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Surgery > PRE-,PERI-,POST-OP CARE AND SURGICAL COMPLICATIONS > Flashcards

PRE-,PERI-,POST-OP CARE AND SURGICAL COMPLICATIONS Flashcards

1
Q

Risk factors for PROPHYLACTIC ANTIBIOTICS:

  1. Systemic? 4
  2. Local factors? 4
A
  1. Systemic factors
    - Diabetes
    - Corticosteroid use
    - Obesity
    - Age
  2. Local factors
    - Foreign body
    - Electrocautery
    - Wound drains
    - Injection with epinephrine
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2
Q

Selection of antibiotics

  1. Should be adminitsered when?
  2. Most commonly given antibiotics for prophylaxis?
  3. Gram neg and anaerobic pathogens can be covered by what? 4
A
  1. Should be administered 60 min before incision
  2. Most commonly given drug:
    Cefazolin (Ancef, Kefzol)
  3. Gram-neg and anaerobic pathogens can be covered by:
    - Cefotetan
    - Cefoxitin
    - Ceftizoxime
    - Each with or without metronidazole (Flagyl)
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3
Q

Diabetic Pt
1. Surgical stress induces a neuroendocrine response which results in what? 3

  1. Pre-op eval includes assessment of what? 2
  2. PE? 4
A
    • insulin resistance,
    • increased hepatic glucose production, and
    • impaired insulin production
    • metabolic control and
    • any diabetes-associated complications
    • Feet
    • Minor injuries
    • Poor hygiene
    • ulcers
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4
Q

Diabetic pt
1. Cardiac
Men have ______ the risk, women have ______ the risk

  1. Can have hypotension from what?
  2. Gastroparesis
    Delay what? Risk of?
  3. Infection
    __________ has effect on immune system
  4. Reduced blood flow decreases what?
A
  1. twice, 4x
  2. cardiac neuropathy
  3. gastric emptying and aspiration
  4. Hyperglycemia
  5. healing
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5
Q

THROMBOEMBOLIC DISEASE
Despite advances in prevention and treatment of what remains most common preventable cause of death? 2
150,000 to 200,000 deaths per year in US

  1. Risk factors? 4
A
  1. VTE, pulmonary embolism
  2. Risk factors
    - Extent of surgery or trauma
    - Duration of hospital stay
    - Previous VTE
    - Immobility
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6
Q 
THROMBOEMBOLIC DISEASE
Risk model/Caprini score
1. Very low risk scores? 2
2. Low risk scores? 2
3. Moderate risk scores? 2
4. High risk scores? 2
A

Risk model/Caprini score

  1. Very low risk
    - General and abdominal-pelvic surgery with Caprini score of 0
    - Plastic and reconstructive surgery with Caprini score 0-2
  2. Low risk
    - General and abdominal-pelvic surgery with Caprini score of 1-2
    - Plastic and reconstructive surgery with Caprini score 3-4
  3. Moderate risk
    - General and abdominal-pelvic surgery with Caprini score of 3-4
    - Plastic and reconstructive surgery with Caprini score 5-6
  4. High risk
    - General and abdominal-pelvic surgery with Caprini score of 5 or more
    - Plastic and reconstructive surgery with Caprini score of 7-8
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7
Q

THROMBOEMBOLIC DISEASE
1. Prevention: Primary Prophylaxis?

  1. Selecting appropriate option includes 4?
A
    • Easy to administer
    • Safe and effective
    • No need for lab monitoring
    • Cost effective

2.

