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Clinical Sonography:
What every student needs
to know.
Harry H. Holdorf
 Principles of Bioethics
Many bioethics principles are
self-evident.
For example, the concept that a
physician should not harm a
patient, or should develop a
care plan that provides the
most benefit to the patient. If
the patient has the mental
capacity to do so, they must
indicate a willingness to
accept the proposed course.
Major Principles of Medial Ethics
Four commonly accepted principles of health
care ethics include:
Respect for autonomy
2. Non-maleficence
3. Beneficence
4. Justice
1.
Respect for Autonomy
 Respect for autonomy means that the patient
has the capacity to act intentionally, with
understanding and free will.
 This principle is the basis of the INFORMED
CONSENT.
 In mak9ing voluntary, knowledgeable
decisions, the patient is assumed to be of
sound mind.
Non-Maleficence
 The principle of non-maleficence requires
that we avoid needless harm or injury to the
patient, whether by action or inaction.
 Imposing careless or unreasonable risk of
harm on a person is negligence.
Beneficence
 The actions of health care providers should
benefit the patient.
 This duty extends from individual patients to
our entire community.
 It includes improving the patient’s health, as
well as preventing disease in the general
population.
Justice
 Justice in health care is usually defined as
fairness.
 Generally, people who are equals should
qualify for equal treatment, regardless of age,
gender, educational background, and other
factors.
INFORMED CONSENT
 Informed consent is the process by which
patients are educated about the essentials of
a medial procedure.
 This process allows them to make an
informed, educated, and voluntary decision
about the health care they are to receive.
 The most important goal of informed consent
is for patients to have an opportunity to be a
knowledgeable participant in their health
care decisions.
 Complete informed consent generally
includes the following:
 The nature of the procedure
 Reasonable alternatives
 The risks, benefits, and uncertainties related to
each alternative
 Assessment of the patient’s understanding
 The patient’s acceptance
 For a patient’s consent to be valid, the patient
must be considered competent to make the
decision and the consent must be voluntary.
 Since the patient’s comprehension is equally
as important as the information provided, the
discussion should be in a layperson’s terms
and the patient’s understanding should be
assessed throughout the process.
When is it appropriate to
question a patient’s ability
to participate in decision
making?
 If a patient is underage (typically under 18),
the patient’s guardian must provide consent.
 If a patient is incapacitated or incapable of
providing consent, the patient’s guardian or
surrogate decision maker must provide
consent.
 If the patient does not speak English, the
assistance of a translator may be necessary to
obtain the patient’s consent.
 It is preferable that the translator be hospital
approved.
 A bilingual family member or other person
can communicate with the patient as long as
the patient has signed a HIPAA-compliant
release form to proactively authorize ongoing
involvement of a family member.
 However, only the patient can provide
consent.
Revocation of Consent
 A patient may withdraw previously granted
consent at any time.
 The sonographer must respect this decision
and promptly bring the exam to a close.
 This should be done without exposing the
patient to any additional risks or threats to
safety.
Patient-Sonographer
Interaction
 What should the sonographer do when first
meeting a patient?
 Upon meeting a patient:
 Treat the patient respectfully. Introduce yourself and
describe the procedure and your role in performing
it.
 Identify the patient. If possible, use the patient’s
wrist-band for identification. If there is no wristband, it is acceptable to include patients in their own
identification. For example, ask the patient for a
birth date or full name.
 If a sedated patient arrives without a wrist-
band, call the nurse.
 The patient may be sent back to the floor and
the study rescheduled when the patient has
appropriate identification.
 It is inappropriate for the sonographer to
cancel the exam.
 Ordering or canceling an examination is
outside the sonographer’s scope of practice.
Patient Dignity
 Dignity is defined as the quality of being
worthy, honored, or esteemed.
 Every patient has a right to be treated in a
dignified manner, one that is respectful and
ethical.
