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Content Reviewed 09/30/2008



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Sonography


Sonographer performing scan.
Figure 1. Sonographer performing scan.

Sonographers may be required to move patients or sonography equipment to various areas of the health care facility. This may require forceful pushing or pulling of  imaging equipment, patient transport equipment (e.g., gurney, wheelchair, etc.) over differing floor materials and transitions for a significant distance. In addition, sonographers may be required to assist patients onto and off the exam table when they arrive on any of a variety of transport devices (e.g., gurney, wheelchair, etc.). This may require heavy lifting in an awkward body posture.


Transporting Patients and Equipment

Some sonography tasks increase the amount of push or pull force that sonographers must exert when moving patients or equipment from one area to another. An increase in force exertion may increase the risk of injury to the back, legs and shoulders.


Potential Hazards

  • Exerting force in awkward postures, such as bending or reaching, due to handles or push points that are too high or too low.
     
  • Any unexpected, abrupt stoppage or deceleration when moving equipment resulting in the use of excessive force and awkward body postures. Examples include:
    • Wheels that are the wrong size for the transitions between flooring types or rooms.
    • Wheels that are too small to easily pass over gaps between elevator and main floor.
    • Obstructions placed in line of travel.
    • Damaged floor.
    • Debris that is left on floor increasing the amount of force exerted, often in awkward postures.
  • Moving equipment with wheels (casters) that are poorly maintained or are inappropriate for the flooring surface. This results in the use of excessive force and awkward body postures.

Possible Solutions

A powered assist device can assist with movement of heavy equipment.
Figure 1. A powered assist device can assist with movement of heavy equipment.

Wheels on ultrasound equipment
Figure 2. Wheels on ultrasound equipment
  Gurney with appropriate mechanisms for control and braking. Figure 3. Gurney with appropriate mechanisms for control and braking.
 
Larger wheels require less force during transport and when moving over transitions. Brakes and swivels on back wheels provide stability and maneuverability.
Figure 4. Larger wheels require less force during transport and when moving over transitions. Figure 5. Brakes and swivels on back wheels provide stability and maneuverability.

Sonographer using proper body mechanics to move ultrasound equipment.
Figure 6. Sonographer using proper body mechanics to move ultrasound equipment.
  • Use smaller handheld equipment to perform bedside studies, whenever it is available and appropriate.
     
  • Use mechanical powered assist devices whenever large or heavy patients or equipment must be moved for longer distances. (Figure 1)
     
  • Ensure that equipment has the appropriate wheels (casters) to facilitate safe transport over all flooring and room conditions. (Figure 2 and 3)
    • Generally, wheels that have a larger diameter, a narrower width and are made of a harder material will traverse gaps and changes in flooring more easily, reducing the necessary push force. (Figure 4)
    • Swivel casters should be used when maneuvering in tight locations. Note: At least one set of casters should be lockable to provide improved inline steering. (Figure 5)
  • Ensure that all equipment is maintained according to established schedules and that all employees understand the procedure for reporting damaged equipment.
     
  • Controls for equipment should be easily accessible without bending or reaching. These may include controls that allow selection between two-wheel, four-wheel and braked positions. Central locking is preferable.
     
  • Handles should be placed on the swivel caster end of equipment to ensure that sonographers push or pull from this end.
     
  • Ensure that a sufficient number of employees are available to move large or heavy patients and equipment. An individual employee should not need to exert a force of more than about 50 pounds at any point during the transport.
     
  • Floors should be clean and free of debris which may cause the wheels to get stuck while in motion.
     
  • Aisles should be kept open and free of extraneous items such as gurneys, wheelchairs or other carts.
     
  • Ensure that employees are aware of the procedures to report damage to flooring and walkways.
  • Sonographers should be trained to use correct body mechanics when moving patients, wheelchairs, beds, stretchers and ultrasound equipment. Correct body mechanics suggestions may include: (Figure 6)
    • Push instead of pull. Lean slightly into the load to let your body weight assist with force exertion.
    • Push at about chest height.
    • Push smoothly and slowly to start.
    • Do not bend or twist while exerting force.
    • Keep wrists straight.
    • Keep elbows close to the body.





Examination Rooms


The layout of the examination room may have an impact on the sonographer by making equipment hard to maneuver and position.

Potential Hazards

  • Doorways that are too narrow may require frequent turning and repositioning to get patients and equipment into the exam room. More force is required when starting, stopping or turning during transport activities.
     
  • Inappropriate flooring material (e.g., thick carpet) or elevated or pronounced transitions between rooms and halls make movement of patients and equipment more difficult and may require the use of excessive force.
     
  • Examination rooms that are too small make it difficult to properly arrange the patient and equipment  for a variety of procedures.
     
  • Examination rooms that are arranged for only one configuration force sonographers to repeatedly use the same body posture or motions for prolonged periods of time. This increases the risk of injury to the shoulder, elbow, wrist and hand.
     
  • Lighting that does not include dimmer switches or controls, makes monitors difficult to read. This may lead to eye strain and back and neck discomfort as sonographers lean forward to detect items on the screen.
     
  • Repeated or prolonged use of extended or elevated reaches to access supplies used for procedures can stress the shoulder and back.

Possible Solutions

Examination rooms should:

  • Provide adequate space for maneuvering and orienting people and equipment around the exam table, allowing access from all sides.
     
  • Have doorways that allow easy access for wheelchairs, beds and ultrasound equipment, minimizing the amount of turning and repositioning.
     
  • Have hard surface flooring which allows easy movement of equipment. Anti-fatigue mats or pads can be placed around the exam area if sonographers must stand for prolonged periods.
     
  • Provide easy access to imaging supplies such as having supplies available in a number of locations.
     
  • Have equipment such as thermal printers or recording devices in an area that reduces reach but allows the equipment to be accessed. Placing equipment or supplies on carts or stands may increase mobility and accessibility.
     
  • Have controllable environmental conditions, especially light levels. Switches, curtain or blind mechanisms should be placed in convenient locations.
     
  • Provide adequate ventilation and temperature controls to ensure the comfort of the sonographer and patient while allowing the equipment to function properly.


Transferring Patients to and from the Exam Table

Sonographers may need considerable support and assistance to move patients onto or from examination tables.


Potential Hazards

  • Pushing or pulling to position beds, gurneys and wheelchairs prior to transferring patients can require exertion of significant force, especially when dealing with bariatric (obese) patients, carpeted floors or poorly maintained wheels and casters.
     
  • Assuming awkward postures such as bending, twisting or reaching when moving patients from wheelchairs, beds or gurneys to the exam table. Awkward postures, especially when combined with the exertion of force, increases the risk of injury to the back, shoulders, and lower and upper extremities.
     
  • Using significant force when lifting bariatric patients from wheelchairs, beds or gurneys, increases the risk of injury to the back and shoulders.

Possible Solutions

  • Use mechanical powered transfer devices such as lifts or hoists to move patients, especially bariatric or non-ambulatory, from wheelchairs, beds, or gurneys.
     
  • When appropriate, use multi-use devices such as chairs that can open up into beds. These allow patients to move from a sitting position to a prone position, without transfer.
     
  • Additional employees should assist in moving and transferring equipment or patients if:
    • A mechanical powered device is not available.
    • Awkward postures must be used.
    • Push force exceeds about 50 pounds.
    • The amount of weight that the sonographer must support is in excess of 40-50 pounds.

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