PreOP,Prep, Practical Considerations – Flashcards

Operative Preparation Anesthesia o General, spinal, epidural, local (MAC) Position o Supine with arms extended on armboards Prep o Shave may be necessary, especially for the male patient. o Prep lower right or left quadrant, using umbilicus, symphysis pubis, and laterally as anatomical points of reference. Draping o Broadly square off quadrant with four towels o Laparotomy drape Practical Considerations Anticipate use of mesh, requiring additional sutures Anticipate if the hernia is strangulated that a bowel resection may need to be performed and cultures may need to be taken. Post Operative considerations Patient instructed not to strain.

Operative Preparation Anesthesia o General o Lubricate and protect patient eyes. o Local anesthetic may be used in conjunction with general anesthesia to minimize bleeding and postoperative pain. Position o Supine with thigh abducted and slightly flexed o 20 degrees reverse Trendelenburg o Lithotomy Prep o Insert Foley catheter, if ordered. o Shave may be necessary, especially for the male patient. o Prep from mid-chest to thighs and laterally as far as possible. Draping o Apply leggings, if necessary. o Anticipated surgical area is outline with towels secured with adhesive or towel clips. o Laparotomy sheet Practical Considerations X-rays and barium studies in room Check insufflators and video equipment prior to patient's arrival. Sterilize delicate items just prior to procedure, if necessary. Be prepared for rapid conversion to laparotomy, if complications arise. Post Operative Considerations Complications may include perforation dysphagia, necrosis of the wrap, infection, hernia, hemorrhage.

Operative Preparation Anesthesia o General o Lubricate and protect patient eyes Position o Supine Prep o Shave may be necessary, especially for the male patient. o Prep from mid-chest to thighs and laterally as far as possible. Draping o Anticipated surgical area (right lower quadrant) is outlined with towels secured with adhesive or towel clips. o Laparotomy sheet Practical Considerations Have a major instrument set available. Procedure can be performed via laparoscopic approach. Post Operative Considerations Complications may include hemorrhage, infection, intestinal obstruction due to adhesions, stump rupture.

Operative Preparation Anesthesia o General o Lubricate and protect patient eyes. Position o Supine Prep o Insert Foley Catheter, if ordered. o Shave may be necessary, especially for the male patient. o Prep shoulders to thighs and laterally as far as possible. Draping o Anticipated surgical area is outlined with towels secured with adhesive or towel clips. o Laparotomy sheet Practical Considerations Patient may be in shock. Notify blood bank of probable need. Prepare fluid pumps and solution warmers Perform cricoid procedure during induction of general anesthesia to prevent regurgitation and aspiration of stomach contents. ST should log how much irrigation fluid has been used. o Be prepared to communicate how many sponges and how much irrigation have been used. Post Operative Considerations Complications may include hemorrhage, intrahepactic hematoma, fistula, infection, hepatic artery pseudoaneurysm.

Operative Preparation Anesthesia o Spinal o General o Local Position o Jackknife (Kraske) o Lithotomy o Lateral Prep o Enema 1-2 hours preoperatively. o Shave may be necessary, especially for the male patient. o Benzion applied to buttocks. o Tape used for retraction of buttocks. o Formal prep may not be required. o Rectal area Draping o Small fenestrated sheet Practical Considerations Benzoin under tape protects skin; do not overuse. Post Operative Considerations Transport to PACU. Complications include pain, infection, hemorrhage, recurrence, and constipation.

Operative Preparation General anesthesia Supine position with foot board in place for reverse Trendelenburg after the trocars have been placed. Skin Prep from nipple line to symphysis pubis, sheet to sheet bilaterally. Endoscopy drape Practical Considerations Anticipate possible intraoperative Cholangiogram. Post Operative Consideration Foley catheter is typically removed prior to patient waking. Patient may experience referred pain to shoulder due to CO2 distention. Complications may include: o Gas or air embolism Pressures higher than 15mm Hg may result in bradycardia or a change in blood pressure or may force a gas embolus into an exposed blood vessel during the operative procedure. o Hemorrhage o Infection o Ileus o Atelectasis o Damage to hepatic artery o Damage to CBD

Operative Preparation Anesthesia o General o Lubricate and protect the patient's eyes Position o Supine o Arm on affected side may be on armrest Prep o Chest o Neck o Axilla o Arm (circumferential) Draping o Anticipated surgical area is outline with towels secured with adhesive or towel clip. o Chest/breast sheet o Draping of arm includes placement of a sheet on the armboard and application of a stockinette over the entire arm. Practical Considerations Have mammogram in the room. Notify pathology if frozen section will be required. Post Operative Considerations Complications may include hemorrhage, infection, impaired arm motion, lymphedema, seromas, hematoma formation, skin necrosis and numbness of anterior chest wall and skin.