  • Early and frequent ambulation for patients at very low risk
  • Mechanical methods for patients with contraindication to pharmacological prophylaxis at low risk
  • Pharmacological for patients at moderate and high risk
  • Combination for patients at very high risk
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8
Q

THROMBOEMBOLIC DISEASE
Medications
4

A
  1. LMW heparins preferred in high risk patients
    - SQ once or twice daily
  2. Low dose Unfractionated heparin (UFH) alternative
    - 5000 units two hours pre-op then 8-12hrs post-op SQ
  3. Warfarin
    - Alternative to LMW/UFH
  4. Aspirin
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9
Q

THROMBOEMBOLIC DISEASE

  1. Mechanical methods? 3
  2. Inferior vena cava filter is used when?
A
  1. Mechanical methods
    - Intermittent pneumatic compression (IPC)
    - Graduated compression stockings (GCS)
    - Venous foot pump (VFP)
  2. Inferior vena cava filter (IVC)
    - Failure to adequate anticoagulation
    - Absolute contraindication to anticoagulation
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10
Q
  1. CDC has defined an infection related to an operation that occurs at or near the surgical incision within _________ of the procedure, or within ________ if an implant is used
  2. Most common _________ infection
  3. Impact? 2
A
  1. 30 days, 90 days
  2. nosocomial
    • Increase in mortality
    • Increase cost to patient and hospital
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11
Q

SSI

  1. Epidemiology? 3
  2. Risk factors? 6
A
  1. Epidemiology
    - Depend on population
    - Size of hospital
    - Experience of surgeon
  2. Risk factors
    - Surgical technique
    - Prolonged surgery time
    - Instrument sterilization
    - Preop preparation
    - Thermoregulation/glycemic control
    - Medical condition of the patient
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12
Q

SSI surgical environment risk factors? 4

A

Surgical environment

  1. Personnel traffic
  2. Excessive use of electrosurgical cautery units
  3. Prosthesis or foreign body
  4. Need for blood transfusion
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13
Q

SSI presentation? 4

A

Presentation

  1. Localized erythema
  2. Induration
  3. Warmth
  4. Pain at incision site
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14
Q

SSI Tx? 3

A
  1. Prophylactic antibiotics
  2. Infected wounds
  3. Antibiotics
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15
Q
  1. What kind of antibiotics for tx after already infected?

2. What kind of labs to detect bug? 2

A
  1. Broad spectrum antibiotic with coverage of gram positive cocci
  2. Culture and gram stain reports
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16
Q

SSI Tx: Surgical technique prevention? 5

A

Surgical technique

  1. Limit electrocautery
  2. Closure subq tissue
  3. Skin closure
  4. Delayed closure and heal by secondary intention
  5. Limit hypothermia
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17
Q

HEMATOMA AND SEROMA

  1. What are these?
  2. Which is more common?
  3. Cause what? 2
  4. Presentation? 3
A
  1. Collection of blood or serum under the incision
  2. Hematomas more common
  3. Cause
    - wound separation and
    - infection
  4. Presentation
    - Appear a few days after surgery
    - Swelling
    - Pain
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18
Q

HEMATOMA AND SEROMA

  1. Tx? 2
  2. Prevention? 3
A
  1. Treatment
    - Percutaneous drains
    - Wound exploration (Packed and heal by secondary intention)
  2. Prevention
    - Closure of dead space
    - Meticulous hemostasis
    - Placement of drains controversial
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19
Q

FASCIAL DEHISCENCE

  1. What is it?
  2. Occur when in the post op period?
  3. Complication?
  4. Risk factors? 4
A
  1. Abdominal wall tension overcoming tissue or suture strength
  2. Occur late or early post-op period
  3. Complications are incisional hernia
  4. Risk factors
    - Age
    - Males
    - COPD
    - Ascites
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20
Q

FASCIAL DEHISCENCE
1. Suture
Main cause is failure to what? 3

  1. Presentation? 2
  2. Treatment?
  3. Prevention? 2
A
    • remain anchored,
    • knot failure,
    • large stitch intervals
    • Profuse serosanguinous drainage
    • Popping sensation with abdominal bulge
  3. Closure in operating room
    • Continuous mass closure or interrupted
    • Internal or external retention sutures
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21
Q

