Draping the surgical pt and intra-op management - scrub/scout

Question 1

purpose of drape

Answer 1

Strategically placed so that it only exposes the operative site and isolates it from surrounding areas.
- Provide an area of which sterile instruments can be placed.
- Draping material must maintain an isothermal environment appropriate to body temperature.
- create barriers against microorganisms, preventing microorganisms from contaminating sterile areas.

Question 2

Points to consider:

Answer 2

1. handle drapes as little as possible
2. hold drapes above waste level
3. don’t move the drape once in place
4. drape the incision site first and work towards the periphery.

Question 3

2 aspects of pt management linked to adverse pt outcomes if managed incorrectly:

Answer 3

1. Prevention of inadvertent perioperative hypothermia (IPH)
   
   2. Prevention of Venous thromboembolism

Question 4

When does IPH occur

Answer 4

In response to general or regional anaesthesia and transpires due to vasoconstriction mechasnicm responsible for maintaining temperature becoming inhibited on administration of anaesthetic agents.

Question 5

normal core temperature range

Answer 5

36.5-37.5

Question 6

Hypothermia

Answer 6

defined as a core body temperature less than 36.

Question 7

Complications of IPH

Answer 7

postoperative shivering, increased blood loss, decreased drug metabolism and clearance, postoperative myocardial ischemia, delayed wound healing and increased rates of surgical wound infection.

Question 8

Conduction

Answer 8

transfer of the pt heat through physical contact with other objects.

Question 9

Radiation

Answer 9

heat generated and emitted due to the pt metabolism.

Question 10

Convection

Answer 10

air that moves around the pt taking the heat away.

Question 11

Evaporation

Answer 11

effective means of removing heat from a pt body, and occurs constantly as the pt breathes.

Question 12

Temp monitoring

Answer 12

• Within the hour before transfer to periop
  
  • arrival to pre-op
  • Preceding induction of anaesthesia
  • Every 15 minutes when forced-air warming used
  • Every 30 mins for all patients
  • On admission to PACU and every 15 min therafter
• Before making a decision regarding readiness for discharged from PACU

Question 13

Warming interventions

Answer 13

• forced air-warming - for anaesthesia longer than 30 mins
• commence pre-op warming 30 mins prior
• active warming intra-op
• room temp of 20-22 whilst pt exposed
• warmed cotton blankets
• active warming strategies - 500ml IV fluid and blood product
• irrigation fluid warmed between 38-40

Question 14

Risk factors for IPH

Answer 14

• ASA grade (2-5)
  
  • Major surgery
  • Planned combined general and regional anaesthesia
  • Major surgery
  • Known risk of CV complication
  • Infant and older adults
  • Hypothyroidism
  • Surgery involving general, regional or neuraxial anaesthesia
• Pre-op baseline temp of less than 36, within one hour before surgery

Question 15

When to use active warming strategies

Answer 15

two+ risk factors, must treat pt as high risk for IPH, pre-warmed using active warming strategies.

Question 16

Venous thromboembolism

Answer 16

Blood clots in the veins.
- includes PE and DVT.

Question 17

VTE non-pharmacological management

Answer 17

• Graduate compression stockings (GCS)
  
  • Intermittent Pneumatic Compression (IPC)
• Patient positioning and positioning devices

Question 18

VTE Pharmacological intervention

Answer 18

• Clexane (Enoxaparin)
  
  • Low Molecular Weight Heparin (LMWH)
  • Unfractionated Heparin (UFH)
• Aspirin