Operating Room Technique - The Carter Center
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Operating Room Technique - The Carter Center
The minimally invasive procedure was performed completely in the catheterization (cath) lab without making any surgical incisions in the operating room. By the evening of the procedure, Carter had already recovered and was back to his baseline.
The center also houses five hospital-type rooms with a whiteboard near each patient that provides opportunities for students to share pertinent information and plans of care. A four-bed bay area replicates a post-anesthesia care unit (PACU) for post-operative recovery, an infusion center for chemotherapy, a neonatal intensive care area, or a trauma bay.
Emphasis on oxygen delivery is critical not only because of increasing flammability but also because of increased rates of injury when operating close to an oxygen source and/or airway. A review of operating room fire claims found that 85% of fires occurred in the head, neck, or upper chest, and 81% of cases occurred with monitored anesthesia care.4 These fires are typically attributed to increases in oxygen content at the surgical site.
Another novel solution may be the use of closed-loop oxygen titration to adjust the delivered Fio2 to the lowest possible amount. There has been considerable research in closed-loop oxygen delivery in order to reduce oxygen consumption in austere environments, reduce hyperoxia, reduce hypoxia, and offer earlier intervention in acute lung injury. This technology may also be applicable in preventing operating room fires, but implementation remains far in the future.32,33
One additional ignition source warrants specific mention due to its increasing use: the fiberoptic light cord. This cord is utilized during laparoscopic and robotic procedures and, when not in standby mode, can rapidly burn through drapes and cause thermal injury to patients.44 In the appropriate setting, it is feasible these cords could ignite an operating room fire, and care must be taken to ensure that they are in standby mode when not in use.
Hair clipping can be easily performed immediately prior to procedures and has been promoted as a technique to decrease infection risk as well as the risk of operating room fires. While hair clipping does decrease the risk of surgical site infection when compared to preoperative shaving, there is minimal evidence to suggest that hair removal itself decreases the risk of surgical site infection or operating room fires.47,48 As an alternative, the Association of periOperative Registered Nurses recommends the use of a nonflammable gel to isolate hair that is not clipped in order to decrease the risk of fire.23
A fire in the operating room is a terrifying event, but it can be stopped quickly with early identification and management. In addition to a fire risk assessment and checklist before surgery, cognitive aids such as emergency manuals have been successfully used during both training and emergencies to improve team performance in times of duress.68,69 In contrast to many emergencies (e.g., cardiac arrest), immediate action is required when a fire is identified; thus, cognitive aids may be of benefit in training alone in this regard.
Free cognitive aids are available from the Anesthesia Patient Safety Foundation and the Emergency Care Research Institute for training, as well as handouts and signage for rapid review in the operating room.8,70 The American Society of Anesthesia published a Practice Advisory in 2013 regarding operating room fires that includes an algorithm from basic risk assessment through management of the fire itself.7 These algorithms distill the key points into a single piece of paper that should be reviewed at least annually by the operating room team in order to adequately prepare for a surgical fire (fig. 4).
When there is suspicion of a fire by any member of the team, the surgery should be stopped immediately. Rapid identification is key and can be problematic with alcohol-based prep fires as they exhibit a light blue flame that is difficult to visualize alongside blue surgical drapes. Besides the obvious heat and smoke, fires may also be preceded by unusual sounds, odors, or patient complaints. Once a fire is identified, the following tasks should be performed almost simultaneously by all members of the operating room team71 :
The operating room has many unique circumstances that make elimination of the fire triad difficult.53 Many surgical drapes are water-resistant and repel water and must be submerged after their removal to completely extinguish flames.72 Fires that occur within a body cavity require dousing with saline or sterile water and should not be extinguished with fire extinguishers.53 Of importance, fire blankets should not be used in the operating room since they can concentrate both heat and oxygen on the patient, potentially worsening the fire.73
Surgical fires also present a unique microcosm of modern medicine. They are rare events that need a systemic approach to prevent and study, yet because of their rarity, interventions are difficult to assess. New safety solutions may have unintended effects. For example, regulations to protect against fire in hospitals in France have been revised five times in the past 8 yr, despite few data on whether these regulations have improved fire safety as opposed to simply making the system more unwieldy.75 The system needs to abandon some professional autonomy, have system-level arbitration to optimize safety strategies, and simplify the system; however, these barriers need to be addressed in a successive manner. Prevention of operating room fires will also require these barriers to be overcome in order to truly decrease risk for all involved in patient care.
