Journal

This week on placement I performed a number of chest x rays. I felt quite confident at performing these as I had performed a good number throughout each week. However this week was more challenging as I began performing these on patients arriving in the department on trolleys and wheel chairs. Most of these patients were unable to stand for their X ray, meaning we had to adapt the examination to the patient. Observing the radiographer setting up these one after another looked straight forward, however when it came to my turn I was extremely nervous. Several times I asked the radiographer to assist and double check the positioning of the patient and the alignment of the tube.

Once I understood the tube needed to be angled parallel to the cassette it was easier to understand the positioning techniques needed. However I found it difficult to constantly have to examine every individual situation and then try
to evaluate the situation to obtain a good projection.

A routine chest projection is done erect to show any fluid or air levels or possible consolidation. Elderly patients on a trolley, who are very ill or in extreme pain, may create possible problems if they don’t want to sit up or be moved. I found it helped in these situations to take the time to explain to the patients the importance of them sitting up for the projection, as this enables us to achieve a better image for the doctors. It also helped if I reassured them that I would assist them to sit up in their own time. I found when I was nervous in these situations explaining and talking to the patient also gave me
time to calm down and not panic, allowing me time to think about what I needed to do and how I was going to achieve it.

I have learnt numerous things throughout the week, ranging from possible problems that I might face to understanding different situations. One thing I learnt was when patients arrive in the department lying on a trolley with a possible perforation, you need to sit them up and they need to be erect for at least twenty minutes before their examination. Another problem I encountered was a patient who was unable to hold their head up. This meant I had to ask the nurse
who was accompanying them if she minded assisting while I performed the x ray. This required her to be wearing a lead apron while stabilizing the patients the head, as their head could be obscuring part of their chest which could possibly
hide a pathological problem.

I performed a number of (Antero-posterior) AP chests throughout the week, some more challenging than others. However by the end of the week, I found them easier to perform, adapting my technique to a number of what I still thought of
as difficult and challenging situations.

My last challenging situation was on a male patient who had a nasal gastric tube. The request was a chest x ray for positioning of the tube. The challenge with this patient was he had difficulty in standing. I adapted this projection by performing a PA examination, allowing the patient to stay seated in his wheel chair, while taking down the back of the his chair. I was able to get quite a good image, but it only showed the top part of the patient’s stomach. We were able to see the tube on the film but couldn’t see the end. I then asked if it was appropriate to repeat the examination to obtain views of the lower part of the stomach, hopefully allowing us to see the end of the tube. I repeated the examination lowering the cassette and asking the patient to sit upright supporting his self with the top of the cassette. I then coned down to
the appropriate position for the projection and obtained the information needed to show the end of the nasal gastric tube.

This entry was posted on Saturday, November 22nd, 2008 at 3:45 pm and is filed under Reflectives. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.