Wound healing: Primary intention
1. How is the wound managed? 2

  1. May drain a small amount of what? 2
  2. Generally kept protected from getting wet with a plastic cover for _____ days depending on wound site, if allowed to get wet—shower only, no bathtub or hot tub
  3. Monitor for what? 4
A
    • Wound closed with stitches or staples
    • Covered w/ sterile dressing
  2. blood or serosangueness fluid
  3. 2-10
    • erythema,
    • swelling,
    • warmth and
    • drainage
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22
Q

Wound healing: Secondary Intention
1. What are not closed, sometimes other layers not closed allowed to granulate in? 2

  1. When do we use this? 3
  2. Should be managed how?
A
  1. Epidermas and dermas
  2. Usually if there has been
    - contamination,
    - an infected wound,
    - peritonitis
  3. Has to be packed daily to every other day w/ saline moistened gauze or sponges and covered w/ a sterile dressing
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23
Q
  1. Pulmonary complications? 3
  2. Occurs in what percent of pts?
  3. Accounts for what percent of peroperative mortality?
A
  1. Complications
    - Hypoventilation
    - Pneumonia
    - Atelectasis
  2. Occur in about a third of patients
  3. Accounts for half of perioperative mortality
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24
Q

CATEGORIES OF PULMONARY COMPLICATIONS:

5

A
  1. Atelectasis
  2. Infection (including bronchitis & pneumonia)‏
  3. Prolonged mechanical ventilation & respiratory failure
  4. Exacerbation of underlying chronic lung dz
  5. Bronchospasm
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25
Q

Physiology
1. Residual effects of anesthesia & post-op opioids depress what?

  1. Inhibition of what? 3
  2. After abdominal and thoracic surgery how are the following affected:
    - Vitial capacity?
    - Functional residual capacity?
  3. What are these capacity changes due to?
A
  1. respiratory drive
    • cough,
    • impairment of mucociliary
    • clearance of respiratory secretions
  3. After abdominal and thoracic surgery:
    - Vital capacity reduced by 50-60%
    - Functional residual capacity reduced by 30%
  4. Due to diaphragmatic dysfunction and postop pain
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26
Q

Pulmonary compliction risk factors? 5

A
  1. Age: age > 50 yrs independent risk factor
  2. Chronic lung disease (COPD)‏
  3. Asthma: if controlled not a higher risk
  4. Smoking: > 20 pack year hx higher incidence of postop pulmonary complications
  5. General health status
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27
Q

What kind of general health problems comtribute to pulmonary complications? 2

A
  1. CHF increases risk

2. URI—best to postpone elective surgery until resolved

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28
Q

Pulmonary: Procedure-related risk factors? 4

A
  1. Surgical site: abdominal and thoracic (especially upper abdominal)‏
  2. Duration of surgery: those lasting > 3-4 hrs
  3. Type of anesthesia: regional vs general—more complications w/ general
  4. Type of neuromuscular blockade: using long acting agent (pancuronium) higher risk then w/ short acting agents
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29
Q

PRE-OP RISK ASSESSMENT
1. GOAL?

  1. What would help us identify this? 2
  2. PE: Note what? 4
A
  1. direct history to recognize chronic lung disease
    • Reports of exercise intolerance
    • Unexplained dyspnea or cough
  3. PE: note decreased
    - breath sounds,
    - rhonchi,
    - wheezes or
    - prolonged expiratory phase
30
Q

Testing for Pulm
1. All patients undergoing lung resection should have pre-op what performed?

For all other procedures, lab tests are adjuncts to clinical evaluation

A
  1. pulmonary function tests
31
Q

PFTs
1. Obtain for pts w/ what if clinically cannot determine if pt at their best baseline? 2

  1. Obtain for pts w/ what that remains unexplained? 2
A
  1. COPD or asthma

2. dyspnea or exercise intolerance

32
Q

PULM testing
1. ABGs?

