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PubMed2000

Applying the health care industry representative statement to your setting. Association of periOperative Registered Nurses.

AORN values the role our industry partners play in the care of our patients. Table 3 is an example of a policy on the health care representative in the OR. This article is meant to assist perioperative nurses in writing policies that enhance the role of the health care industry representative in the OR, promote collegial relationships with an important player on the team, and preserve patient safety and privacy.

Humans↗
PubMed1991

Glaucoma. Classifications, treatment options, patient care.

Advances in pharmacology, cell biology, and laser and fiberoptic technology are providing many opportunities in glaucoma research. As researchers increasingly understand the physiology of the eye, they develop new therapies. A wide variety of new drugs including dopaminergics, calcium channel blockers, and prostaglandins are under investigation for glaucoma treatment. The THC:YAG laser is being developed to perform thermal sclerotomy and may eliminate much of the risk associated with standard filtering surgery. Biologic, anatomic, and biochemical studies of the trabecular meshwork are leading to greater understanding of aqueous humor formation, aqueous humor outflow in the normal eye, and aqueous humor flow resistance in the glaucomatous eye--knowledge that eventually could provide preventive measures or eliminate glaucoma entirely.

Drug Therapy↗
PubMed1998

Lymphatic mapping and sentinel node biopsy. New technology for women's health.

The current surgical standard of care for the management of invasive breast cancer is the complete removal of the cancer with documented negative margins by either mastectomy or lumpectomy followed by complete axillary lymph node dissection. These procedures can be associated with significant morbidity which leads to increased hospitalizations, increased overall costs and considerable discomfort and life-style changes for the patients. With sentinel node identification and biopsy, patients with probable negative lymph nodes may avoid axillary dissection, and easily be treated as outpatients.

Biopsy↗
PubMed2002

Massive transfusion exceeding 50 units of blood products in trauma patients.

BACKGROUND: Massive transfusion of blood products in trauma patients can acutely deplete the blood bank. It was hypothesized that, despite a large allocation of resources to trauma patients receiving more than 50 units of blood products in the first 24 hours, outcome data would support the continued practice of massive transfusion. METHODS: A retrospective review of charts and registry data of trauma patients who received over 50 units of blood products in the first day was conducted for a 5-year period at a Level I trauma center. Patients were stratified into groups on the basis of the number of transfusions received. Results are expressed as mean +/- SD. Univariate analysis and multivariate logistic regression were used to identify those risk factors determined in the first 24 hours after admission that were predictive of mortality. Physiologic differences between survivors and nonsurvivors were also examined. RESULTS: Of 7,734 trauma patients admitted between July 1, 1995, and June 30, 2000, 44 (0.6%) received > 50 units of blood products in the first day. Overall mortality in these patients was 57%. There was no significant difference (p = 0.565, chi2) in mortality rate between patients who received > 75 units of blood products in the first day versus those who received 51 to 75 units. Multiple logistic regression analysis identified only one independent risk factor, base deficit > 12 mmol/L, associated with mortality. Base deficit > 12 mmol/L increases the risk of death by 5.5 times (p = 0.013; 95% confidence interval, 1.44-20.95). Neither the total blood product transfusion requirement in the first day nor the packed red blood cell transfusion amount in the first day were significant independent risk factors. Causes of the 25 deaths in this series included exsanguination in the operating room (n = 1) or in the surgical intensive care unit (n = 12), multiple organ failure/sepsis (n = 3), head injury (n = 3), respiratory failure (n = 2), cerebrovascular accident (n = 1), and other (n = 3). Of the survivors, 63% were discharged to home, 21% to rehabilitation, 11% to nursing home, and 5% to another acute care facility. Of the nonsurvivors, the mean Injury Severity Score was 43, 88% had a base deficit > 12 mmol/L, 68% had a Glasgow Coma Scale score < 8, and 64% had a Sequential Organ Failure Assessment score > 10. CONCLUSION: The 43% survival rate in trauma patients receiving > 50 units of blood products warrants continued aggressive transfusion therapy in the first 24 hours after admission.

Adult↗
PubMed1984

Two Broviac catheters for intensive long term support of patients with cancer.

