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8) Do you have any specific information on scanning a patient with a high BMI?

The following points are all particularly relevant when scanning high BMI/bariatric patients and are in addition to general good practise methods of reducing the incidence of WRMDs.

All Trusts and Health Boards should have policies relating to care and manual handling associated with high BMI/bariatric patients which should also be available and consulted.

  • Use ‘high BMI’ presets on the machine as a starting point to manipulating the image. Manufacturers can set these up to your requirements at the time of installation and will optimise features such as transducer frequency and harmonics.
  • Wherever possible the sonographer workforce should be rotated to ensure that it is not the same sonographer group exposed to risk. This is of course will depend on the skill mix of the local sonographer workforce.
  • Do not extend the examination time beyond what is normally allowed if there is unlikely to be any gain. It may be that a second appointment is necessary in some cases. FASP provide guidance with respect to repeat examinations on those women attending for the 18 - 20+6 fetal anomaly scan and where the image quality is compromised by such as by an increased BMI. There is also ‘twice on the couch only’ advice for the 11w 2d  to 14w 1d scan which forms part of the combined test. The June 2015 FASP Programme Handbook is at:
  • Avoid pressing unnecessarily hard and for too long. This may increase the risk of WRMSD and it can be uncomfortable for the patient. Firm pressure may be contra-indicated for some types of pathology or clinical situations.
  • Use a helper to support tissue/fatty aprons and generally assist with the examination.
  • Consider the patient’s feelings.
  • Use good quality equipment with good harmonics.
  • Do not exceed the couch weight limit which should be clearly posted.
  • Use available manual handling aids when necessary; scan in-patients in their beds rather than transferring to an examination couch.
  • Report pain/injury to occupational health/line manager as a record and so that current practise can be reviewed.
  • BMI should be recorded on request forms if above 30.
  • If image quality is compromised, state how the examination has been affected in the report.
  • Record BMI on report.
  • Keep current practice for high BMI patients under review.
  • Consider wording of information leaflets about limitations of scanning at time of booking.

Nigel Thomson, Professional Officer, Ultrasound.  
Lyn West-Wigley, Policy Officer: Health and Safety.

SCoR headquarters:  020 7740 7200
Drafting information:    1st edition September 2011
                                      2nd edition September 2014 Revised with updated weblinks August 2016

Copyright Society and College of Radiographers 2014

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