  1. CXR: obtain in who? 2
A
  1. no data support use of pre-op ABGs as helpful to stratify risk for post-op pulmonary complications
    • Obtain in pts w/ known CVD
    • In those > 50YO undergoing high risk surgical procedures
33
Q

STRATEGIES TO REDUCE POST-OP PULMONARY COMPLICATIONS
1. COPD? 3

  1. Asthma? 1
  2. URI?
A
  1. COPD
    - Combinations of bronchodilators, antibiotics and systemic steroids
    - All pts should receive daily inhaled ipratropium or tiotropium
    - Beta-agonists as needed
  2. Asthma
    - Well controlled w/ beta-agonists, peri-operative systemic steroids if needed
  3. delay elective surgery in the presence of a viral URI
34
Q

Patient education before lung procedures?

A

Patient education:

Lung expansion maneuvers—coughing, incentive spirometry, and deep breathing should be taught prior to surgery

35
Q

INTRA-OPERATIVE STRATEGIES

  1. Use what when possible?
  2. For neuromuscular blockade use what instead of pnacuronium?
  3. _________ procedures in high risk pts?
A
  1. spinal or epidural when possible
  2. intermediate agents (vecuronium, atracurium)
  3. pnacuronium
36
Q

POST-OP STRATEGIES

Lung expansion? 4

A
  1. Deep breathing exercises
  2. Incentive spirometry
  3. Adequate pain control
  4. Routine use of nasogastric tube increases post-op pulmonary complications
37
Q
  1. What is a post-op fever defined as?

2. Most early post- op fever is caused by what? Resolves?

A
  1. Fever > 38° is common in 1st few days after major surgery

2. Most early post-op fever caused by inflammatory stimulus of surgery and resolves spontaneously

38
Q

POST-OP FEVER

Describe the 5 Ws?

A

5 W’s

  1. Wind day 1-2
  2. Water day 3-5
  3. Walking day 4-6
  4. Wound day 5-7
  5. Wonder drugs day 7+
39
Q

TREATMENT for post op fever?

3

A
  1. Remove unnecessary treatments including medications and catheters
  2. Suppress fever with Tylenol
  3. Antibiotics per clinical judgment/culture results
40
Q

MALIGNANT HYPERTHERMIA
1. An uncommon and sometimes life-threatening reaction to some what?

  1. What drug categories are dangerous for this? 2
A
  1. anesthetic agents.
    • Depolarizing muscle relaxants (Anectine)
    • Potent inhalational agents:
41
Q

MALIGNANT HYPERTHERMIA
Potent inhalational agents?
5

A
  1. Halothane
  2. Isoflurane
  3. Enflurane
  4. Desflurane
  5. Sevoflurane
42
Q

MALIGNANT HYPERTHERMIA
Safe drugs?
8

A
  1. Barbiturates (Thiopental)
  2. Benzodiazepines (Midazolan, Diazepam, Lorazepan)
  3. Droperidol (Inapsine)
  4. Ketamine
  5. Local anesthetics (Lidocaine, Bupivacaine)
  6. Nitrous oxide
  7. Nondepolarizating muscle relaxants (pancuronion, rocuronium, vecuronium)
  8. Opioids (Morphine, Demerol)
    Propofol
43
Q

MALIGNANT HYPERTHERMIA
Clinical Manifestations
Signs of hypermetabolism
11

A
  1. Hypercarbia (the most sensitive indicator of potential MH in the OR)
  2. Skeletal muscle rigidity (the most specific sign)
  3. Tachycardia
  4. Tachypnea
  5. High temperature (usually a late sign of MH)
  6. Hypertension
  7. Cardiac dysrhythmias
  8. Acidosis
  9. Hypoxemia
  10. Hyperkalemia
  11. Myoglobinuria
44
Q

MALIGNANT HYPERTHERMIA

PP? 3

A
  1. Genetic predisposition
  2. Increased intracellular Calcium
  3. Continuous muscle contraction
45
Q

MALIGNANT HYPERTHERMIA: HOW DO WE KNOW??
3

What should be avoided in caring for this patient?

A
  1. Just because prior anesthetics have been uneventful does not mean that MH will not occur.
  2. Ask about any muscle cramps, progressive weakness after prior surgeries.
  3. Any family history of muscle disease or anesthetic problems

Succinylcholine (probably the most dangerous “triggering agent”) should be avoided in caring for this patient.

