ECHO – A pain in the neck.

1. ECHO – A pain in the neck. Alan Caulfield. Chief Cardiac Physiologist. Causeway Hospital

2. The Echo Lab Friday 5pm

3. Sonographers and Occupational Overuse Syndrome • CAUSE • EFFECT • SOLUTIONS

4. RESEARCH • Shows that 84 % of Clinical Sonographers experience pain related to their profession. • Of those, 20% suffer career ending injury. • At present ,workforce shortages are affecting productivity ,patient care and targets. (Pike, Russo, Berkovitz, Baker and Lessoway )

5. AREAS OF BODY MOST OFTEN INVOLVED IN INJURY WITHIN THE SONOGRAPHY PROFESSION • Shoulder 84% • Neck 83% • Wrist 61% • Back 58% • Hands 56%

6. LEGISLATION • Health and Safety at Work (NI) Order, 1978 • Management of Health & Safety Regs • Workplace, Health & Safety Welfare Regs • Provision and use of Work Equipment Regs • Manual Handling Operations Regs • Personal Protection Equipment at Work Regs • Display Screen Equipment Regs

7. WORK RELATED MUSCULOSKELETAL DISORDERS • The causes of WRMSD can be attributed to three groups of factors – • 1.BIOMECHANICAL – awkward scanning postures, excessive force used in performing exam, poor workspace design

8. 2.POOR WORK ORGANIZATION Inadequate employee training Too many studies. Infrequent breaks. Pressure to meet targets leading to increased overtime demands.

9. 3.INJURY MANAGEMENT • Delayed reporting and diagnosis of injuries. • Improper injury management. • Too quick a return of Sonographer to an injury producing environment.

10. No change in education, environment, equipment or work schedule will improve the ergonomics situation if the Sonographer fails to take advantage of preventative measures. ERGONOMICS

11. Equipment • Use motorized adjustable tables (including those equipped with drop-down side rails) to optimize the positions of the patient and the sonographer

12. RISK FACTORS • Poor workplace ergonomics in the design of equipment, chairs, tables, and lighting

13. The table should be as narrow as possible (preferably 24 to 27 inches wide) to allow for proximity to the patient and to reduce the amount of shoulder abduction needed to reach the patient’s far side.

14. Use a posture-enhancing adjustable chair to accommodate the sonographer through adjustable footrests, seat heights, and lock and release casters. • Casters should allow for rolling between patients and the ultrasound machine when necessary, yet prevent rolling backwards when performing necessary procedures

15. EQUIPMENT Position the keyboard to allow the arm to be in a relaxed position with the upper arm close to the body (minimal flexion and abduction) and the elbow at a 90-degree angle.

16. Work Practices • Decrease the duration of static posturing: • Vary postures throughout the day. • Sit or stand, depending on the exam.

17. Scheduling • Schedule different types of exams for each sonographer in a workday to decrease strain on musculoskeletal tissues specific to one type of exam.

18. scheduling • Limit the number of portable exams to help minimize those tasks with higher number of pinch grips and increased static or awkward postures.

19. scheduling • Consider a maximum number of scheduled exams for sonographers. Take into account existing ergonomic conditions and equipment, the type of exams performed, experience of the sonographer, and the duration of the individual exams.

20. scheduling • Because of the complexity of each diagnostic situation, it is difficult to specify an allowable limit to the number of exams per day. Until better information is obtained, take into account the total examination time per day (more exams of shorter duration or fewer exams of longer duration).

21. BAD PRACTICE • NON ADJUSTABLE CHAIRS / STOOLS AND EXAMINATION COUCHES FORCE THE SONOGRAPHER TO REACH AND TWIST HIS OR HER TRUNK. • GREATER DEMANDS ON THE MUSCLES RESULT IN FATIGUE AND STRAIN. • PERSISTENT AND CONTINUAL PRESSURE FOR SUSTAINED PERIODS OF TIME DURING THE EXAMINATIONSSHOULD BE AVOIDED.

22. NOT LIKE THIS !!!!! • Whats wrong ?

23. CAREFUL postioning • Couch is too high. • Chair is too low. • This causes the operator to abduct his arm 90o from his body. • Monitor is too high. • Patient is too far away causing Operator to bend his trunk and lean out to the right

24. WRONG BETTER

25. MUCH BETTER

26. Best Practice • Exam chair properly positioned. • The chair’s position allows the Sonographer to view the monitor without neck extension. • Positioning the patient closer to the Sonographer eliminates the Sonographer’s trunk twist and reduces his arm abduction to 30o.

27. OPTIMAL POSITIONING. Here is the optimal posture to perform echocardiography right handed - a table with a drop section opening for the sonographer to sit (or stand) allows the sonographer to keep the back straight and rest the feet on the table frame. The ultrasound unit is moved in close proximity to the sonographer so she can keep her left elbow close to her side with minimal reach to the control panel. The monitor is positioned level with her line of sight to reduce tilting or twisting of the head or neck.

28. Body Parts Sonographers Reported Using in Repetitive Motions Prevalence Reported Repetitive Movements by Sonographers Wrist/hand motion Repetitive 92% Awkward position or bending 100% Twisting 62% Arms/shoulders Repetitive 100% General Sustained positions 92% Repeated stretching/reaching 84% Repeated pressing/twisting 77%

29. Useful velcro arm / cable support • Stops cable ‘drag’ and offers support to hand and wrist.

30. Breast Sling • Makes access to apical windows easier.

31. Reporting Station.

32. A bright idea? • Some propose scanning right handed sitting or standing next to the patient’s head, with the patient facing the sonographer and the ultrasound system placed toward the patient’s feet. • That posture poses two situations which are both bad. Either the head or neck are twisted to view the monitor or there is too much wrist flexion. 1

33. AMBIDEXTROUS ? • Ambidextrous scanning is helpful in that it allows one set of muscles and joints to ‘rest’ and recover from strain. • Training to scan with both hands may help prolong the length of many careers by resting muscles for 50% of working time.

34. Sonographer CHECK LIST • How close/far is the patient from me? • Is my chair / couch adjusted properly for my height and the patient’s body habitus? • Is my posture ‘straight’ or is it awkward enough to be hazardous to my back and neck? • Is my wrist supported and in a neutral position?

35. checklist • Do I have easy access to the monitor and keyboard without having to stretch? • Are my limbs properly supported during the entire examination? • Am I taking micro-breaks – releasing tension of the scanning hand for a few seconds at a time? • Am I having any symptoms that could be warning signs of potential injury such as numbness , burning, swelling, clumsiness or pain.

36. IN SUMMARY - • Experienced Sonographers are a valuable resource to healthcare facilities around the world. Unfortunately, they are also more at risk for musculoskeletal disorders. • Sonographers who are beginning their careers can benefit from the knowledge that has been gained through difficult circumstances by their predecessors. • By focusing on those factors that they can control, and working together with others to effect change in their work environment all Sonographers can be proactive in generating a transformation that will improve their ergonomic environment and reduce their risk for injury.

37. Go Ireland Go……… • Sorry u Brits !