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A latex-free contents box or trolley (this holds stock of all latex-free products that will be required during surgery and anaesthetic) should be ready in every theatre department and recovery room. There should be a list of all latex-free equipment with the manufacturers listed available in the box or trolley.

Notify surgeon if no alternative product is available.

Notify anaesthetist if latex-containing product to be used and develop plan of emergency care if necessary.

Where a type I (immediate hypersensitivity reaction) allergy is suspected, suitable clinical management procedures must be ready for use in the event of the patient having a hypersensitivity reaction.

(AORN 2004)

Further guidance may be sought from the Association of Peri-operative Registered Nurses (AORN) proposed latex guideline at www.aorn.org/proposed/latex.htm.com.

Preoperative theatre checklist

The preoperative checklist (see Procedure guideline 14.2 and Figure 14.1) is the final check between the ward and the operating theatre and should be completed as fully as possible to reduce the possibility of any complications during the period that the patient is put under anaesthetic or during surgery itself.

Figure 14.1 Preoperative assessment care plan.

One item on the list is ensuring that blood results and X-rays or imaging accompany the patient. The blood results are important for assessing patient haemoglobin levels which will help in transporting oxygen and also the electrolytes to identify any imbalances such as low sodium or potassium as these can interfere with anaesthetic agents and can cause cardiovascular disturbances such as arrhythmias (see Tables 14.1 and 14.2).

Table 14.1 Haematology values

Test Reference range Functions/additional information

RBC Men: 4.5–6.5 × 1012/L

Women: 3.9–5.6 × 1012/L

The main function of the RBC is the transport of oxygen and carbon dioxide

Hb Men: 13.5–17.5 g/dL

Women: 11.5–15.5 g/dL

Haemoglobin (Hb) is a protein pigment found within the RBC which carries the oxygen

Anaemia (deficiency in the number of RBC or in the Hb content) may occur for many reasons. Changes to cell production, deficient dietary intake or blood loss may be relevant and need to be investigated further

WBC Men: 3.7–9.5 × 109/L

Women: 3.9–11.1 × 109/L

The function of the white blood cell (WBC) is the defence against infection

There are different kinds of WBC: neutrophils, lymphocytes, monocytes, eosinophils and basophils

Leucopenia is a WBC count lower than 3.7 and is usually associated with the use of cytotoxic drugs

Leucocytosis (high levels of neutrophils and lymphocytes) occurs as the body’s normal response to infection and after surgery

Leukaemia involves an increased WBC count caused by changes in cell production in the bone marrow. The leukaemic cells enter the blood in increased numbers in an immature state

Platelets Men: 150–400 × 109/L

Women: 150–400 × 109/L

Clot formation occurs when platelets and the blood protein fibrin combine. A patient may be thrombocytopenic (low platelet count) due to drugs/poor production or have a raised count (thrombocytosis) with infection or autoimmune disease

Coagulation/INR INR range 2–3 (in some cases a range of 3–4.5 is acceptable) Coagulation occurs to prevent excessive blood loss by the formation of a clot (thrombus). However, a clot that forms in an artery may block the vessel and cause an infarction or ischaemia which can be fatal

Aspirin, warfarin and heparin are three drugs used for the prevention and/or treatment of thrombosis

It is imperative that patients on warfarin therapy receive regular monitoring to ensure a balance of slowing the clot-forming process and maintaining the ability of the blood to clot

Table 14.2 Biochemistry values

Test Reference ange Functions/additional information

Sodium 135–145 mmol/L The main function of sodium is to maintain extracellular volume (water stored outside the cells), acid/base balance and the transmitting of nerve impulses

Hypernatraemia (serum sodium >145 mmol/L) may be an indication of dehydration