46
Q

MALIGNANT HYPERTHERMIA

11 steps?

A
  1. Call for help; management is involved and difficult for one person.
  2. Stop triggering agents.
  3. Hyperventilate patient with 100% oxygen.
  4. Finish or abort procedure.
  5. Administer Dantrolene (2.5mg/kg bolus; may repeat 2mg/kg every 5 minutes, then 1-2mg/kg/h).
  6. Cool patient (cold IV normal saline, cold body cavity lavage, ice bags to body, cold nasogastric lavage, cooling blanket).
  7. Monitor and treat acidosis (follow serial arterial blood gases and administer sodium bicarbonate).
  8. Promote urine output (maintain >2ml/kg/h management; furosemide, mannitol).
  9. Treat hyperkalemia.
    Insulin + D50W
  10. Treat dysrhythmias with procainamide and calcium chloride.
  11. Monitor creatinine kinase, urine myoglobin, and coagulation for 24-48 hours.
47
Q

SURGICAL CARE IMPROVEMENT PROJECT (SCIP): Preventable Complication Modules? 3

A
  1. Surgical infection prevention
  2. Cardiovascular complication prevention
  3. Venous thromboembolism prevention
48
Q

SURGICAL CARE IMPROVEMENT PROJECT

PERFORMANCE MEASURES - PROCESS: Surgical infection prevention? 4

A
  1. Antibiotics*
  2. Glucose control in cardiac surgery patients
  3. Proper hair removal
  4. Normothermia in surgery patients
49
Q

Surgical infection prevention: Antibiotics

  1. Administration when?
  2. Use of what recommended in guideline?
  3. Discontiinuation when?
A
  1. Administration within one hour before incision
  2. Use of antimicrobial recommended in guideline
  3. Discontinuation within 24 hours of surgery end
50
Q
  1. PRE-OPERATIVE SHAVING: Shaving the surgical site with a razor induces what?
  2. Other risks? 3
  3. Patient education?
A
  1. small skin lacerations
    • potential sites for infection
    • disturbs hair follicles which are often colonized with S. aureus
    • Risk greatest when done the night before
  3. be sure patients know that they should not do you a favor and shave before they come to the hospital!
51
Q

TEMPERATURE CONTROL

Helps us prevent what?

A

SSI

-treatment - active warming (mean temp on arrival to recovery 36.6°C)

52
Q

Prevention of cardiac events: Myocardial ischemia either clinically occult or overt confers a 9 fold increase in risk of what? 3

A
  1. unstable angina,
  2. nonfatal myocardial infarction,
  3. and cardiac death
53
Q

SURGICAL CARE IMPROVEMENT PROJECT

Prevention of Perioperative cardiac events?

A

Perioperative beta blockers in patients who are on beta blockers prior to admission

54
Q

PREVENTION OF VENOUS THROMBOEMBOLISM

8

A
  1. Hospitalization/Nursing home** 61.2 %
  2. Active malignant neoplasm
  3. Trauma
  4. CHF
  5. CV catheter
  6. Neurologic disease with paresis
  7. Superficial vein thrombosis
  8. Varicose veins/stripping
55
Q

PREVENTION OF VENOUS THROMBOEMBOLISM
Despite the well known risk of VTE and the publication of evidence-based guidelines for prevention, previous medical record audits have demonstrated underuse what?

A

-of prophylaxis

VTE prophylaxis a must!

56
Q

SCIP-1-2-3 ANTIBIOTICS
APPROPRIATE, PRE-INCISION TIMING, D/C TIME
Antibiotics
1. Given when?
2. Which drugs do you give two hours before? 2
3. Discontnued when?
-Unless?

