Preventing injury and error Surgical Basics Jan Moss, RN

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  • Slide 1
  • Preventing injury and error Surgical Basics Jan Moss, RN
  • Slide 2
  • Agenda Pre-operative preparation Anesthesia Options Intraoperative Considerations Patient Identification Patient Positioning Postoperative considerations Pain control Infection Length of recovery
  • Slide 3
  • Blah, Blah, Blah The table was placed in beach chair configuration. Head, neck, trunk and limbs were padded and protected in appropriate fashion. The right lower extremity was prepped and draped in the usual sterile fashion. Bilateral upper extremities were prepped and draped in standard sterile fashion.
  • Slide 4
  • Types of Injuries Wrong site, wrong procedure Wrong medication Skin breakdown/decubiti Burns Nerve damage Ischemia Eyesight
  • Slide 5
  • Pre-operative Preparation Testing Determines ability to sustain surgical insult Determines type of anesthesia delivery Blood Pressure, Diabetes, EKG, Liver function, CBC, Chest X-ray, UA Medications Day before surgery, anti-inflammatory Day of surgery, antibiotics Post op pain meds Smoking cessation?
  • Slide 6
  • Patient/Procedure Confirmation Surgical Consent Pre-operative marking Time Out in the operating room
  • Slide 7
  • Anesthesia Choices Goals of anesthesia Exposure, Relaxation Keep patient alive Pain free, unaware, stable Local Anesthesia Regional Anesthesia Conscious Sedation General Anesthesia LMA vs. Intubation Many photos courtesy of John DiPaola, MD
  • Slide 8
  • Surgical Positioning Goals Exposure for surgeon Immobilize patient Injury prevention Maintain circulation Maintain anatomic alignment Prevent pressure points
  • Slide 9
  • Surgical Positioning Considerations No movement for minutes to hours No ability to identify pain Sometimes exposure wins out over comfort Even supine can be injurious
  • Slide 10
  • Knee Arthroscopy Tourniquet Leg holder (human and mechanical) Apply pressure to open the medial aspect of knee Possible complications Hip injury Circulatory d/t tourniquet, thrombosis tourniquet abrasion/skin breakdown Quadriceps/hamstring muscle injury Non-operative leg
  • Slide 11
  • Tourniquet Leg Holder
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  • Non-Operative Leg unsupported
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  • Item laying on Patient
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  • Shoulder Arthroscopy o Beach Chair o Operative arm is free to be moved. May be held or rested. Non-operative arm must be secured o Head is secured with head rest o Back of table may be removed o Patients legs must be positioned bent and circulation maintained o Possible complications o Cervical o Axillary nerve, brachial plexus o Thrombosis
  • Slide 15
  • Head Support Knees Bent Compression Stockings
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  • Neck injury Potential?
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  • Ready to prep Operative arm is vulnerable
  • Slide 18
  • Skinny Model Add 150 lbs & imagine the injury potential
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  • Spinal Surgery Positioning o Prone o Positioning tables o Supine (infrequent) o Possible complications o Cervical o Axillary nerve o Pressure Points o Genital trauma o Facial trauma
  • Slide 20
  • Patient induced on back and then turned Process reversed at the end of procedure Elevated frame Gel pad under knees Arms supported Face in cradle
  • Slide 21
  • Table is adjusted to get C-arm under tippy! C-Arm
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  • Challenges to positioning Obesity Trauma Pre-existing conditions Arthritis, amputation, injury Diabetes Cardiac/Vascular disease Smoking
  • Slide 23
  • Documentation The table was placed in beach chair configuration. Head, neck, trunk and limbs were padded and protected in appropriate fashion. The right lower extremity was prepped and draped in the usual sterile fashion. Bilateral upper extremities were prepped and draped in standard sterile fashion.
  • Slide 24
  • Postoperative Care Pain Control Pain affects blood pressure, vital signs Narcotics affect respiration Pain control is a chemical balance Challenges in pain control Surgical procedure, duration History of prior medication use Age, co-morbidities Experience with pain
  • Slide 25
  • Recovery Times Any surgery, requires recovery Routine post op MD appt in 1 week Generally speaking: Knee 1week-6mo Shoulder 4-6 mo Back 3mo Infection, complications will delay recovery Smoking complicates everything
  • Slide 26
  • Questions? Jan Moss, RN GENEX Services, Inc jan.moss@genexservices.com (503) 381-1065

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