Although often not considered a form of restraint, Velcro straps can be effective as restraining or positioning devices. A good example of the use of straps is provided by an upright lateral chest position. The patient should be standing for a chest examination if at all possible. Although capable of standing, a patient who has not been regularly ambulatory for a time may be unsteady when standing at the upright cassette holder. Placing Velcro straps across the upper portion of the patient’s chest can help the patient hold still and also provides a sense of security. Holding the arms up out of the way when positioning for a lateral chest radiograph raises the center of balance and can cause slight swaying even in the steadiest subject.
Velcro straps also can be used in immobilizing only the area of interest during the procedure. For example, an axial projection of the calcaneus requires extreme dorsiflexion of the ankle to produce an optimally diagnostic image (Fig. 14-3). The use of the strap beneath the plantar surface of the foot allows the patient to maintain the extreme flexion required and at the same time reduces the possibility of motion that may result from maintaining an uncomfortable position.
Velcro straps can serve as a safety precaution when performing a procedure on a patient who is not completely cognizant, such as those who are heavily medicated or intoxicated or who have diminished mental capacities. This type of patient should never be left unattended; the straps serve only to facilitate protection of the patient from injury. With straps in place, sudden or unexpected movement by the patient would not result in injury to the patient and would allow the attendant to respond to the situation.
Velcro Strap Restraints
Velcro strap restraints are designed to be attached easily to the radiography table. These types of restraints include two brackets that mount to each side of the table with a strap that is adjustable for any size patient. It can be adjusted to cover any part of the body, such as the chest, abdomen, or legs (Fig. 14-4). These restraints also can be used for compression. Tightening the strap a little further applies gentle pressure to the abdomen to enhance diagnostic information in certain procedures.
When performing gastrointestinal procedures—for example, placing the patient in the semi-erect position—may be desirable. In these circumstances, when a patient is too weak to stand unassisted, Velcro strap restraints can be applied across the patient’s upper and lower abdomen to support the patient firmly during the procedure (Fig. 14-5). This precaution helps reassure the patient that he or she will not fall.
Sandbags are useful positioning and immobilization devices and can be used in a variety of ways. By themselves or in combination with positioning sponges, sandbags are extremely helpful in reducing voluntary motion (Figs. 14-6 and 14-7). Sandbags, unlike radiolucent positioning sponges, are radiopaque (i.e., radiation does not pass through easily). As a result, they cannot be placed in such a way that diagnostic information is obscured within the anatomic area of interest. They must be placed gently on or against the areas adjacent to the anatomic area of interest so as not to injure or cause further damage.
A common use of sandbags as positioning aids is in performing examination of a lateral cervical spine or of the acromioclavicular joints. Both examinations require that the shoulders lie in the same transverse plane and that the patient hold sandbags of equal weight. For the lateral cervical spine, the patient must depress the shoulders as much as possible to demonstrate the lower cervical vertebrae (Fig. 14-8).
Here again, as in the case of positioning sponges, the variety of uses for sandbags is limited only by the technologist’s imagination.
Head clamps can be attached to radiographic imaging devices (e.g., radiographic table, upright cassette holder) and are designed strictly for use in positioning various projections of the skull. When applied safely and appropriately, head clamps serve more as positioning aids than as immobilization devices. A patient so desiring can easily pull away from the head clamps. Head clamps serve as a reminder to the patient of the importance of remaining as still as possible, and they ensure the reduction of voluntary movement on the part of the patient.
Immobilization techniques are often required for use with trauma, pediatric, and geriatric patients. Each type of patient provides unique opportunities to apply immobilization techniques.
Methods for safely and expeditiously performing examinations on badly traumatized patients involve entirely different concepts. Immobilization is one of the most critical considerations when working with seriously injured patients. In these instances, the technologist is faced with immobilization devices that already have been applied to the trauma patient by the emergency medical team to stabilize the area of injury and to facilitate safe transport to the trauma center. The technologist must be familiar with the various types of traction and immobilization techniques and devices used by emergency medical personnel. This familiarity must include knowledge of which devices are radiolucent, which must be left in place for initial examinations, and when these devices can safely be removed for more detailed procedures.
In many situations the technologist must consider performing the initial examination with immobilization devices left in place. In fact, more often than not, the technologist has no choice but to perform the procedure in this manner. Fortunately, manufacturers of emergency traction devices are designing equipment to use radiolucent materials whenever possible. This equipment permits initial studies to result in increased diagnostic information without endangering the trauma patient by necessitating the removal of immobilization devices.
In most instances, initial images can and should be produced without removing immobilization devices. Only after a radiologist or an attending physician has read the initial images and approval has been given should the technologist remove the immobilization device for a more complete examination.
Immobilization devices should be removed gently while maintaining patient comfort and safety by immobilizing the injured area above and below the device. Positioning sponges should be placed to support the anatomic area of interest. Depending on his or her condition, the patient may be moved or rolled slightly to facilitate removal of the device. If help is available, safety and comfort for the patient are enhanced if two people, working together, remove immobilization devices.
The most common spinal trauma traction device encountered by a technologist is probably the cervical collar. This device is designed to place traction on the cervical spine to prevent further life-threatening movement in this vital area. The cross-table lateral, anteroposterior (AP), and AP open-mouth positions may be used to evaluate the cervical spine during a cervical trauma examination. After evaluating the images, the attending physician or neurosurgeon can determine the next step in treatment. All projections can be produced with the cervical collar in place (Fig. 14-9), and it will be removed only after the physician has reviewed the radiographic images and determined that it is safe to move the patient without the collar.
The backboard, or spineboard, is another spinal immobilization device often seen in trauma situations. Although the backboard is mentioned here under spinal trauma considerations, its uses are by no means limited to spinal injury. It is used to immobilize and support the victim’s entire body. A backboard can be used if the thoracic or lumbar spine is involved. Additional trauma situations in which the backboard is used include injuries to the pelvis, hips, and lower extremities and when multiple injuries in addition to spinal trauma are present.
Most backboards are made from radiolucent materials (e.g., wood, plastic), making radiography of patients relatively easy. With assistance, one end of the backboard can be lifted and a cassette placed under the area of interest beneath the board (Fig. 14-10). All AP projections from head to toe can be accomplished in this manner.
Another advantageous purpose for the backboard is to transport a stable trauma patient to the radiology department for the initial examination. Moving the patient onto the table by sliding the entire backboard onto the examination table is relatively easy for the movers and comfortable for the patient. Once the radiologist has evaluated the initial images, the backboard can be moved from under the patient for further projections. Conversely, if the findings indicate the presence of fracture or other traumatic involvement, the patient can be safely moved back onto a stretcher for transport to surgery, the emergency department, or the appropriate treatment area.