A
  1. Given on time: 1 hour before incision,
  2. 2 hrs – Vancomycin & Levaquin
  3. Discontinued within 24 hour after anesthesia end time
    - (exception: 48 hours for cardiovascular surgery)
57
Q 
Name the preferred med for the following surgery:
Adult Surgery Procedure
1. Cardiac? 1
2. Vascular? 1 
3. Hip/Knee Arthroplasty? 1
4. Colon? 5
5. Hysterectomy? 4
A

No history of Penicillin OR Cephalosporin Allergies = rash

  1. Cefazolin (Ancef®)
  2. Cefazolin (Ancef®)
  3. Cefazolin (Ancef®)
    • Cefotetan
    • Ertapenem (Invanz®) x 1 dose only
    • Cefoxitin (Mefoxin®)
    • Ampicillin/Sulbactam (Unasyn®)
    • Cefazolin + Metronidazole (Flagyl®)
    • Cefazolin (Ancef®)
    • Cefotetan
    • Ampicillin/Sulbactam (Unasyn®)
    • Cefoxitin (Mefoxin®)
58
Q 
Name the preferred med for the following surgery if Yes, history of Penicillin OR Cephalosporin Allergies
Adult Surgery Procedure
1. Cardiac? 2
2. Vascular? 2
3. Hip/Knee Arthroplasty? 2
4. Colon? 5
5. Hysterectomy? 5
A
    • Vancomycin**
    • Clindamycin
    • Vancomycin**
    • Clindamycin
    • Vancomycin**
    • Clindamycin
    • Levofloxacin (Levaquin®) + Metronidazole (Flagyl®)
    • Gentamicin + Metronidazole (Flagyl®)
    • Clindamycin + Gentamicin
    • Clindamycin + Aztreonam
    • Clindamycin + Levofloxacin (Levaquin®)
    • Clindamycin + Gentamicin
    • Levofloxacin(Levaquin®) + Metronidazole (Flagyl®)
    • Clindamycin + Aztreonam
    • Clindamycin + Levofloxacin (Levaquin®)
    • Gentamicin + Metronidazole (Flagyl®)
59
Q

IF USING VANCO
**If Vancomycin is marked on the physician order and patient does NOT have any allergies, one of the following needs to be documented?

7

A
  1. MRSA, Colonization or infection
  2. Patient with an acute inpatient hospitalization within the last year
  3. Patient residing in a nursing home within the last year
  4. Patient with chronic wound care or dialysis
  5. Patient with continuous inpatient stay more than 24 hours prior to the principal procedure
  6. Patient transferred from another inpatient hospitalization after a 3 day stay
  7. Patient undergoing valve surgery
60
Q 
RE-DOSING
Which meds need to be redosed in the following timelines:
1. 2 hours? 2
2. 3 hours? 1
3. 4 hours? 2
4. 6 hours? 2
5. 12 hours? 1
A
  1. -Cefoxitin
    -Ampicillin/
    sulbactam
  2. Cefotaxim
    • Cefazolin
    • Aztreonam
    • Cefotetan
    • Clindamycin
  5. Vanco
61
Q
  1. SCIP-4 BLOOD GLUCOSE under what?

2. Cardiac surgery patients – controlled ____ postoperative serum glucose (less than _____ mg/dl postop day 1 and 2)

A
  1. 200

2. 6AM, 200

62
Q

SCIP-6 HAIR REMOVAL?

A

Hair Removal

Clippers in OR only-no other option

63
Q

SCIP-9 FOLEY D/C
1. Discontnue when?

  1. Unless?
A
  1. Urinary Catheter
    - Discontinued by postop day 2
  2. Or physician, PA, NP documented reason to continue beyond day 2
64
Q

SCIP-CARDIAC-2, BETA BLOCKER

  1. If pt is on home beta blocker?
  2. Beta blocker may be given when prior to op or day of procedure (up to 12 midnight)?
  3. heart rate must be ≥ ___ and systolic blood pressure ≥ ____
  4. If held according to parameters, physician, PA, APN reason must be what?
  5. Then Beta blocker continued postop days ______?
    (Physician, PA, APN documented reason if held postop)
A
  1. Continue if patient on home beta blocker therapy
  2. 24 hrs
  3. 50, 100
  4. documented
  5. 1 & 2
65
Q

