagnose a joint disorder or problem

where does fluid obtained from a joint aspiration go

sent to the lab for analysis

what gloving technique is demonstrated

open gloving technique

what is labeled by A

arachnoid mater

what is demonstrated by B

dura mater

what is demonstrated by letter C

adipose

what is demonstrated by letter D

cerebral spinal fluid

what is demonstrated by letter E

pia mater

which letter represents the middle layer of the meninges

A

which letter represents the outer layer of the meninge

B

which letter represents where contrast would be injected for a myelogram

D

what procedure is being performed

arthrogram of shoulder

what substance is shown as black on this image

radiopaque contrast (omnipaque 300)

what modality will a patient typically go to after having this procedure performed

MRI or CT

what procedure is being performed on this image

lumbar myelogram

what level is the needle placed at for this procedure

L2/L3

what contrast was used for this procedure

isovue M 200

what procedure is being performed

cervical myelogram

what intervertebrak disk space is at #1

C3-C4