Two Broviac catheters were placed simultaneously in 93 patients who required prolonged intravenous support while receiving chemotherapy or a bone marrow transplant. The technique involved two venotomies in a single vein and was performed under local anesthesia in the operating room. Pancytopenia was not considered a contraindication. Blood sampling and intensive treatment with blood products, chemotherapy, parenteral nutrition and multiple antibiotics were facilitated by these durable, well-tolerated Silastic catheters. Patients were taught to care for them following discharge, and the majority of catheters were used for outpatient treatment. The few complications encountered were compensated for by the convenience and safety of the double Broviac method. The danger of chemotherapy extravasation was completely obviated, as were the complications of repeated central line insertion, and the anxiety and pain associated with multiple unsuccessful attempts at venipuncture. Because of the enthusiastic acceptance of long term Silastic catheters by patients and nursing staff, we regard this technique was a step forward in solving the problem of difficult vascular access in cancer patients.

Catheterization↗
PubMedDate not supplied

Implications of transplantation surgery for theatre nurses: 2.

In the first part of this article (Vol 5(7): 400-3), potential difficulties for theatre staff in relation to organ retrieval for transplantation were explored. This second part examines how the death of patients can be a major cause of stress for nurses. It focuses on work which suggests that lack of peer support among nurses and the perception that nurses should always appear to be 'coping' are common features which can prevent nurses from asking for, and receiving, support. Possible mechanisms are explored for ameliorating some of the stress that staff experience in association with this work. These include the role of managers and transplant coordinators in supporting nurses involved in transplantation work, reiterating (to staff) the benefits of transplantation surgery for recipients, and the possibility of debriefing staff after surgery. It recommends that more thought should be put into preparing and supporting theatre staff involved in transplant work.

Attitude to Death↗
PubMed1989

Transcutaneous cardiac pacing: expanding clinical applications.

Transcutaneous cardiac pacing is an exciting alternative to invasive endocardial pacing methods for the treatment of hemodynamically significant bradyarrhythmias. Prompt institution of a pacing support system is crucial for improving outcomes in this patient population. Recent advances in technology and microcircuitry have eliminated the problems of painful, musculoskeletal stimulation and excessive distortion of the ECG signal associated with earlier devices. The ease of application and simplicity of operation associated with this technique make it ideally suitable for employment in the emergent situation, especially in the prehospital setting. The noninvasive nature of this technique is particularly beneficial for patients receiving thrombolytic therapy who are at risk for developing reperfusion dysrhythmias. Prophylactic use of transcutaneous pacemakers in a variety of clinical situations, such as atrioventricular blocks, may eliminate the need for transvenous electrode insertion and its related complications. A transcutaneous pacing system with the capability of functioning in the demand mode should be readily available in emergency rooms, intensive care units, and telemetry floors. Although unlikely to replace transvenous methods, the growing popularity of this technique has many implications for the nurse in the critical care setting.

Cardiac Pacing, Artificial↗
PubMed2002

Carotid artery stenosis and endarterectomy.

This article reviews the disease process of carotid artery stenosis, its symptomatology, and prognosis for progression to ischemic stroke. Indications for both medical and surgical treatment are reviewed as is criteria for surgical categorization as specified by the American Heart Association guidelines for carotid endarterectomy. Although diagnostic testing, medical treatment and alternative therapy options of angioplasty, stenting and thrombolysis are presented, a thorough overview of the surgical procedure of carotid endarterectomy is the major focus of discussion, as it remains the "gold standard" of treatment for severe carotid artery stenosis.

Carotid Stenosis↗
PubMedDate not supplied

Head trauma. Perioperative nursing implications.

1. The highest mortality rate in the adult trauma patient population is among those presenting with acute head trauma and associated multiple trauma. 2. Motor vehicle crashes are the leading cause of head trauma, with alcohol being a primary associated factor. The other major mechanisms of head trauma are falls and assaults. 3. Secondary brain injury is a result of brain swelling and intracranial hemorrhage causing hypoxia and ischemia of the brain tissue. 4. The goals of surgical intervention are to evacuate intracranial hematoma and prevent increases in intracranial pressure.

Craniocerebral Trauma↗
PubMed2002

Effect of jewellery on surface bacterial counts of operating theatres.

