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Surgical Basics

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

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  1. Surgical Basics Preventing injury and error Jan Moss, RN

  2. Agenda • Pre-operative preparation • Anesthesia Options • Intraoperative Considerations • Patient Identification • Patient Positioning • Postoperative considerations • Pain control • Infection • Length of recovery

  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.”

  4. Types of Injuries • Wrong site, wrong procedure • Wrong medication • Skin breakdown/decubiti • Burns • Nerve damage • Ischemia • Eyesight

  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?

  6. Patient/Procedure Confirmation • Surgical Consent • Pre-operative marking • “Time Out” in the operating room

  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

  8. Surgical Positioning • Goals • Exposure for surgeon • Immobilize patient • Injury prevention • Maintain circulation • Maintain anatomic alignment • Prevent pressure points

  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

  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

  11. Tourniquet Leg Holder

  12. Non-Operative Leg unsupported

  13. Item laying on Patient

  14. 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

  15. Head Support Knees Bent Compression Stockings

  16. Neck injury Potential?

  17. Ready to prep Operative arm is vulnerable

  18. Skinny Model Add 150 lbs & imagine the injury potential

  19. Spinal Surgery Positioning • Prone • Positioning tables • Supine (infrequent) • Possible complications • Cervical • Axillary nerve • Pressure Points • Genital trauma • Facial trauma

  20. 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

  21. C-Arm Table is adjusted to get C-arm under… tippy!

  22. Challenges to positioning • Obesity • Trauma • Pre-existing conditions • Arthritis, amputation, injury • Diabetes • Cardiac/Vascular disease • Smoking

  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.”

  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

  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

  26. Questions? Jan Moss, RN GENEX Services, Inc jan.moss@genexservices.com (503) 381-1065

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