The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [615]
Other causes of burns include skin preparation solutions or other liquids pooling around the plate site (Fong et al. 2000). With alcohol-based skin preparations especially, the skin should be allowed to dry before diathermy is used, as the alcohol can ignite (Fong et al. 2000).
If the patient’s position is changed during the operation, the diathermy patient plate should be rechecked to ensure that it is still in contact and that the connecting clamp or lead is not causing pressure in the new position. Use of diathermy and the plate position should be noted on the nursing care plan and the patient’s skin condition (plate site, pressure areas, and other areas where exposure to metal could have occurred) should be checked before the patient is transferred to the recovery unit.
The use of an electrosurgical diathermy unit during surgical procedures results in a smoke by-product from the coagulation or cutting of tissue. This smoke plume can be harmful to the perioperative personnel because it can contain:
toxic gases and vapours such as benzene, hydrogen cyanide and formaldehyde
bio-aerosols
dead and live cellular material, including blood fragments
viruses.
(Allen 2004)
To reduce the risk to staff and patients, an efficient filtered evacuation system should be used, such as a smoke evacuation machine; piped hospital suction must not be used (Scott et al. 2004).
The suction unit is also checked to ensure that it is patent and the suction power is adequate to withdraw excessive bodily fluids from the operating site. This is a mobile unit which has the ability to allow high suction power.
The operating lights need to be bright enough to ensure that the procedure is fully illuminated. These are checked to ensure they are bright and all the lamps are in working order prior to every operation.
The Flowtron machine is the intermittent compression device which is used in prevention of DVT in conjunction with VTE stockings.
Equipment for laparoscopy procedure
Camera system (consisting of light source, camera, insufflator, DVD recorder and monitors × 2). See Figure 14.5.
Laparoscope.
Laparoscopy-specific instruments (scissors, biopsy forceps, grabbers, dissectors, ports, retrieval pouches, insufflating tube, light lead). See Figure 14.6.
Figure 14.5 Laparoscopy equipment.
Figure 14.6 Laparoscopic equipment.
The equipment used for laparoscopic surgery is very specialized. The AORN recommends that all equipment is regularly and competently maintained and a maintenance record kept in a log (AORN 2000, Wicker and O’Neill 2006). Policies should be developed for the checking procedure, and all staff thoroughly instructed in the operation of laparoscopic equipment. The staff must be able to ‘white balance’ the camera to ensure clarity of colour and picture (this is done before use) and set the pressure and flow rate of the insufflator for insufflating the abdomen with carbon dioxide. The surgeon will determine the level to achieve and this will be activated at the beginning of the procedure.
Procedure guideline 14.4 Operating theatre procedure
Procedure
Action Rationale
1 Prior to transferring the patient from the trolley to the operating table, check with the anaesthetist that the patient’s airway is protected, patent and safe. To prevent complications with breathing. E
2 Ensure that there are adequate staff to transfer the patient onto the operating table. Ensure the brakes on the trolley and operating table have been applied. Ensure the patient’s head and limbs are supported when transferring to the operating table. To prevent patient injury during the transfer between trolley and operating table (AORN 2001, C).
3 When transferring the patient, ensure all limbs are supported and secure on the table. Ensure adequate padding and cushioning of bony prominences. The patient’s position will be dictated by the nature of the surgery but must take into account the requirements of the anaesthetist and the physical needs