Twenty items of three jewellery types were studied. Finger rings, nose and ear piercings increased local surface bacterial counts when in situ, and especially after removal (P<0.0001). Although in the UK the National Association of Theatre Nurses' guidelines suggest that all jewellery should be removed before scrubbing, we suggest that jewellery worn on noses and ears should be left in situ and covered by masks and hats, respectively. The effect of jewellery on skin disinfection needs further study before guidelines can be made concerning finger rings.

Bacteria↗
PubMed1988

Total temporal bone resection. A radical but life-saving procedure.

Traditional therapeutic approaches for malignancies of the temporal bone have produced unacceptably low survival figures. The morbidity and mortality associated with temporal bone cancer justify extensive surgery. Total temporal bone resection can be performed successfully in the hands of an experienced skull-base surgical team. By circumscribing the tumor rather than transgressing it, this procedure follows generally accepted principles of oncologic surgery. This procedure also shows promise in resection of extensive, carefully selected, recurrent benign tumors. We believe this approach offers hope for improved survival in patients with malignancy of the temporal bone. Further refinements in technique are suggested by each new case. Additional experience and long-term follow-up are needed to assess the efficacy of this procedure. The interest, expertise, and active participation of the operating room nursing team are critical to the success of this surgery. Ideally, not only intraoperative participation but also preoperative assessment and postoperative support should be routine. Close cooperation and extensive communication among the surgeons and nurses are essential.

Adult↗
PubMed1982

Automatic vs manual injections for thermodilution cardiac output determinations.

To investigate the effects of operator variability on thermodilution cardiac output determinations, a group of physicians and nurses made a series of manual indicator injections and automatic injections using a gas powered injector in a simulated clinical situation. The data show significant variability in injection time, injectate flow rate, consistency of injection, and cardiac output values obtained during manual injections. There was little variability in these parameters during automatic injections. When other variables are properly controlled, the automatic injector may improve the precision of cardiac output measurements by controlling the consistency of injection and variables introduced by different operators performing manual injections. However, despite significant variation in parameters associated with manual injection, it is interesting to note that 8 out of 10 operators obtained cardiac output values by hand injection using room temperature injectate, which did not differ significantly from those obtained by automatic injection.

Animals↗
PubMed2006

The naked researcher. Stripping research down to its bare essentials.

The Siobhan Rankin Lecture is given each year at Congress in memory of a previous Chair of the Association. Individuals invited to give this lecture are experts within their chosen fields. In 2005 Professor Judith Tanner was asked to describe her work in encouraging perioperative practitioners to undertake research in clinical practice. This paper is based on Professor Tanner's presentation.

Attitude of Health Personnel↗
PubMed1993

Blood contact and exposures among operating room personnel: a multicenter study.

Blood exposures are increasingly recognized as a risk for health care workers in the operating room. Trained circulating nurses supervised by site coordinators queried surgical team members about blood contact and collected data on 8502 surgical procedures from seven community and two university hospitals in 1992. Blood contact occurred during 864 cases (10.2% case-contact rate) in 1054 health care workers (12.4% person-contact rate). The parenteral exposure (punctures or cuts, mucous membranes, nonintact skin) rate was 2.2% and the cutaneous exposure (intact skin) rate was 10.2%. Blood contacts were twice as likely to be parenteral among surgeons as among other operating room personnel (odds ratio, 2.0; 95% confidence interval, 1.4 to 2.9). Of cutaneous exposures, 46.9% were from unknown sources or were surprise spatters. Logistic regression analyses indicated that risk factors associated with any blood contact (parenteral or cutaneous) were length of procedure (odds ratio, 1.51; 95% confidence interval, 1.46 to 1.56), emergency versus scheduled status (odds ratio, 1.44; 95% confidence interval, 1.21 to 1.66), selected surgical services, and the hospital. Logistic regression analyses of parenteral exposures, as compared with cases in which no contact occurred, indicated that risk factors were length (odds ratio, 1.39; 95% confidence interval, 1.31 to 1.47), thoracic surgery (odds ratio, 2.79; 95% confidence interval, 2.18 to 3.40), and university hospital versus community (odds ratio, 2.26; 95% confidence interval, 1.89 to 2.63). Parenteral exposures are clear risks to health care workers; however, it is also important to study all contact with blood in the operating room to appreciate potential risks and develop appropriate intervention strategies.

