This week I have been at Crosshouse hospital. Despite the fact that this was my first time at this particular hospital and department, I was looking forward to it as it had a reputation for being a good place to work.

Following an initial tour of the department I was allocated the room where I would be working throughout the week. After familiarising myself with the room I enquired about their system and procedures regarding the examination process of patients. It was explained how the request cards are received and the order they were taken. The radiographer then took me through the entire procedure from finding a patient on the system, all the way through to post processing. The cassettes that were used at Crosshouse hospital were different from the ones I had used previously and the system of post processing was completely different to the systems I had encountered in the past.

The system they used is called Radiographic Image Interpretation System (RISS) and the Computed Radiography (CR) system they use is called an AGFA system. Both systems were completely new to me and, initially, they were quite daunting.

The AGFA system is reportedly widely used, but unfortunately for me, I had no experience of it. This system has a cassette buffer which is designed to eliminate waiting time and allows for a continuous workflow within a department. The system has an automated cassette system which requires no buttons to operate it.

The RIIS system is a computerised system used for every aspect of a patient’s medical imaging history. It aids a department to manage work flow, and maintains records of a patient’s history of examinations.

Once I learned and mastered the systems that the hospital utilises then I found them to be beneficial and quite straight-forward. However the unfamiliarity of the department, the people and the systems really compounded my difficulties on the first day.

Throughout my first day it felt like I was being bombarded with information about the new things I had to learn. One of the hardest things about working in a new department is conquering my nerves, especially when I’m on my own. Luckily I was accompanied by another student during this placement and it was comforting to be working alongside a familiar face.

On the second day I was much more relaxed and it didn’t take me long to settle in. I also became quite adept at working with the new systems as well as learning some of the more technical details of their operation.

By the end of the week I had really settled into the department, I enjoyed working with the people I had met. I had enjoyed my clinical assessment and, for the first time, I hadn’t been nervous. I also went to theatre and performed my first ever femoral nailing. This surgery was a new experience for me and one that I had been keen to observe. I really look forward to opportunities to attend theatre as I find it invaluable experience and quite exciting. This is a common procedure and one I was really looking forward to although I had been warned that it could be gory and wasn’t really for the squeamish.

After entering the theatre and setting up the machine the radiographer talked me through entering the patients’ details into the system, and then explained what was going to happen. Once the surgery was underway I was then given full control of the Image Intensifier (II) and instructed to do the screening for the surgery.

Everything was going well until the surgeon was fitting the screws at the distal end of the femur and I needed to acquire a true lateral of the knee and distal femur. The patients’ leg was supported by a stirrup and her foot supported in a boot which was angled so that it was slightly turned out laterally. This made getting a true lateral difficult. The surgeon instructed me that I needed to turn the II through to the lateral position. However the II was turned as much as it could go. I explained it only rotated 180 degrees in either direction and I would need to rotate it 360 degrees to get a true lateral. This wasn’t possible as it would mean the machine would breach the sterile area. He still insisted that he couldn’t proceed without these images and suggested that the II would rotate further than I had told him. The supervising radiographer then confirmed my assessment of the situation was correct. The surgeon then requested one of us to call the department and request a specific radiographer attend and help obtain the required images. This radiographer assists in a large number of trauma surgeries in theatre. While we waited for the other radiographer to arrive I advised the surgeon of another potential problem. It was going to prove very difficult to obtain the lateral image due to two reasons. The patient was of small stature and therefore her legs were quite short and wouldn’t raise high enough to allow the image receptor access. This problem was compounded by the fact that she also had fractures to her inferior and superior pubic ramus, so her good leg could only be supported at a certain height.

When the requested radiographer arrived we explained the problem to him and he confirmed to the surgeon the difficulties that were being experienced were not due to a problem with the machine or the staff. The problem was finally resolved by the having four nursing staff lift the patient’s good leg as high as possible and then tilting the table in order for us to obtain the required projections.

We attained the images that the surgeon required and he managed to complete the surgery successfully. When the surgery was over the nursing staff apologised for the surgeons’ attitude. It was an embarrassing situation that was difficult at the time but could have easily been avoided if the surgeon had believed what he was being advised and didn’t think the problem was due to either of us being unable to work the machine.

Even though this proved to be a difficult situation, I think we both dealt with it very professionally and I loved the experience of observing the surgery. Overall it has been a good week and I have really enjoyed my experience at Crosshouse hospital. Although it is nerve-wracking to enter a new department and work with equipment that I am unfamiliar with, I do find that I gain invaluable experience by doing so. It is really good experiences to see how different departments work, encountering new students from other universities and being able to compare courses and exchange views. Attached to this piece of writing are images of a femoral nailing.

This entry was posted on Monday, March 29th, 2010 at 6:22 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.