The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [614]
Safe manual handling and the safety of the patient depend on the participation of the correct number of staff in the specified handling manoeuvre. There should be a minimum of four staff: one at either end of the patient to support the head and the feet and one on either side. Additional staff may be required if the patient weighs over 90 kg.
Once the patient has been positioned safely, the intermittent compression device is attached. Figure 14.3 shows the Flowtron machine used in prevention of deep vein thrombosis in conjunction with VTE stockings.
Figure 14.3 Flowtron machine and boots.
Preprocedural considerations
Equipment
In the operating room the staff should ensure that all equipment is ready and checked before the first patient is sent for.
Anaesthetic machine and vital signs monitor: this allows the anaesthetists to administer the correct dosage of oxygen and air whilst the monitor displays what is happening to the cardiovascular system such as heartbeat, blood pressure and also the level of oxygen in the blood.
Suction unit (Figure 14.4): this is attached to the anaesthetic machine and will help in the event of obstruction or aspiration due to vomit.
Vaporizer: this is also attached to the anaesthetic machine and helps to administer inhaling anaesthetic agents. This allows the patient to remain asleep during the procedure.
Scavenging system: this absorbs and draws away all the anaesthetic gases that the patient exhales so it is important to ensure that this is operational. If it isn’t the exhaled gases would be released into the air and can be harmful to the staff (Beths 2006).
Operating table: as part of the equipment check, the operating table is assessed to ensure it is fully operational and performs all the required functions to enable correct positioning of the patient. It is also possible to adjust the height of the operating table in relation to the height of the surgeon and team to prevent any unnecessary strain on the back and neck. The power to the table is provided by a battery. This is charged overnight via the mains.
Diathermy machine: diathermy is used routinely during surgery to control haemorrhage by sealing bleeding vessels or cutting body tissues. It uses heat from electricity and this is achieved by passing normal electrical current through the diathermy machine and converting it into a high-frequency alternating current. There are two types of diathermy.
– Monopolar: this works by producing current from an active electrode such as diathermy forceps, which are insulated so that the skin does not come into contact with metal, and then returned back to the machine through another electrode such as a patient diathermy plate/pad. This creates a complete circuit.
– Bipolar: this does not require a patient diathermy plate/pad. It works by current coming from the machine down one side of the forceps prong, through the tissue and back to the machine through the other side of the forceps prong.
Figure 14.4 High vacuum suction unit.
Diathermy is potentially hazardous to the patient if used incorrectly. The main risk when using diathermy is of thermoelectrical burns. The most common cause is incorrect application of the patient plate or a break in the connecting lead (Vedovato et al. 2004) or if the patient is in contact with metal. The machine will automatically switch off or will alarm if the neutral electrodes become loose from the patient, but if the patient is in contact with metal this is a little harder to identify. To prevent these injuries, only equipment fitted with adaptive neutral electrodes should be used. It is important that all theatre nurses know how to test and use all diathermy equipment in their department to prevent patient injury (Molyneux 2001, Wicker 2000). This involves checking that the cables and plugs are not damaged and indicator lights are all in working order. It is also important to