Intraoperative patient care and safety Flashcards
What is the second phase of the universal protocol?
the timeout process
what is the purpose of the timeout?
to prevent harm to the patient related to operating on the wrong site, operating on the wrong patient, or performing the wrong procedure
When should the timeout be performed?
after the patient has been prepped and draped for surgery and just before incision is made
When should antibiotic administration occur?
1 hour of the initial surgical incision
What is the I PASS CARE pneumonic for timeout?
Introduce the team
Procedure
Assessment for fire and safety
Site confirmed and marked
Sterilization
Consent
Antibiotics administered
Radiographs displayed
Equipment available
What are the goals of appropriate patient positioning?
- maintain the patient’s privacy and comfort
- maximize surgical site exposure
- promote access to the IV lines
- stabilize the patient to prevent friction and shear to the skin and patient shift during surgery
- maximize circulation and oxygenation
- promote perfusion to all vital organs and extremities
- protect the muscles, nerves, joints, and vital organs from injury
What are possible patient positioning injuries related to cold?
- reduce peripheral circulation
- reduce oxygen delivery
- affect the skin and underlying tissue
What are possible patient positioning injuries related to heat?
- increase tissue metabolism
- increase oxygen demand
- constrict or impede blood flow
What are possible patient positioning injuries related to moisture?causing?
- macerate tissue - causing the connective tissue to dissolve and tear
What can moisture present as on a patient?
- patient perspiration
- irrigants
- blood
- urine
- fecal matter
- skin prep solution
What nerves are most commonly injured during patient positioning?
- brachial plexus
- peroneal
- facial nerves
What are the risks for positioning injuries?
- bony prominences
- external devices
- high BMI and obesity
- internally implanted devices
- limited ROM, nutritional status, preexisting conditions
- presence or history of a pressure injury
- psychologic considerations
- skin tears, presence of rash, history of skin breakdown
- smoking - causes vasoconstriction
What is the position where…
a. the patient is lying flat on the back on the surgical table in an anatomic position
supine
Where should the arms be in supine traditionally?
with arms extended
Where should the palms be facing if they are tucked to the side?
palms facing torso
Where are the 2 anatomic regions most commonly exposed in supine?
- head
- abdomen
What kind of abdominal procedures do you see in supine?
- abdominoplasty
- appendectomy
- cholecystectomy
- laparoscopic abdominal procedures
What kind of head procedures do you see in supine?
- craniotomy
- sinus surgery
What is the position where…
a. the patient is lying on the back on the surgical table in an anatomic position
b. the table is tiled with the head lower than the feet
trendelenburg
What does trendelenberg cause during abdominal procedures?
elevation in cerebral blood and cerebrospinal fluid volume
What abdominal procedures are used for trendelenberg?
- colorectal surgery
- gynecology procedures
- laparoscopic abdominal procedures
What pelvic procedures are used for trendelenberg?
robotic prostate surgery
What is a position where the surgical site is elevated above the heart to improve drainage of fluids away from the site?
reverse trendelenburg
what position reduces intracranial pressure and improves pulmonary function where the torso is higher than the feet?
reverse trendelenberg
What is the position where…
a. the patient is lying not he back on the surgical table in an anatomic position
b. the table is tiled with the feet lower than the head
reverse trendelenberg
What are 3 examples of abdominal procedures where the patient will be in reverse trendelenburg?
- bariatric surgery
- laparoscopic abdominal procedures
What other procedures would you see where the patient will be in reverse trendelenburg?
head and neck surgery
What is the position where the patient is sitting with the head, neck, and torso elevated at 20 degrees-90 degrees, the hips are flexed between 45 degrees and 60 degrees, and the knees flexed 30 degrees
sitting and modified sitting
What is sitting and modified sitting also called?
flowler’s, semi-fowlers, high-fowler’s, and beach chair
What procedure is commonly done with the chest where patient is sitting and/or modified sitting?
breast reduction
What procedure is commonly done with the head where patient is sitting and/or modified sitting?
nasal surgeries
What procedure is commonly done with the shoulder where patient is sitting and/or modified sitting?
shoulder arthroscopy and replacement
What position offers exposure to the vagina, rectum, and perineum through the use of stirrups for the legs?
lithotomy
What are the five levels of lithotomy?
- low
- standard
- hemi
- high
- exaggerated
describe the low lithotomy position
the patient’s hips are flexed and lower legs are parallel with the OR table
describe the standard lithotomy position
the patient’s hips are flexed at 80 degrees to 100 degrees and the lower legs are parallel with the OR table
describe the hemi lithotomy position
the patient’s nonoperative leg is positioned in a supine and flat position while the operative leg is in traction or another positioning device (i.e. fracture table)
describe the high lithotomy position
the patient’s hip care flexed and the stirrups are fully elevated
describe the exaggerated lithotomy position
the patient’s hips are flexed and the lower legs are almost at a vertical position
What kind of abdominal procedures use lithotomy?
colon surgery (low anterior colectomy)
What kind of pelvic procedures use lithotomy?
1
What position provides exposure to the sacral, rectal, or perineal areas?
prone
Why is prone used for spinal procedures?
used for spinal procedures due to the reduction in abdominal pressure
What is the patient doing in prone?
lying on their stomach
What kind of procedures occur on the back in prone?
neurospine and cranial./brain surgery
What kind of procedures occur on the extremities in prone?
surgery on the posterior aspect of the extremities
What additional surgery occurs in prone not already asked?
rectal surgery
What kind of position is a patient in when they are lying on the stomach and the surgical table is lowered at the waist? patient’s head and feet are lower than the hips
jackknife/kraske
What kind of surgeries occur in jackknife?
rectal
What kind of position is the patient in when they are lying on the side. the dependent side, which is lying on the OR table, is the nonoperative side?
lateral
What kind of procedures occur in lateral? abdomen
kidney surgery
liver surgery
What kind of procedures occur in lateral? chest
lobectomy
What kind of procedures occur in lateral? thorax
thoracotomy
What kind of procedures occur in lateral? extremities
hip arthroplasty
What kind of position is it where the patient is lying on the side with the affected side up, the kidney post is elevated once the patient has been positioned
kidney
what kind of procedures do you see kidney positioning used
- kidney surgery
- liver surgery
- lobectomy
- thoracotomy
describe the fracture table positioning:
a. patient is lying flat on the surgical table from the lower back to the occiput
b. the arm on the operative side may be elevated in a sling or secured across the chest
c. the other arm is placed on a padded arm board or tucked
d. nonoperative leg is placed in a padded leg holder
e. operative leg is positioned in the traction boot
what procedures might you see where the fracture table is used?
- hip fracture
- hip: intramedullary rod insertion
- anterior hip arthroplasty
What is the position where the patient can be lying lateral or prone?
knee-chest
What 2 procedures do you see most commonly with knee-chest?
- hemorrhoidectomy
- pilonidal cyst removal
What is a variation in the prone position to maximize exposure for spinal surgery?
wilson frame
What happens to the chest and pelvis in the Wilson frame position?
chest and pelvis are slightly elevated
what kind of surgery occurs for the back in Wilson frame?
neurospine surgery
what kind of surgeries occur for the extremities in Wilson frame?
- surgery on the posterior aspect of the extremities
- rectal surgery
what kind of surgeries occur for the rectum in Wilson frame?
- hemorrhoidectomy
- pilonidal cyst removal
What patient population do you need to be extra careful with when it comes to positioning?
obese patients