SCIP-VTE-2 TIMING OF VTE PROPHYLAXIS
1. Mechanical and/or pharmacological prophylaxis is ordered according to what? 2

  1. Prophylaxis is given____hrs. prior to surgery or within ____ hours after anesthesia end time
  2. Provider documentation required if contraindicated such as? 2
A
  1. VTE risk assessment tool and type of surgery
  2. 24, 24
    • open wound,
    • bleeding risk.
66
Q

RECOMMENDED VTE PROPHYLAXIS
Pharmacological VTE Prophylaxis is required for surgeries below unless contraindication is documented. Applicable for surgeries of 60 minutes or greater
1. General and Colorectal Surgery? 2
2. Unless? 2

A
    • Heparin
    • Enoxaparin/Lovenox
  2. If contraindication to above is documented, then:
    - Graduated compression stockings
    - Sequential compression devices
67
Q

RECOMMENDED VTE PROPHYLAXIS
Pharmacological VTE Prophylaxis is required for surgeries below unless contraindication is documented. Applicable for surgeries of 60 minutes or greater
1. Elective Hip Replacement? 4
2. Unless? 2

A
  1. Enoxaparin/Lovenox
  2. Fondaparinux/Arixtra
  3. Warfarin/Coumadin
  4. Rivaroxaban/Xarelto

If contraindication to above is documented, then:

  1. Venous foot pumps
  2. Sequential compression devices
68
Q

RECOMMENDED VTE PROPHYLAXIS
Pharmacological VTE Prophylaxis is required for surgeries below unless contraindication is documented. Applicable for surgeries of 60 minutes or greater
1. Hip fractures? 4
2. Unless? 3

A
  1. Heparin
  2. Fondaparinux/Arixtra
  3. Enoxaparin/Lovenox
  4. Warfarin/Coumadin

If contraindication to above is documented, then:

  1. Graduated compression stockings
  2. Venous foot pumps
  3. Sequential compression devices
69
Q

Pharmacological or Mechanical VTE Prophylaxis is required for surgeries below. Applicable for surgeries of 60 minutes or greater. Patients should be evaluated for risk factors for VTE.

  1. Elective Total Knee Replacement 6
  2. Urologic Surgery 4
  3. Gynecological Surgery 3
  4. Intracranial Neurosurgery 3
A
    • Enoxaparin/Lovenox
    • Warfarin/Coumadin
    • Rivaroxaban/Xarelto
    • Fondaparinux/Arixtra
    • Venous foot pumps
    • Sequential compression devices
    • Heparin
    • Enoxaparin/Lovenox
    • Sequential compression devices
    • Graduated compression stocking

3.

  • Heparin
  • Enoxaparin/Lovenox
  • Sequential compression devices
    • Heparin
    • Enoxaparin/Lovenox
    • Sequential compression devices
70
Q

SCIP-10 NORMOTHERMIA measures?

A

Temperature Management

At least ≥ 96.8°F/36°C within 15 minutes of anesthesia end time or warmer used in OR

Exception: Provider documentation of intentional hypothermia

71
Q

Name the CURRENT SCIP MEASURES? 9

A
  1. SCIP-1 Pre-op Antibiotic given within 1 hr. before incision
  2. SCIP-2 Must receive SCIP recommended prophylactic antibiotic
  3. SCIP-3 Discontinue antibiotic within 24 hrs. of anesthesia end time
    (cardiac op exception)
  4. SCIP-4Controlled 6 am postoperative serum glucose (cardiac only)
  5. SCIP-6 Appropriate hair removal
  6. SCIP-CARD-2 Perioperative beta-blocker therapy for pre B blocker Rx
  7. SCIP-VTE-2 VTE prophylaxis within 24 hrs. prior to or after anesthesia end time
  8. SCIP-9 Remove urinary catheter by postop day 2
  9. SCIP-10 Temperature >96.8 F- 15 min. after anesthesia end time

Surgery (20 decks)

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