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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


Tourniquet

Leg Holder


Non-Operative Leg

unsupported



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


Head Support

Knees Bent

Compression Stockings


Neck injury

Potential?


Ready to prep

Operative arm is

vulnerable


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


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


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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