ADULT
ECHOCARDIOGRAPHY
Lecture 4
Technique and Patient
Care
Harry H. Holdorf PhD, MPA, RDMS, RVT, LRT, N.P.
Technique
• High gain destroys resolution
• The goal is even brightness of
tissue throughout the image.
Patient care
• Electrical Safety
– Always use proper grounded
electrical devices with threeprong plugs.
– Avoid the use of extension
cords.
– Do not use any device with
frayed cords.
– Inspect systems routinely.
– During an ECG, patient
should not be grounded, but
chassis of ECG machine
should be grounded.
Patient relations, confidentiality &
Assessment
• In 1996, Congress enacted the
Health Insurance Portability and
Accountability Act, or HIPAA.
• The primary purpose was
continuity of health insurance
coverage if you change jobs, but
is also provided for standards for
health information transactions
and confidentiality and security
of
patient
data.
This
confidentiality portion will most
affect the day-to-day workflow
among health care professionals.
Privacy
• Privacy is somewhat different than
confidentiality. It refers to individuals’
right to keep some information to
themselves and to have it used only
with their approval. Under HIPAA,
physicians must use and disclose only
the minimum necessary amount of
patient information needed fro the
purpose in question. The institution may
use and disclose patient information for
treatment, payment, and health care
operations without patient authorization.
Most other uses and disclosures of
patient information require such an
authorization.
• Liability
– Holds each individual responsible
for their actions.
• Negligence
– Doing something that a reasonable
person will not do or Not doing
something that a reasonable person
would do.
• Informed consent
– Protects doctor from claims of
unauthorized procedure. In order to
be legally binding, patient must be
capable of giving consent (before
given morphine, etc.) For invasive
procedures, informed consent
should be given to operating
physician or cardiologist.
• Interpretation of exams
– Sonographers cannot provide
interpretation of exam to
patient. Interpretation must
come from physician.
• Malpractice
– Claims can be avoided by
effective communication
between patients and medical
personnel.
• Denial
– The refusal to acknowledge
the existence or severity of
unpleasant external realities
or internal thoughts and
feelings.
• Initial assessment
– Including vitals, are used to
establish a baseline to
compare future results.
• Wheelchair
– Moving a patient in or outbrakes engaged, footrests
retracted.
Foley Catheter
• An indwelling Foley catheter is a
flexible plastic tube that is inserted
through the urethra into the bladder, to
drain urine.
• To keep the catheter for slipping out, it
as a balloon on the end that is inflated
with sterile water or saline once the end
is inside the bladder.
• Keep the urinary drainage bag below
the level of he bladder to keep the fluid
flowing from the bladder into the
collection bag. If the bag is elevated
above the bladder, urine will collect in
the bladder.
Sterilization
• Sterilization is the elimination of all
transmissible agents (such as bacteria
and viruses) from a surface or a piece
of equipment. This is different from
disinfection, where only organisms that
can cause disease are removed by a
disinfectant.
• In general, any instrument that enters
an already sterile part of the body (such
as the blood, or beneath the skin,
should be sterilized. This includes
equipment like scalpels, hypodermic
needles, and artificial pacemakers.
• Pathogens or infectious agents
are biological agents that causes
disease or illness to its host.
Pathogens disrupt the normal
physiology or an animal or plant.
The term pathogen is derived
from the Greek “Birth of Pain”.
• The human body has many
natural defenses against some of
the more common pathogens in
the form of the human immune
system and by some helpful
bacterial present in the human
body’s normal flora.
• However, if the immune system or good
bacteria is damaged, pathogenic
bacteria that were being controlled can
multiply and cause harm to the host.
Such cases are called opportunistic
infections.
• Flora- Mucus membranes, such as the
intestinal lining, are constantly in
contact with environmental organisms
and become readily colonized by
various microbial species, called flora.
• Pathogens are responsible fro massive
amounts of casualties and have harmful
effects on affected groups. (AIDS)
Methods of Sterilization
Preferred principle for sterilization is
through heat and pressure. There are also
chemical methods of sterilization.
1. Autoclaves
A widely-used method for heat
sterilization
is
the
autoclave.
Autoclaves use steam heated to 121
degrees C (250 F)and pressure at 103
kPa (15 psi) above atmospheric, for 15
minutes. The steam and pressure
transfer heat into organisms to kill
them. Useful parameters – time and
temperature.
2. Chemical Sterilization
Chemicals are also used for
sterilization.
Although
heating
provides the most effective way to
destroy transmissible agents, it is
not always appropriate, because it
destroys objects such as fiber
optics, electronics, and plastics.
Ethylene oxide (EO) gas is
commonly used to sterilize objects
that cannot survive temperatures
greater than 60 degrees C, such as
plastics, optics, and electrics.
• Sepsis
– Means to soil or dirty. “A”
means without.
• Aseptic
means
without
microorganisms.
Aseptic
technique refers to practices that
reduce post procedure infection
in patients by decreasing the
likelihood that microorganisms
will enter the body during clinical
procedures.
