l3 - non-aseptic techniques
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Patient Care II Non-aseptic Technique
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OUTLINE
Nasogastric tube
Insertion
Removal
Transferring patients ithnasogastric tube
Urinals
!e"pans
Enemas
Cleansing enema
Other aspect ofpreparation
!arium enema
Post-proce"uralinstructions
Colostomies
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INTRO#UCTION
Un"erstan"ing non-aseptic technique is important tothe professional practice of a ra"iographers$
%ost of these techniques are performe" ith patients
ho are ver& sic' or in great "iscomfort$
Ra"iographers nee" to "evelop abilities ofcompassion( caring( an" competenc& to be able an
e)cellent practitioner
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N*+O,*+TRIC TU!E
Nasogastric tube are plastic or rubber tubes inserte"through the nasophar&n) into the stomach$
Primar& use
#ecompression or removal of flatus an" flui"s fromthe stomach
.ee"ing the patient
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N*+O,*+TRIC TU!E
%ost common t&pes use"
Levin tube - single lumen tube ith several hole nearthe tip
+alem-sump tube - "ouble lumen( ra"iopaque tube$One of the lumina provi"es air vent( the other is forremoval of the gastric contents$
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N*+O,*+TRIC TU!E
Patients ith nasogastric tube usuall& suffers from"iscomfort$
/eep the patient reassure" an" informe" is ver&
important so that the proce"ure is smooth an"complications can be avoi"e"$
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N*+O,*+TRIC TU!E - IN+ERTION
Usuall& the "octor or nurse is responsible for inserting the nasogastrictube$
The proce"ures of inserting are as follos
i$ I"entif& the patient an" e)plain the proce"ure$
ii$ Place the patient in high .oler0s position$ +upport patient ithpillos$
iii$Lubricate the tube at the "istal en" ith ater-soluble lubricating1ell& 1ust before insertion$
iv$Instruct the patient to sallo ater through a stra as theproce"ure begins$ If unable to ta'e flui"s( then as' patient tosallo air$
v$ The tube shoul" go "on easil& ith little force$
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2I#EO #E%ON+TR*TION
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N*+O,*+TRIC TU!E - +ECURIN,
The tube is usuall& secure" using butterfl& metho"$
The proce"ures of inserting are as follos
i$ Cut to pieces of tape appro)imatel& 3 inches longan" tear one lengthise$ Leave the other intact$
ii$ 4rap the intact piece aroun" the tubing$
iii$ Crisscross the to pieces of tape at the front of the
tubing( an" place them over the bri"ge of the nose$
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N*+O,*+TRIC TU!E - RE%O2*L
The proce"ure to remove a nasogastric tube is as follos
i$ I"entif& the patient an" e)plain the proce"ure$
ii$ 4ash han"s an" the turn off an" "isconnect the suction
apparatusiii$,entl& remove the tape from the patient0s nose( an" ma'e
certain that the tubing is free from the patient0s facial s'in
iv$Put on clean gloves an" as' the patient to ta'e in "eep
breath as the tube is gentl& ith"ran$
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TR*N+.ERRIN, P*TIENT+
4hen use" as a gastric "ecompression( nasogastrictube is often connecte" to an intermittent gastricsuctioning "evice$
4hen transferring patient( ma'e sure the "octor isinforme" an" give permission for the patient to betransferre"$
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TR*N+.ERRIN, P*TIENT+
If the "evice coul" be "etache"( fin" out the e)actlength of time that the "evice can be interrupte"$
If it is onl& for a short time( the "evice must be
reattache" to the suctioning "evice available in thera"iolog& "epartment$
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TR*N+.ERRIN, P*TIENT+
!efore patient is transferre"( the amount of suctionpressure require" must be "etermine"$
The amount of pressure is varie" an" can be
obtaine" b& rea"ing the "octor0s chart or as'ing thenurse-in-charge$
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URIN*L+
Urinals is use" for male patients for urination$
If the patient is able to help himself( ra"iographer can give theurinal to him an" leave( thus provi"ing privac&$
If patient require assistance( ra"iographer shoul"4ear gloves an" raise the sheet a"equatel& to permitvisibilit& hile protecting patient0s privac&
+prea" the patient0s leg an" place the urinal beteen it$
Place the penis into the urinal far enough that it "oesn0t slipout$
*fter urination( empt& the urinal( ash ith col" ater( an"put it in the soile" supplies to be resterilise"$
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URIN*L+
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!E#P*N+
!e"pans are for non-ambulator& patient for"efecation an" urination purpose$
3 t&pes are available5 the stan"ar" an" fracturebe"pans$
Usuall& ma"e from metal or plastic5 noa"a&smost commonl& plastic( out of concern for
infectious "isease$
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!E#P*N+
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2I#EO !RE*/
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!E#P*N+
6an" ashing is important an" shoul" be performe"before an" after assisting the patient ith a be"pan$
If the be"pan is col"( run arm ater over it( then "r&
it$
Patient0s privac& must be secure" an" respecte"$*la&s place a sheet over the patient$
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!E#P*N+ - Placement
Remove the be"pan cover an" place it at the en" of the table$
If the patient able to move( place one han" un"er the loer bac'(
as'ing the patient to raise his7her hips$ Place the pan un"er the hips$
If the patient is able to sit up( then this is the i"eal position$ If
possible( the patient0s hea" shoul" be elevate" 89 "egrees$
#o not leave patient for too long hen on be"pan$ 4hen leaving is
necessar&( please provi"e patient ith a a& to call for help in case
an&thing happens$
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!E#P*N+ - Placement
4hen finishe"( ear clean "isposable gloves( an"
remove the be"pan from patient b& instructing
him7her to raise the hips$
Plastic be"pans can be "iscar"e"( hile metal be"pans
must be emptie" in "esignate" area( run through col"
ater( an" place" in use" equipment area$
Offer patient a et cloth to ash up$ Then provi"e
clean toel$
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2I#EO #E%ON+TR*TION
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ENE%*+
Enema is a proce"ure of in1ecting a liqui" into therectum$
There are to t&pes of enema in ra"iolog&
"epartment
Cleansing enema
!arium enema
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CLE*N+IN, ENE%*
Cleansing enema is use" to promote "efecation$ .lui"sill brea' "on the fecal matter( stretches the rectalall( an" initiate "efecation refle)$
There are : t&pes of cleansing enemaTap ater
6&pertonic solution
Normal saline
+oapsu" solution
Oil retention
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CLE*N+IN, ENE%* - %etho"
I"entif& the patient an" obtain consent$ E)plain theproce"ure to the patient$
Prepare the enema solution$
Put an un"erpa" an" put patient in +im0s position ;leftanterior oblique
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CLE*N+IN, ENE%* - %etho"
The the patient that the proce"ure is about to start$
Lift the patient0s right buttoc' ith &our palm an"gentl& insert the tip of the tube( hile patient
breathing slol&$ If problem happens( as' for helpfrom others$
Let patient 'no that the enema is about to start$Cramping ma& occur ( so instruct patient to breatherapi"l& through mouth$
Tell patient to retain the flui"s as long as possible$
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Cleansing Enema - %etho"
*fter all flui"s have been inserte"( as' patient to liesupine then roll to right si"e to clean the transversean" ascen"ing colon$
,entl& remove the enema tip( rap it in paper then"ispose in appropriate container$
Patient shoul" rest quietl& for =9 minutes before as'e"to go to toilet$
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OT6ER *+PECT O. PREP*R*TION
!oel preparation aspect shoul" also be consi"ere" inbarium enema e)amination$
%ost preparation consist of the folloing
#ietar& restriction
Purgation ;la)ative inta'e
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