OR Flashcards
Leading cause of medical errors/patient harm
ineffective communication
Ineffective communication causes about ___ % of sentinel events.
70
Most common med errors
opioids
muscle relaxants
antibiotics
1 in ___ anesthetics are assoc. w/ an error
133
OR temp
when is it higher?
68-73 F
burns, peds, greater body exposure, trauma
Hypothermia risk factors
wound infxn
higher blood loss
impaired coagulation
OR humidity
30-60%
too low = greater airborne motility (infxn risk)
OR air exchange frequency
25x/hr
How loud can it get in the OR?
70-80 decibels
Fire Triad
Ignition source
Oxidizer
Fuel
Fire risk factors
- Increased risk w O2 concentration of 30% or greater
- Surgery above the xiphoid
- Laser surgery and surgery in the airway
- Alcohol-based skin preps that don’t dry
Fire prevention
*COMMUNICATION
*O2 <30%
*let alcohol dry
* Wet gauze around the area to prevent
* Turn O2 down for 2-3 min before surgeon needs cautery
Airway Fire
- Turn off gas source
- Stop vent
- Pull breathing tube
- Pour saline in the airway
- Reintubate
CO2 extinguisher
when to use
pros
Safe during external and internal exposure for fires in the OR
Nontoxic
readily dissipates
less likely to cause thermal injury
not liquid
Electric shock is produced by ___.
current
NOT VOLTAGE
What do line isolation monitors do?
- Continuously monitors the integrity of an isolated power system
- Does not provide complete protection from electrocution
alarms @ 2-5 mA
alarm = leak
Which is more common?
microshock
macroshock
macroshock
OR power is ____. Machines in the OR are ___.
(grounded/ungrounded)
OR = ungrounded
machines = grounded
Maximum harmless current
5 mA (miliamps)
Most common cause for macroshock?
damaged/faulty equipment wiring
Isolation transformer
isolates the operating room power supply from ground
T/F
You can use the outlets in the back of the anesthesia machine for equipment.
False
don’t plug stuff into the back of the machine
If the line isolation monitor starts alarming, what does this mean? Are we all gonna die?
alarms at 2-5 miliamps
reading is not the actual current flowing
it is how much current WOULD flow in the event of a second fault (a second fault could/would be bad)
does not indicate a hazardous situation
it indicates that OR is no longer isolated from the ground
If the line isolation alarms, do we unplug life support machines?
No
unplug all other nonvital equipment, as this may be reason for alarm
vital equipment can be safely used but do not plug in more equipment, as it can introduce a second fault
Electrosurgical Units (cautery)
- Doesn’t usually produce shock effects
- Remember placement of the return plate on the patient
- Bipolar cautery is usually used for much smaller/finer areas to have more control
When and how to disable cardiac implants
when cautery is used
placing a magnet over the AICD device during electroconvulsive therapy
Electrosurgical units can interfere with what other equipment?
ECG
CO
pulse ox
ALARP
as low as reasonably possible
(exposure to ionizing radiation)
Factors to protect from radiation
time
distance
sheilding
Can gas sampling lines be reused?
No
Whats the number 1 occupational hazard in anesthesia?
substance abuse
Macroshock starts at….
1+ mA
How much amperage is needed to cause vfib?
100 mA
Touching a faulty piece of equipment in the OR causes…
IPS (Instant Power Supply) to be converted into grounded system
What is needed to increase risk to macroshock?
a second piece of faulty equipment
T/F
The Line Isolation monitor prevents shock
False
only able to alert increased risk of shock
ground-fault circuit interrupter (GFCI)
monitors hot and neutral wires
ensures equal current flow
interrupts power if difference is detected
In the case of faulty equipment, current may flow thru the person touching it and trip the ____.
ground-fault circuit interrupter (GFCI)
GFCI trip: disconnects the current flowing through an unintended ground path (even if the current is too small to trip a typical circuit breaker)
Risks for hypothermia
Wound infection
increased intraoperative blood loss
impaired coagulation
What does a leak check of the machine’s low-pressure system evaluate? Why is this so important?
The integrity of the anesthesia machine from the flowmeters to the common gas outlet.