 Dignity includes a patient’s perception of
being in control and having self-worth.
 Factors that make a patient vulnerable to a
loss of dignity include advanced age,
infirmity, and lack of privacy.
Sonographer-Work Environment
Interaction
 No matter what we do, it is important to be
safe, comfortable, and free from workrelated injuries.
Interpretation of the exam
 In order to produce a diagnostic examination, a
sonographer must be knowledgeable of
abnormal and normal sonographic findings.
 Sonographers must be aware of and follow
departmental guidelines when providing their
preliminary findings of the exam to a physician.
 However, sonographers should refrain from
providing a clinical interpretation or discussing
the findings directly with the patient.
 In fact, in some states, these acts may be
considered the unauthorized practice of
medicine.
Ergonomics
 Ergonomics studies the interaction between
the sonographer, patient, and equipment in
order to optimize the well-being of
sonographers in their professional
environment.
 Sonographers must be in good physical shape
and have full use of their hands, wrists, and
shoulders.
 More than 3 out of 4 sonographers experience
pain from work related musculoskeletal injury.
 Nearly 20% of sonographers end their careers as
a result of such injuries.
 The Occupational Safety and Health
Administration (OSHA) and Society of
Diagnostic Medial Sonography (SDMS) have
formed an alliance, with goals of reducing and
preventing work related musculoskeletal
disorders.
Causes of Injury
 The causes of such injuries include repetitive
motions, forceful or awkward movements,
poor posture, improper positioning, strain,
and pressure on joints for extended periods.
Ergonomic Devices
 Adaptive ergonomic devices have been
designed and created for the sonographer.
 These devices include wrist support braces,
adaptive support cushions, cable braces to
keep the cable out of the sonographer’s way,
ergonomic transducer design, chairs with
adjustable armrests and footrests and bed
designs with expandable adjustment options.
 Most importantly, control panel and monitor
articulation (swivel and extension) allow the
sonographer to maintain the recommended
wrist, eye, neck, and body positions.
Best Practices
 Best practices include:
 Keeping your arm close to the body
 Staying close to the patient
 Positioning the system’s monitor directly in front

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of you and at eye level
Minimizing the extent of twisting or bending over
Using proper sitting positions
Holding the probe using a whole hand grip,
PLAMER GRIP
Keeping the wrist in a neutral position
Using proper foot support
Laboratory Polices and
Procedures
 Laboratory polices and procedures must
include standards for ergonomics and
sonographer health.
 Routine lab operation should include
educational programs regarding best
practices, proper use of equipment, and
safety concerns.
 Annual continuing medical education
regarding ergonomics is essential.
 Effective patient scheduling can also reduce
workplace injuries.
 Avoid scheduling the same type of exam
consecutively to minimize strain and
repetitive motion for extended periods.
 Limit the number of studies each day and
incorporate non-scanning activities between
studies.
Standard Precautions
 Standard precautions are a set of guidelines
to minimize the exposure and risk of health
care workers when in contact with a patient.
 Standard precautions are based on the idea
that all patients should be treated as
potentially infectious.
 Standard precautions are an extension and
clarification of universal precautions.
 Universal precautions were originally
developed in the 1980s to minimize the risk
of patients with HIV, and other Bloodborne
pathogens.
 All health care workers should routinely
practice good hygiene habits, which include
hand washing and the use of appropriate
barrier precautions to prevent skin and
mucous membrane exposure during contact
with any patient’s blood or body fluids
 This includes the use of appropriate personal
protective equipment such as gloves, gowns,
eye wear and face masks whenever exposure
to a patient’s body fluid is anticipated.
 Standard precautions apply over a very broad
range: all body fluids, secretions, excretions,
mucous membranes, airborne particles, and
to non-intact skin.
 Standard precautions also apply to any items
soiled with these substances.
Take-a-ways
 Come to work fit
 Come to work educated
 Do not overextend, overstate, or
misrepresent yourself