TEACHING MOMENTS IN THE O.R.

A GUIDE FOR WORKING WITH C-ARM EQUIPMENT IN THE O.R. PREPARED BY: Jesse Robertson RT(R)

GOAL AND PURPOSE OF THIS POWERPOINT PRESENTATION Teach Technologists information they need to

know while working in the O.R. Review important policies that pertain to the

O.R. Help technologists gain quick knowledge

when orientating to the O.R.

MOVING YOUR PATIENT OVER IN EPIC It’s important to pay attention to the

examination that the nurse has ordered in EPIC, because if he/she has made a mistake, it can result in trouble for you.

If the nurse has ordered FL<HR, and you move the exam over to begin it, you will not be given the option to move this patient into an operating room fluoroscopic procedure. If you begin the exam in X-RAY Room 1 or 2, the anesthesiologist and nurses will no longer be able to find the patient information in EPIC. This causes a lot of confusion, and eventually irritation will be directed toward you (when they find out what happened).

WHAT TO DO WHEN THIS HAPPENS When you see that an order has been put in

incorrectly, call the nurse that placed the order and ask him/her to make the needed adjustment.

When the order is correct, you may proceeded in moving the patient over in EPIC to

ENDING YOUR EXAM IN EPIC When your exam is finished, be sure that the

study that is ordered reflects the study that was done.

If you Are doing a lap chole and the doctor decides not to do cholangiogram, change your order to fluoro support if there were no films taken.

If you are doing a cysto and the doctor never injects contrast, but he places a stent that you take an x-ray of, change the cysto order to FLP<HR.

ADDING PATIENT INFORMATION TO BEGIN YOUR EXAM

• Always use the worklist to populate patient data fields, except for these machines that do not have worklist capabilities.

• The Cysto room does not have a worklist. Be very careful when adding patient information. Check your work 2 or 3 times before sending to E-UNITY.

C-ARM C & THE MINI-C

Both of these c-arms require manual data input.be very careful when adding patient information.

O.R. ROOM 1

The c-arm parked in O.R. 1 is used for endoscopy cases. This c-arm does not have worklist capabilities.

Be careful when adding patient information: make sure all data is correct

WORKLIST CAPABLE MACHINES

All of the Ziehm machines are worklist capable. Worklist should always be used to populate your data fields when setting up your case.

2ND POINT TO REMEMBER: MARKERS

BE SURE TO USE MARKERS FOR EVERY EXAM

DON’T DO THIS!

Even though digital markers are available on most of the c-arm equipment, they are not to be used. Always use a physical marker.

Create an imaging report at the end of your exam by selecting this button (ZIEHM MACHINES ONLY)

Be sure to send every image that is saved in your study to E-Unity. Each image is a part of the patients medical record and needs to be protected.

EQUIPMENT SAFETY IN THE O.R.

Protect c-arm equipment from blood and fluids during surgical cases.

Cover foot switches with a clear plastic bag for doctors who wish to do their own IMAGING

When power cords are crossing work paths within the operating room, use the orange cord protectors to help bring attention to this trip hazard. These orange pads stick to the floor, and are disposable after your case. IF YOU DON’T KNOW WHERE THEY ARE, Ask the or aides where you can find these.

X-RAY CONTRAST IN THE O.R.

Radiology provides the Isovue 300 for studies requiring contrast.

We charge for the contrast when we end the exam.

The nurse charts the administration of the contrast.

Always bring an extra bottle with you for cases requiring contrast. Carry back any unopened bottles of contrast and lock them up in Radiology.

Never leave bottles behind in the O.R.

DON’T LEAVE BOTTLES OF CONTRAST BEHIND WHEN YOU ARE FINISHED WITH YOUR EXAM

C-ARM STORAGE

Every c-arm in the OR has a place for storage. The small Ziehm is stored in the hallway outside of

O.R. 7. There is a niche marked off with striped black and yellow tape for this c-arm. When you are finished working with it, please be sure to put it back in it’s spot.

The big Ziehm is parked in the hallway by OR 10. The flat panel Ziehm is parked in the hallway by OR

10 The small white Siemens (c-arm C) is stored in the

closet in that same hallway. The mini-c is also stored in that closet

C-ARM STORAGE AREA

This is better. The cord is hanging:Not tightly wound.

When storing cords on the c-arms, please do not wrap them on the holder tightly. This causes the cord to bend and kink, which shortens the life of the cord.

THIS IS AN EXAMPLE OF HOW THE POWER AND C-ARM CONNECTION CORDS SHOULD LOOK ON THE BACK OF THE C-ARM WHEN PROPERLY STORED.

LOWER TO “0”

When finished with your exam, lower the c-arm to “0” before turning off the machine. This will ensure that you don’t hit the door jam on the way out of the surgical suite.

Do This

NOT THIS

Be careful when storing monitors

When this monitor is parked in this position, the screen rams into the wall, causing damage to the monitor and the wall.

Dirty rage go hereClean rags

It is important to clean the c-arms after every use. When you are finished with your case, you will find a cart like the one above in the or hallway. While wearing gloves, take a rag and clean the c-arm. When finished, dirty rags go in the hamper on the left end of the cart.

X-RAY (grey) aprons are stored in the hallway by room 10. Please help us keep track of the 4 we have by putting them back when you are finished with your exam.

CHARGE EXAM AND LOG ON SURGERY LOG

Check to make sure your images have crossed over into E-Unity (every time you charge out an exam)

After you charge your exam, go to the surgery log and put your initials by the case you have finished.

If the medical record number is not already entered into the surgery log for you, it is your responsibility to do this.

Working in surgery has been described by some as "boring;” however, this does not excuse the use of cell phones in the O.R. for texting, shopping, or facebooking (etc). Be professional in your work area, and provide the best patient care by staying alert and paying attention to what is happening in the room.

SUMMARY1. Be sure your exam info

and patient info are correct

2. Use your markers3. Save every image to E-

Unity4. Protect equipment and

protect people5. Manage your contrast6. Properly store your c-arm

7. Clean your c-arm after every use

8. Put away lead aprons and thyroid shields.

9. Charge and log your exam.

10. Refrain from personal cell phone use (including surfing the web)while working in the O.R.

WHAT’S NEXT? More “Teaching Moments” are to come. Doctor preference cards for the O.R. are

being developed. This will help you to know exactly what the doctor expects of radiology for the procedures you may be involved in.

THANKS FOR VIEWING If you have any questions about this

powerpoint presentation, please ask Jesse. All questions about the O.R. can be

answered by your lead techs and Marty.