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JULY 1989, VOL. 50, NO 1 ___I__ AORN JOURNAL Practical Innovations Using an ice cream maker to make sterile slush t times, the consulting urologists at the A Veterans Administration Medical Center, Manchester, NH, requested slush for a pending surgical procedure. Because this was not a common request, the nursing staff was concerned about obtaining slush on a cost-effective basis. In previous years, we borrowed cups of sterile slush from other hospitals, but all too often, we found that the product’s expiration date had been exceeded and that the company no longer manufactured the slush. Our other ideas were not cost-effective. Purchasing a slush-making machine would be too expensive; it also would be too noisy, require too much upkeep, and would be used only a few times a year. Commercially available slush was another option, but the cost and expiration date limitation would make it too wasteful. It seemed impractical to freeze sterile solution in empty bags. During surgery, we would have to use a sterile hammer to break the ice into chunks. We did not want to use dry ice in sterile basins because it took too much time to balance the basin of saline on top of the ice, hoping that slush would form before the procedure started. We had to find a solution because slush is needed for a variety of procedures at our hospital. It is used to chill the kidney during a hemine- phrectomy and to decrease warm ischemic time (Fig 1). It also is used to store and transport freshly harvested organs for implantation. Sterile slush is used during cardiac surgery. Some surgeons apply the slush directly on the heart, while others use iced lap sponges to chill the heart. Using an Ice Cream Maker e decided to try making slush with the W Donvier@ ice cream maker. It is simple to use and does not require salt, ice, or electricity. Within minutes, slush forms. It produces enough slush for the entire procedure and remains frozen for one or more hours in its own container. The following supplies are needed: a sterile plastic table drape, a onequart Donviere ice cream maker, a sterile plastic scraper or slotted Dorothy S. Anderson, RN, CNOR, is an OR staff nurse, Veterans Administration Medical Center, Manchester, NH She received her nursing diproma from the Melrose-Wakefleld Hospital School of Nursing, Melrose, Mass. The author acknowledgesStephen Smith, MD, and Margaret Caron, RN, Veterans Administration Medical Center, Manchester, NH, for their assistance with this article. I52

Using an ice cream maker to make sterile slush

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Page 1: Using an ice cream maker to make sterile slush

JULY 1989, VOL. 50, NO 1 ___I__

AORN JOURNAL

Practical Innovations

Using an ice cream maker to make sterile slush

t times, the consulting urologists at the A Veterans Administration Medical Center, Manchester, NH, requested slush for a pending surgical procedure. Because this was not a common request, the nursing staff was concerned about obtaining slush on a cost-effective basis. In previous years, we borrowed cups of sterile slush from other hospitals, but all too often, we found that the product’s expiration date had been exceeded and that the company no longer manufactured the slush.

Our other ideas were not cost-effective. Purchasing a slush-making machine would be too expensive; it also would be too noisy, require too much upkeep, and would be used only a few times a year. Commercially available slush was another option, but the cost and expiration date limitation would make it too wasteful.

It seemed impractical to freeze sterile solution in empty bags. During surgery, we would have to use a sterile hammer to break the ice into chunks. We did not want to use dry ice in sterile basins because it took too much time to balance the

basin of saline on top of the ice, hoping that slush would form before the procedure started.

We had to find a solution because slush is needed for a variety of procedures at our hospital. It is used to chill the kidney during a hemine- phrectomy and to decrease warm ischemic time (Fig 1). It also is used to store and transport freshly harvested organs for implantation. Sterile slush is used during cardiac surgery. Some surgeons apply the slush directly on the heart, while others use iced lap sponges to chill the heart.

Using an Ice Cream Maker

e decided to try making slush with the W Donvier@ ice cream maker. It is simple to use and does not require salt, ice, or electricity. Within minutes, slush forms. It produces enough slush for the entire procedure and remains frozen for one or more hours in its own container.

The following supplies are needed: a sterile plastic table drape, a onequart Donviere ice cream maker, a sterile plastic scraper or slotted

Dorothy S. Anderson, RN, CNOR, is an OR staff nurse, Veterans Administration Medical Center, Manchester, NH She received her nursing diproma from the Melrose- Wakefleld Hospital School of Nursing, Melrose, Mass.