Operative Preparation General anesthesia Supine position Prep is from nipple line to symphysis pubis and bilaterally. Depending on length of surgery the patient may be catheterized. Laparotomy Drape

Special Considerations Often a bowel prep is done prior to surgery to cleanse the bowel of fecal matter and bacteria. Special precautions are taken to prevent contamination of the field by the bowel contents. o Once the bowel has been opened, the team members must use a "bowel technique". All contaminated instruments, sponges and other equipment are kept separate from equipment that is used for closure. Operative Preparation General anesthesia Supine Prep nipple line to symphysis pubis. Laparotomy drape Post Operative Considerations Possible complications may include leakage from anastomosis, infection, and wound dehiscence.

Post Operative Considerations The patient's voice will be checked as soon as possible. Have tracheotomy tray available (if nerve is damaged or cut the patient may have difficulty breathing). Complications include hemorrhage, infection and damage to nearby structures.

Operative Preparation Anesthesia o Anesthesia of choice is an epidural anesthetic. o May be performed with general, spinal, or local anesthetic Position o Supine position with a roll placed under the right hip to keep uterine pressure off the vena cava Prep o Abdominal prep plus vagina and inner thighs o Foley catheter inserted if not already in place. Draping o Laparotomy (specialized C-section drape may be needed)

Operative Preparation Anesthesia o General anesthetic preferred o May be performed under regional block Lithotomy Position Vaginal prep Lithotomy Draping Practical Considerations Preoperative sonography may be done Post Operative Considerations Complications may include perforation, lacerations, bleeding and infection.

Operative Preparation General Anesthesia Lithotomy Position Vaginal prep Lithotomy Draping Practical Considerations Check all equipment prior to the patient's arrival Post Operative Considerations Surgeon will ask for amount of fluid returned in suction. o Rate of flow and total fluid volume should be monitored throughout the procedure. Complications could include gas or air embolism, laceration of cervix and rupture.

Operative Preparation General Anesthesia is preferred but may be performed with local anesthetic. Position o Modified lithotomy o Hip flexion constrained to 45 degrees o Patient's buttocks must clear the operating table by approximately 4 inches. o Grounding pad usually placed on thigh o Trendelenburg position at about 15 degrees Prep o Laparotomy plus vaginal prep Draping o Laparotomy plus lithotomy may be used. o One-time urethral catheterization performed prior to prep. Practical Considerations Check all equipment prior to the patient's arrival. Separate field will be necessary if vaginal access is necessary. Post Operative Considerations Complications may include perforation, hemorrhage or infection.

Operative Preparation General Anesthesia Supine Position Abdominal and vaginal prep Probable placement of indwelling catheter Laparotomy draping Post Operative Considerations Complications may include damage to bowel, bowel obstruction, bladder injury, infection, ureteral injuries and hemorrhage. Vaginal Hysterectomy Involves the same structures as the abdominal hysterectomy; however the structures are encountered in the reverse order.

Operative Preparation General Anesthesia Low lithotomy position with Allen stirrups Abdominal and vaginal prep, and catheterization Draping o Drape sheet under the buttocks o Leggings o LAVH Laparoscopic drape sheet (may have attached leggings) Practical Considerations Check all equipment and supplies prior to patient's arrival. Post Operative Considerations Complications may include: o Hemorrhage o Failed LAVH and conversion to laparotomy o Injury to major blood vessels o Bowel, urethral or bladder injury o Wound infection o Hernia at trocar site o Fistula formation

Practical Considerations Informed consent is extremely important since this is a permanent method of sterilization/some states may require the husband to also sign the consent. After a vaginal delivery, tubal ligation is done on the first or second postpartum day. If a cesarean delivery is done, the tubes may be ligated at that time. Operative Preparation General anesthesia Modified Lithotomy position Prep abdominal and vaginal prep Drape is laparotomy with lithotomy One time catheterization must be done to empty the bladder A separate field will be necessary for the vaginal set up Post Operative Considerations Complications may include hemorrhage, infection, perforation of viscus and damage to other structures.