Surgical fires are a rare but devastating complication that can occur in surgical or endoscopic procedures. Knowledge of the three ingredients for a fire (oxygen, heat, and fuel) and their sources in the operating room are key to decreasing the fire risk. Constant preparation with freely available training aids and routine team training are needed to ensure the rapid extinguishment of a fire so that patient, personnel, and hospital injury is minimized.
A full range of specialty and subspecialty care services and some of the most advanced diagnostic and surgical techniques are available here. We provide private patient rooms and have separate specialized units for newborn, pediatric, medical and surgical intensive care.
The surgical faculty at MMC is comprised of excellent, busy clinical surgeons. The magnet attracting them to MMC is the opportunity to teach medical students and residents and to continue to bring new ideas and technology to the bedside and to the operating room.
This procedure can be performed in the office with topical anesthetic or can be performed in an operating room under general anesthesia. Sometimes this procedure is performed in conjunction with other procedures to improve nasal breathing (ie: sinus surgery, nasal endoscopy, nasal cautery or septoplasty)
The procedure is typically performed either in the pediatric ENT clinic procedure room, or in an operating room. The procedure usually takes about 5-10 minutes, but can take longer depending on the severity and any additional combined procedures planned. The surgeon provides an idea of how much time is expected, but this may change during the procedure. If done awake in the office, topical anesthetics and decongestants are typically used to decrease discomfort.
OMFS providers are in the main operating room three days a week. Additional main operating room time is utilized as needed. Residents are usually in the operating room three to five days a week. In addition to the main operating room at Carle Foundation Hospital, the surgeons also utilize the ambulatory surgery center at Carle Outpatient Services at The Fields in Champaign.
The Carle Division of Oral and Maxillofacial Surgery offers two one-year internship positions per year for dental school graduates interested in gaining further experience in the specialty. The position includes equal clinical responsibilities, privileges, salary and benefits as the first year resident. The intern will participate in the outpatient clinic, operating room and emergency room. The intern will share call responsibility and participate in the daily care of inpatients and outpatients to function as an integral part of the resident team. Additionally, the intern participates fully in all didactic conferences and is enrolled in the Core Concepts of Physical Diagnosis course to improve examination skills.
The use of RFID offers many benefits to the healthcare industry related to patient safety, tracking, efficiencies in patient care, and provider satisfaction. Research shows that RFID can help to improve patient safety. RFID tags provide the ability to reduce misidentification issues in healthcare (Alqarni et al., 2014). Ohashi, Ota, Ohno-Machado, and Tanaka (2010) conducted a study using RFID technology to authenticate patients and medical staff during interventions such as medication administration and blood sampling. The study evaluated whether or not the RFID technology identification and confirmation methods were efficient and effective in the prevention of medical errors. The results of this study showed that the system correctly identified medical staff, patient ID, and medication and blood sampling data in real time. Ohashi et al. (2010) examined 27 workflow patterns for each of the three clinical interventions (administering IV medication, injection, and sampling blood) that were tested that provided 81 clinical scenarios. The study found that the point of care system using RFID technology was effective at recognizing individuals and medications. No critical errors occurred during the trial. With the implementation of RFID technology in the operating room, Ku, Wang, Su, Liu, and Hwang (2011) found an increase in patient identification verification from 75% pre-implementation, to 100% post-implementation. Physician time-out completion rates improved from 43% to 70%. Instrument loss decreased from 0.146% to 0.089%. 041b061a72