The author acknowledges Stephen Smith, MD, and Margaret Caron, RN, Veterans Administration Medical Center, Manchester, NH, for their assistance with this article.

I52

Page 2: Using an ice cream maker to make sterile slush

JULY 1989, VOL. 50. NO 1 AORN JOURNAL

Fig 1. Sterile slush packed arc the kidney during a heminephi tomy.

lurid :ec-

Fig as3

2. The ice cream maker is dis- mbled and thoroughly cleaned

before using.

Fig 3. The slush is ready to in about 10 minutes.

use

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Page 3: Using an ice cream maker to make sterile slush

AORN JOURNAL JULY 1989, VOL. SO, NO I

spoon, and chilled intravenous (IV) solutions (eg, 0.9% salineAactated Ringer’s solution).

Using an ice cream maker to make slush requires preparation beforehand. The ice cream maker must be thoroughly disassembled, cleaned, and sterilized (Fig 2). After disassembling it, water and a mild detergent are used to clean it. A soft brush or cloth should be used.

After rinsing and drying it thoroughly, the aluminum cylinder is separated from the plastic parts and placed in two peel pack wrappers. The plastic parts (ie, the large ring, top, handle and large container) and a plastic scraper or slotted spoon are placed in two other peel pack wrappers. Both packages are gas sterilized by using a cold cycle at 98.6 O F (37 “C). The manufacturer’s guidelines for cold cycle sterilization and AORN’s recommended practices concerning the use of packaging materials should be used.’

The sterile, double-wrapped aluminum cylinder is placed in a sealed, waterproof bag and placed upright in a freezer set at 0 O F (-17.8 “C). The cylinder is placed in the freezer for at least eight hours. The IV solutions also are placed in a refrigerator to chill overnight.

Twenty minutes before the slush is required, the circulating nurse removes the chilled fluids from the refrigerator and removes the aluminum cylinder from the freezer. The scrub nurse takes the sterile items from the circulating nurse and places them on the plastic drape and begins to assemble the unit. The scrub nurse takes the large plastic ring and places it securely on the frozen cylinder, making sure that the triangular marks are aligned. After inserting the cylinder, the nurse places the blade into the middle of the container.

While the scrub nurse is assembling the unit, the circulating nurse pours the chilled IV solutions into a sterile basin. The scrub nurse takes this basin and puts its contents into the frozen cylinder, quickly places the lid on top, and attaches the handle. He or she turns the handle clockwise twice every two to three minutes, and slush starts to form within minutes. The nurse uses the scraper or slotted spoon to remove the slush as it is formed and places it in a basin (Fig 3). It is important that the blade is not removed from the center of the container while scooping out the slush.

Evaluation

hen compared to the other alternatives, an W ice cream maker is very cost-effective. A one-quart ice cream maker costs between $29 and $39, cleans and sterilizes easily, and is easy to store.

Empty, sterile bags cost about $16 each, are packaged in boxes of 20, and have a storage life of several years. The sterile IV saline bags hold 1,000 mL and are packaged six bags per case. They cost $150 per case or $25 per bag. They have a storage life of 18 months from the date of manufacture. Dry ice is the most inexpensive method to use, but it requires a special freezer for storage, otherwise, the dry ice evaporates within a short period of time.

From experience, we offer the following tips: keep the ice cream maker away from any source of heat, keep the cylinder upright; if it tips, it causes ice to form unevenly around the edges, which slows the slush-making process, turn the handle twice every few minutes, otherwise, ice builds up on the edges and makes the handle difficult to move, use only plastic scrapers or spoons; do not use any metal utensils or instruments, use only chilled solutions in the frozen cylinder; room-temperature solutions increase the time it takes the slush to form and decrease the amount of slush that can be made, use only sterile saline or lactated Ringer’s solution; do not use distilled water because it freezes too fast, and make sure your hands are dry before handling the frozen aluminum cylinder; do not touch it with wet hands or gloves.

DOROTHY S. ANDERSON, RN, CNOR

Note 1 . “Recommended practices for selection and use of

packaging materials,” in AORN Standards and Recommended Practices for Perioperative Nursing (Denver: Association of Operating Room Nurses, Inc, 1989) IIIr14-1 to 14-4.

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