RTEC 93
Venipuncture for Radiographers
When hands are visibly soiled
Before and after patient contact
After removal of gloves
After using the toilet
After blowing or wiping the nose
Upon leaving an isolation area
How long do you wash?
A Stethoscope
A Blood Pressure Cuff
(Sphygmomanometer)
A Watch Displaying Seconds
Vital Signs
Indication of
Homeostasis
Primary Mechanisms
Heart beat
Blood pressure
Body temperature
Respiratory rate
Electrolyte balance
Physical assessment include measurement of vital signs
Body Temperature
Pulse
Respiration
Blood Pressure
Mental Status
Ideally the patient should be sitting with feet on the floor and their back supported.
The examination room should be quiet and the patient comfortable.
History of hypertension, slow or rapid pulse, and current medications should always be obtained.
Body
CAUTION: Do not mix oral and rectal thermometers.
Normal average body temperature: 98.6 F
Humans can survive between 106 F and
93.2 F.
Hypothermia
Hyperthermia
Measuring Body
Temperature
Oral
Rectal
Axillary
Tympanic
Temporal
Artery (TA)
Thermometers
Pulse
Pulse rate: Adult = 60 to 100 beats per minute
Children under 10 = 70 to 120 beats per minute
Tachycardia
Bradycardia
1. Radial artery--inside the wrist near the base of the thumb
2. Brachial artery--located in the depression proximately ½ inch from the crease on the inside of the elbow
3. Carotid artery--located in the groove on either side of the windpipe
4. Apical--at the apex of the heart
(stethoscope needed)
Pulse
Wash Hands
Identify your patient
Introduce your self and explain the procedure
Position the patient lying down or seated, with palm up, arm comfortable and supported
Sit or stand facing your patient.
Grasp the patient's wrist with your free (nonwatch bearing) hand (patient's right with your right or patient's left with your left). There is no reason for the patient's arm to be in an awkward position, just imagine you're shaking hands.
Compress the radial artery with your index and middle fingers. Is using your thumb a good idea?
Pulse
Note whether the pulse is regular or irregular:
Regular - evenly spaced beats, may vary slightly with respiration
Regularly Irregular - regular pattern overall with "skipped" beats
Irregularly Irregular - chaotic, no real pattern, very difficult to measure rate accurately
Pulse
Count the pulse for 15 seconds and multiply by 4.
Count for a full minute if the pulse is irregular.
Record the rate and rhythm.
Respiratory Rate
Breaths per minute: Adult = 12 to 20
Children under 10 = 20 to 30 per min
Tachypnea
Bradypena
Dyspnea
Apnea
Respiratory Rate
Best done immediately after taking the patient's pulse. Do not announce that you are measuring respirations.
Have patient remove bulky clothing (if possible) that might interfere with observation of chest movement.
Position patient sitting or supine.
Respiratory Rate
Place your fingers on patient's wrist as if you are taking his pulse. Also, if there is difficulty in seeing chest movement, you may fold the patient's arm diagonally across their chest, allowing you to feel the movement instead.
Without letting go of the patients wrist begin to observe the patient's breathing. Is it normal or labored?
Respiratory Rate
Inspiration + Expiration = 1
Count breaths for 15 seconds and multiply this number by 4 or 30 seconds and multiply by 2 or for 1 minute to yield the breaths per minute.
• Normal Pulse
Oximeter = 95% to 100%
Oxygen
Oxygen constitutes 21% of atmospheric gases
If O2 levels in the body drop below 21% homeostasis is altered.
Hypoxia: Inadequate amount of oxygen at the cellular level.
• Blood Pressure
• Systolic pressure =
95-140 mmHg
• Diastolic pressure =
60-90 mmHg
• Hypertension
• Hypotension
Blood Pressure
Wash Hands
Identify your patient
Introduce your self and explain the procedure
Position the patient lying down or seated, comfortable
Position the patient's arm so the anticubital fold is level with the heart. Support the patient's arm with your arm or a bedside table. Position the patient's arm so it is slightly flexed at the elbow.
Blood Pressure
Locate brachial pulse by palpation
Place cuff 1 to 2 inches above elbow or anticubital fold.
Proper cuff size is essential to obtain an accurate reading.
Position arrow on the cuff over brachial artery
CAUTION: The inflated cuff is not to stay in place any longer than 2 minutes
Blood Pressure
Position gauge where you will have full view to observe the column or dial
Place ear piece of stethoscope facing forward in ears. This is the only correct placement any time a stethoscope is used
Do not use thumb to stabilize diaphragm on arm, as your pulse may be heard instead of the patient's blood pressure
Blood Pressure
Palpate the radial pulse and inflate the cuff until the pulse disappears. This is a rough estimate of the systolic pressure
Place the stethoscope over the brachial artery.
Inflate the cuff to 30 mmHg above the estimated systolic pressure.
Release the pressure slowly, no greater than
5 mmHg per second.
Blood Pressure
The level at which you consistently hear beats is the systolic pressure
Continue to lower the pressure until the sounds muffle and disappear. This is the diastolic pressure
Release remaining air
Record the blood pressure as systolic over diastolic ("120/70" for example).
• Does California Law address arterial injection by RT’s ?
• What are the important parts of the law to know?
• The California Law does not address arterial injection by
RT
• Employers policies
• Saline flush
Review
Vital Signs
Homeostasis
Body
Temperature
Pulse
Respiration
Blood Pressure
Mental Status
Pulse Oximeter