Operative Preparation Anesthesia o General, spinal, or local anesthesia can be used depending on the extent of the operative procedure. Position o Patient is supine. o End of the OR table may be lowered according to surgeon's preference. o Padded lateral post is attached to the side of the OR table approximately at the level of the mid-thigh of the operative leg to facilitate placing countertraction on the knee join to open the medial side. o Tourniquet is applied prior to prep and is inflated at surgeon's request. Prep o Affected leg - circumferential Draping o Lower extremity draping method Practical Considerations Prior to prep, surgeon will perform an examination under anesthesia (EUA) to confirm diagnostic findings. Have X-rays or MRIs in OR. Notify radiology of possible intraoperative X-ray. Have C-arm near OR. Follow radiology safety procedures. Notify orthopedic technician if external stabilization methods are needed post operatively. Check monitors, camera and light source. Apply tourniquet preoperatively but do not inflate until surgeon requests. Arthroscopy pump tubing must be primed prior to use. Post Operative Considerations Observe for local hemorrhage Complication could include wound infection

Operative Preparations General or regional anesthesia Position supine with tourniquet applied to the proximal portion of the thigh Prep from foot to mid calf or thigh, circumferentially Extremity drape is used Post Operative Considerations Complications include risk of infection. Recovery is a minimum of 6 weeks.

Operative Considerations General or regional anesthesia Supine position Prep upper extremities Upper extremity draping method Practical Considerations Have X-rays or CT scans in OR Notify radiology of possible intraoperative X-ray Have C-arm in OR Follow radiology safety procedures.

Operative Preparation General anesthesia Supine position with a roll towel used as a bump under the scapula of the affected side. o Arm is positioned on a hand table. Prep includes hand, entire arm, and past the shoulder up to the border of the neck in case the incision has to be extended. Upper extremity draping method Practical Considerations Have X-rays or MRIs in OR Notify radiology of possible intraoperative X-ray. Have C-arm in OR. Follow radiology safety procedures. Notify orthopedic technician Post Operative Considerations Patient's arm is placed in a sling. Splint may be applied. Complications may include hemorrhage, infection and nerve injury.

Operative Preparation Anesthesia o General o Scalene block may be administered preoperatively to aid with postoperative pain. Position o Supine of semi-Fowler's o Roll under scapula on affected side Prep o Wrist, arm, shoulder region, and a portion of the anterior chest Large extremity draping method Practical Considerations Have X-Rays or MRIs in OR. Notify radiologist if possible intraoperative X-ray. Have C-arm near OR. Follow radiology safety procedure. Post Operative Considerations Complications include hemorrhage, infection. Patient will require postoperative rehabilitation.

Operative Preparation Regional or general anesthesia Position supine on fracture table Entire leg is prepped, circumferentially, waist to mid-calf/ankle Large see-through drape that hangs from overhead pole Practical Considerations Suction and Bovie are handed up over the pole to the circulator. Bovie and suction are secured to the hanging drape. Post Operative Considerations Weight bearing may begin as early as the first postoperative day, dependent on patient condition. Complications may include hemorrhage, infection.

Operative Preparation o General anesthesia; may receive a block as well for pain relief post operatively o Positioned laterally (with use of a vacuum beanbag) or most often in a "beach chair" position (special shoulder table may be used) o Prep includes the base of neck, shoulder, scapula, chest to midline, and circumference of the arm up to the level of the elbow. o Drape includes special shoulder draping which allows full range of motion during the procedure. Practical Considerations o Fluid may leak onto the floor during the procedure and the ST should anticipate the use of a device to suction up the water collecting on the floor Post Operative Considerations Patient must keep arm in the sling so as not to disrupt any repairs that may have been completed.