Sterile Fields
• A sterile field is an area created
by placing sterile towels or
surgical drapes around the
procedure site and on the stand
that holds sterile instruments
used during the procedure.
• The doctor’s sterile area is the
only area that should come in
contact with the sterile field. Only
sterile objects and personnel
may be allowed in the sterile
field. The sterile area should be
draped starting from the area
closest to the person and
extending outward.
•
•
•
While a sterile field is created around a
procedure site, items below the level of the
draped client are outside the field and are
not sterile. A properly gowned and gloved
person’s sterile area extends from the chest
to the level of the sterile field. Sleeves are
sterile from 5 cm ( 2 inches) above the
elbow to the cuff.
Once a sterile object comes in contact with
a non-sterile object or person or with dust or
other airborne particles, the object is no
longer sterile. If even one non-sterile object
or person enters the sterile field, the field is
no longer sterile. For example, sterile
objects become contaminated if you touch
the object with your bare hand, if the object
comes into contact with dust or other
airborne particles, or if the object is held
below the level of the sterile field.
The spike of an IV set is sterile and must not
come in contact with non-sterile objects.
To maintain the Sterile Field
1. Do not place sterile items near
open window or doors
2. Place only sterile items within
the sterile field
3. Do not contaminate sterile items
when opening, dispensing, or
transferring them
4. Consider items located below
the level of the drape to be
unsterile.
5. Do not allow sterile personnel to
reach across unsterile areas or
to touch unsterile items.
6. Do not allow unsterile personnel to
reach across the sterile field or to touch
unsterile items.
7. Recognize and maintain the provider’s
sterile area.
8. Recognize that the edges of a package
containing a sterile item are considered
unsterile.
9. Recognize that a sterile or high-level
disinfected (HLD) barrier that has been
penetrated (wet, cut, or torn) is considered
contaminated
10. Be conscious of where your body is at
all times, and move within or around the
sterile or HLD field in a way that maintains
sterility or HLD status.
Radiopaque objects: block
radiation and appear white
on a x-ray film.
Bodily Fluid Spills
• Care must be taken with blood,
vaginal secretions, saliva in
dental procedures or any body
fluid that is visibly contaminated
with blood. In addition, care must
be taken in situations where it is
difficult
or
impossible
to
differentiate between body fluids.
• Universal
precautions
in
emergency situations suggest
that all body fluids are potentially
infected material (PIM).
Infectious fluids can enter our
bodies through:
•
•
•
•
•
Absorption through mucus membranes
covering the body openings
Through an open, bleeding wound
Through damaged areas of the skin, caused
by other severe skin diseases.
Mucus membranes are much thinner than
normal skin. Microscopic cuts in the
membranes can allow germs to cross the
membrane and enter the blood stream.
Also, fluids can be absorbed through these
membranes even without any cuts or
breaks.
Normal skin is much thicker than mucous
membranes and provides a good barrier to
blood diseases. Infectious fluids cannot be
absorbed through skin that is intact.
Have these materials on hand for cleaning up spills:
• A durable container to store the clean up supplies
• Several biohazard labeled bags
• Disinfectant-freshly prepared 10% solution of
household breach ( 1 part bleach and 9 parts
water, or add ½ cup bleach to 1 quart water) or
other commercial chlorine or iodine based
disinfectant
• Inert absorbing material (Kitty litter)
• A small dust pan and hand brush
• Personal protective equipment, including several
pairs of latex gloves, goggles, face masks,
coveralls, and paper boots.
• A roll of paper towels
• Antiseptic wipes
Cleaning a Blood Spill
1. If blood has spilled onto you, it should
be thoroughly washed off as soon as
possible. If the material has spilled on
your clothing and soaked through so
that that is skin contact, the cloths
must be removed. Following removal,
wash those areas where exposure is
evident, even to the point of taking a
shower. If blood or PIM has come into
contact with any of the mucous
membranes (eyes, nose, lips) they
need to be thoroughly rinsed. If there
is contact with open wounds or cracks
(chapped skin) in the skin, there is a
risk of exposure. Immediately and
thoroughly wash your hands with water
and soap or an antiseptic cleaner if
contaminated with a body fluid.
2. When clean up involves blood or a flat surface, you
should first delineate and mark the spill area so that
others do not inadvertently enter the area until clean
up is complete.
3. Soak the area for at least 20 minutes with a
disinfectant (freshly prepared 10% bleach solution).
You can be liberal with disinfectant but don’t apply so
heavily that it begins to run.
4. Allow at least 20 minutes with a disinfectant to
complete the decontamination. You can use the small
hand broom and dustpan to clean up the spill.
5. Deposit all clean up material in bio-waste disposal
bag and close tightly. The bag should be secured in a
biohazard BURN BOX. Carefully remove gloves,
coveralls, and boots (if used) and discard in a biowaste bag. If used, the facemask should also be
disposed. Goggles can be disinfected, rinsed, and
reused. The dustpan and broom can be disinfected
and reused.
6. Record and report the incident to your supervisor.
End Lecture four
NEXT: THE AORTIC VALVE