Blood-Borne Pathogens↗
PubMed2003

[Improving the quality of work life. Awkward and strained postures among scrub nurses].

Latest statistics show worrying figures about labour accidents and illnesses in surgical nursery, due to the lack of preventing measures or unsuitable working conditions. Actually the duties of a scrub nurse bring an important static physical burden and the fulfilment of reiterative movements, as well as environmental conditions that may raise the provability of the development of skeletal muscular diseases in a medium-long time. In order to monitor the correct accomplishment of preventing rules related to working postures and the handling of heavy loads and identify risk factors that may lead to these disorders and asses symptoms related to inadequate positions and/or heavy efforts, a descriptive quantitative study was carried out over 24 theatre nurses from 2 hospitals in Murcia. According to the gathered information, analysed with the statistic program SPSS, the adopted measures to avoid risks are inadequate and insufficient. The inquired population adopt unsuitable postures in a high proportion moreover, what let us establish a significant correlation with the obtained information referred to the posture adopted. As a result, we cannot any longer state that scrub nurses are undergoing the established preventive rules in order to avoid those symptoms associated to the kind of job they carry out. To sum up we believe as very necessary to improve the scrub nurses' quality of work life, the removal of risk factors and the supply of suitable instrumental, drawing up a protocol of safety and working behaviours as well as offering seminars to teach that protocol.

Adult↗
PubMed1992

Development of a computerized database for the study of anaesthesia care.

To record, tabulate and report problems associated with anaesthesia, we have developed an information collection system and computer software to follow all patients attended by an anaesthetist at a teaching hospital in Canada. For the last 15 mo, data for 17,000 patients have been collected and the system is ongoing. Data collection is from three sources: carbonless copies of the handwritten Operating Room (OR) and Post Anaesthetic Care Unit (PACU) records, other hospital databases, and postoperative visits. Adverse events (observations which differ from specific physiological variables, or require an intervention and do not normally occur during the routine conduct of anaesthesia), are defined directly on each OR and PACU record. These events are recorded when they occur by the attending anaesthetist or the PACU nurse. All data are verified by a research nurse and an anaesthetist. Computer software, developed from DBase IV, is used to track 95 individual items on preoperative status and anaesthetic technique and another possible 1,450 selections for drugs, physicians, airways, surgical procedures and events for each patient. Data are analyzed with SAS software and reports generated to link the casemix and process with outcome. Comparison of data entered into the computer programme to a retrospective chart review revealed discrepancies of less than 0.5%. Collection, verification and computer entry takes five minutes per patient and the on-going cost is estimated at $4 per patient record. Analysis of the information collected in this database has been useful for research of adverse outcome following anaesthesia, resident expertise profiles, and the administrative management of an anaesthesia department.

Anesthesia Department, Hospital↗
PubMed2006

Health care-associated infections.

BACKGROUND: The incidence of postoperative infections in surgery can be reduced by 20% to 34% through adoption of "safe" patient care practices. Moreover, some of the recently highlighted epidemiologic features of infections in surgery, such as the increasing prevalence of antibiotic-resistant organisms, are strongly associated with questionable clinical choices. In recent years, several governments and scientific institutions have launched initiatives aimed at improving the safety of surgery, a key component of which is the availability of surveillance data. METHODS: In 2003, an audit was performed in the Emilia-Romagna region of Italy on a random sample of general, orthopedic, and gynecologic surgical units to explore the knowledge, perceptions, and practices of surgeons and nurses regarding control of surgical site infections (SSI). RESULTS: The Emilia-Romagna regional audit found good agreement between the infectioncontrol standards and knowledge (70%), claimed practices (73%), and observed practices (78%). Surgical hand antisepsis was applied consistently, and surgical attire was used widely, but surgeons and nurses paid little attention to keeping operating room doors closed and limiting the number of people. Handwashing and sterile technique for postoperative incision care were the recommendations least frequently followed. CONCLUSIONS: Greater attention to proven methods of infection control and availability of surveillance data should reduce the incidence of SSI.

Cross Infection↗