Important: Leaks in this circuit can lead to hypoxia and/or patient awareness
Does a manual positive-pressure leak test check the integrity of the unidirectional valves?
No
This test does not check the integrity of the unidirectional valves
What are the risk of hypothermia in the patient?
Wound infection
increased intraoperative blood loss
impaired coagulation
What if the humidity in the OR is too low or high?
Humidity too high: damp or moist supplies (contamination)
Humidity too low: increases incidence of static changes & airborne motility of particular matter (vector for infection)
*Maintained between 30-60% humidity
What should you do if there is fire on the patient?
Turn off gases
Remove drapes & burning materials
Extinguish flames with water, saline, or fire extinguisher
Assess pt’s status, devise care plan, assess for smoke inhalation
What should you do if the line isolation monitor’s alarm is activated?
Check gauge to determine if true or false alarm
Gauge reads > 5 mA = likely a faulty piece of equipment plugged into IPS
Identify fault equipment by unplugging each piece of equipment
Remove unneeded equipment from room
*If faulty piece is needed for life support then it can be safely used
What is a line isolation monitor (LIM)?
Continuously monitors the integrity of an isolated power system
Primary purpose: alarm if power system is no longer “ungrounded” due to faulty equipment.
If a faulty piece of equipment is connected to the IPS, this will change the system back to a conventional grounded system; the faulty piece of equipment will continue to function normally
Reading LIM indicates how much current would flow in the event of a first fault - it would require a second fault to create a dangerous situation
What is an isolation transformer?
Supplies underground power to OR
Uses electromagnetic induction to induce a current in the ungrounded or secondary winding of the transformer from energy supplied to the primary winding
Prevents shock from occurring in the OR by isolating the electrical power system and keeping it ungrounded
What are the OSHA occupational limits on radiation exposure?
OSHA dose limit for whole body radiation is 1.25 rem per calendar quarter
*not to exceed a 5-rem annual whole body-dose of ionizing radiation
How are various anesthesia equipment kept clean? (Airway equipment, anesthesia machine, face masks)
Wiped down in the morning and in between each case by cleaning staff.
Circuits/masks are replaced for every single pt
What are the CVC insertion, a-line insertion, and regional anesthesia precautions?
Sterile technique is maintained
Describe the fire triad?
Ignition: electrosurgical cautery, laser
Oxidizer: oxygen, nitrous oxide (Anesthesia)
Fuel: endotracheal tube, drapes, surgical supplies, surgical prep (alcohol, chlorhexidine)
What are the CDC Tier I and II precautions?
Tier 1: standard precautions - Used for all patients
Tier 2: transmission-based precautions for pts with known/suspected infections
Contact: gown + gloves
Droplet: mask for workers + mask on patient
Airborne: N95 masks for workers + mask on patient
How can you prevent an OR fire?
Keep inspired O2 low (< 30%)
Wet gauze around the area
Turn down O2 for 2-3 min before surgeon needs cautery
Communicate/Timeouts
When should you wash your hands in the operating room?
after induction
before and after entering OR
follow universal precaution
Discuss the one needle, one syringe, and one time campaign.
The CDC’s and SIPC’s campaign to provide guidance on safe infection and medication vial management to eliminate unsafe medical injections
What is the AANA’s position statement on infection control during an anesthetic?
Per AANA they “support patient safety through the use of evidence-based infection prevention and control practices”
What should you do if there is fire on the patient?
Turn off gases
Remove drapes & burning materials
Extinguish flames with water, saline, or fire extinguisher
Assess pt’s status, devise care plan, assess for smoke inhalation
What effects do the anesthetic gases have on the health care worker?
Studies have not shown any evidence
conflicting evidence
headaches, possible DNA damage due to exposure to high levels, cancer, miscarriage per Barash
How many air exchanges occur per hour in the operating room?
CDC: minimum of 15 total air change per hour
National Fire Protection Agency (NFPA): 25
At what temperature is the operating room usually maintained?
between 68-73°F
Kept warmer for: burns, large surface area exposed (i.e., plastic surgery), pediatric patients, trauma
