Journal

Paraplegia

This week on placement I faced a new challenge when I found myself x-raying a patient who was referred from the orthopaedic clinic and was paraplegic. The clinical information on the card stated discharge sinus, querying osteomyelitis, with not a complete description of why she needed her pelvis andfemur x-rayed. However the patient and her husband informed us, she had initially been suffering from lesions on her buttocks and, while getting them cleaned and dressed, the nurse had found what she thought was a piece of bone. This led to the patient being referred for a pelvis and right femur examination in order to try and discover if it was a piece of bone and where the bone had originated from.

Prior to performing the examination, the radiographer had researched the patients’ previous medical history and then requested my help with the examination. She explained to me that the previous examinations did not provide
a very good view of the patients’ hip joints and her right neck of femurs. These would be the images that we would be attempting to achieve.

The patient and her husband had been placed in a cubicle in order to get the patient changed before the examination. When I invited them into the room the husband offered to transfer his wife (the patient) to the x-ray table. I think, understandably, she felt more comfortable being handled by her husband than members of staff. When she was comfortable and relaxed I then explained the procedure to her, emphasising that we were trying to achieve good images that show as much of her hips and femur as possible.

Before bringing the patient and her husband into the examination room I was quite nervous. I had never met anyone who suffers from paraplegia before and, although I knew what the condition entailed, I was not really sure what to expect.
However, they were a lovely couple and really made me feel at ease, although the patient seemed like she was slightly embarrassed by the situation. This was exasperated by the fact that the patient had no control of the lower part of
her body and could not straighten her legs. This made it very difficult to achieve a position that would give us the required image of her pelvis.

I concentrated on making the patient feel at ease as we tried to reconcile the situation. We attempted to prop her legs together with sand bags and pads but this was unsuccessful and the patients legs always reverted back to a ‘frogs
legs’ position. I then had the idea of holding her legs together by tying an apron around them. The patient was happy with this solution after I explained that this would allow us to view her hips properly. This technique, along with carefully placed pads and sand bags, allowed us to obtain an antero-posterior and a lateral projection of her right femur.

Although we managed to obtain good images it was obviously a very challenging situation. On the one hand I was very happy that I had managed to find a solution to obtaining the images we needed. However, on the other hand, I found it frustrating that there was not a piece of equipment in the department that was designed for examinations of this type or similar, involving a patient with paraplegia.

I feel that the fact that I had to ‘think outside the box’ in order to complete this projection enhanced the feelings of embarrassment for the patient. Luckily, this particular patient was very good humoured and we had a good conversation after the examination, joking about every day things. This allowed us both to connect and helped her see me as a person rather than someone in uniform who was simply there to prod and poke and examine her.

This entry was posted on Wednesday, April 15th, 2009 at 3:10 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.