Surgical basics
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Surgical Basics. Preventing injury and error. Jan Moss, RN. Agenda. Pre-operative preparation Anesthesia Options Intraoperative Considerations Patient Identification Patient Positioning Postoperative considerations Pain control Infection Length of recovery. Blah, Blah, Blah….

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Surgical basics

Surgical Basics

Preventing injury and error

Jan Moss, RN


Agenda

Agenda

  • Pre-operative preparation

  • Anesthesia Options

  • Intraoperative Considerations

    • Patient Identification

    • Patient Positioning

  • Postoperative considerations

    • Pain control

    • Infection

    • Length of recovery


Blah blah blah

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.”


Types of injuries

Types of Injuries

  • Wrong site, wrong procedure

  • Wrong medication

  • Skin breakdown/decubiti

  • Burns

  • Nerve damage

  • Ischemia

  • Eyesight


Pre operative preparation

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?


Patient procedure confirmation

Patient/Procedure Confirmation

  • Surgical Consent

  • Pre-operative marking

  • “Time Out” in the operating room


Anesthesia choices

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


Surgical positioning

Surgical Positioning

  • Goals

    • Exposure for surgeon

    • Immobilize patient

    • Injury prevention

      • Maintain circulation

      • Maintain anatomic alignment

      • Prevent pressure points


Surgical positioning1

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


Knee arthroscopy

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


Surgical basics

Tourniquet

Leg Holder


Surgical basics

Non-Operative Leg

unsupported


Surgical basics

Item laying on Patient


Shoulder arthroscopy

Shoulder Arthroscopy

  • “Beach Chair”

  • Operative arm is free to be moved. May be held or rested. Non-operative arm must be secured

  • Head is secured with head rest

  • Back of table may be removed

  • Patient’s legs must be positioned bent and circulation maintained

  • Possible complications

    • Cervical

    • Axillary nerve, brachial plexus

    • Thrombosis


Surgical basics

Head Support

Knees Bent

Compression Stockings


Surgical basics

Neck injury

Potential?


Surgical basics

Ready to prep

Operative arm is

vulnerable


Surgical basics

Skinny Model

Add 150 lbs

& imagine the injury

potential


Spinal surgery positioning

Spinal Surgery Positioning

  • Prone

    • Positioning tables

  • Supine (infrequent)

  • Possible complications

    • Cervical

    • Axillary nerve

    • Pressure Points

    • Genital trauma

    • Facial trauma


Surgical basics

Patient induced on back and then turned

Process reversed at the end of procedure

Arms supported

Face in cradle

Gel pad under

knees

Elevated frame


Surgical basics

C-Arm

Table is adjusted to

get C-arm under… tippy!


Challenges to positioning

Challenges to positioning

  • Obesity

  • Trauma

  • Pre-existing conditions

    • Arthritis, amputation, injury

  • Diabetes

  • Cardiac/Vascular disease

  • Smoking


Documentation

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.”


Postoperative care

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


Recovery times

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


Questions

Questions?

Jan Moss, RN

GENEX Services, Inc

[email protected]

(503) 381-1065


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