Lasergirltwu1's Weblog

Preventing fires in the operating room

lasergirltwu1 — Wed, 07 May 2008 17:21:48 +0000

FLAMMABILITY HAZARDS AND FIRE SAFETY

PURPOSE: To prevent the risk of incidents and accidents involving laser and electrocautery ignition of materials, tissues, or other substances.

POLICY: All Procedures regarding safe application of laser and electrocautery energy will be adhered to during clinical use, demonstrations, service, practice laboratories, and all other laser and electrocautery operations.

PROCEDURES:

1. Laser and electrocautery operator will know the location of the nearest fire extinguisher approved by biomedical engineering for fires in electrical equipment

2. A basin of water will be poured and positioned within the laser and electrocautery operator’s reach.

3. Reflective and plastic instruments will not be used in the operative field for laser procedures.

4. Flat specular surfaces will be draped with wet sponges for all laser procedures.

5. Alcohol & Iodophor based solutions will be allowed to dry thoroughly before the electrocautery and laser is activated.

6. Wet cloth towels will be used to drape tissues immediately adjacent to the operative site that may be exposed to direct or diffuse laser energy.

7. The anus will be protected with a wet sponge, during perianal procedures, to prevent ignition of methane gas.

8. No disposable, or dry materials will be used near the operative site, or neat the path of a laser beam.

9. Carbon sparking resulting from the overheating of tissue, will be

controlled by irrigation or other appropriate surgical means.

10.During tracheostomy procedures the incision into airway will not

be made with electrocautery.

LASER & RADIATION SAFETY CORE TEAM MEMBERS

lasergirltwu1 — Mon, 05 May 2008 13:22:00 +0000

Cindy

Alma D.

Anna M.

Eugenio V.

Guadalupe

John

Kimberly

P. Loise.

Samantha

Sessily .

Sylvia

Management of Airway Fires During Surgery

lasergirltwu1 — Mon, 05 May 2008 12:52:49 +0000

MANAGEMENT OF AIRWAY FIRE

DURING SURGERY

PRIMARY EMERGENCY CARE 1. STOP VENTILATION!!!!

(disconnect O2)

2. Extubate – place oral airway and

Ventilate by mask

SECONDARY EMERGENCY CARE 1. Reintubate with small cuffed tube

or ventilating bronchoscope

2. Perform rigid bronchoscopy to

Remove foreign bodies, debris,

and lavage trachea.

3. Perform flexible bronchoscopy to

visualize and lavage distal airway

4. Evaluate airway & remove debris

From mucosa by direct laryng- oscopy & pharyngoscopy

5. If necessary tracheostomy

Preferably below 3^rd tracheal ring

Using a low pressure cuff.

TERITIARY EMERGENCY CARE 1. Administer antibiotics and short-

term steroids

2. Provide high humidity

Environment, positive & expiratory pressure ventilation.

SUBSEQUENT MANAGEMENT 1. Place patient in reverse isolation

2. Culture trachea daily

3. Perform endoscopy 3-5 days post

burn evaluate extent of injury

4. Do ventilation perfusion studies

5. If early extubation is not possible

place a T-tube.

Laser and Radiation Safety Committee Goals for 2008

lasergirltwu1 — Mon, 05 May 2008 12:48:29 +0000

Laser and Radiation Safety Committe Goals for 2008

1. To have an accurate list of surgeons who are credentialed for laser procedures.

2. To develop a formal laser training program for nursing personnel and surgeons.

3. To have at least three staff members who are proficient in providing laser support for sugeries on each shift.

4. To maintain a current list of lead aprons used in each operating room.

5. To have the lead aprons x-rayed yearly to ensure integrity and therefore protection for staff members.

frame work versus model

lasergirltwu1 — Sat, 16 Feb 2008 17:47:55 +0000

As I struggle to conceptually define framework and model I find in most situations the terms used interchangeably. My thoughts after reviewing chapter 9 of Billings and Halstead (2005) is that a framework is an outline or guide describing a process. A framework can be used in any situation and therefore adapted to many disciplines. For example Patricia Benner’s novice to expert theory is a framework. It can be used for nursing but also could be used in teaching, engineering or hairdressing. A framework can be expanded for each situation as it, building on the objectives that each framework point needs to address. In my laser program, the novice would be mentored with someone experience in laser procedures. The next step would be to have the clinical nurse be able to perform the laser procedure with a mentor not in the room but available as back up for trouble shooting or unusual patient/surgeon needs. The third tier of the framework would have the nurse being clinically competent and not need any assistance with laser procedures. The 4th area of the framework would have the nurse expert who would be able to assist and teach the clinical and novice nurses. Each level of the framework would address objectives to prove/ meet each level of expertise.

The model I am contemplating using for my curriculum design project is the AORN’s Perioperative Patient focused Model. I believe it is a model because it is specific to nursing in the operating room. It would be difficult to use the model in an realm other than nursing. It deals with four domains: behavioral response, patients safety, physiological responses and health systems. Another reason I feel this a model is that there is a specific picture representation describing the format of the information. Like a model as a fashion model or model airplane this “model” is a representation of what the nurse should address or learn during the course.

The AORN’s model is attached for reference.

The PNDS Model

The PNDS model as a whole illustrates the dynamic nature of the perioperative patient experience and the nursing presence throughout that process. The PNDS Model consists of four domains:

Behavioral responses
Patient safety
Physiologic responses
The health system

The components of the model are in continuous interaction with the health system, encircling the focus of perioperative nursing practice: the patient. The fourth domain, the health system, is comprised of the structural data elements and focuses on clinical processes and outcomes.

Various areas of the patient care experience have the potential to comprise the behavioral responses, patient safety, and physiological responses The highest areas of concern to perioperative nurses and the needs of surgical patients include:

Nursing diagnoses
Nursing interventions
Nurse-sensitive patient outcomes

Working in a collaborative manner with other members of the health care team and the patient, the nurse establishes outcomes, identifies nursing diagnoses, and provides nursing care.

The nurse can then intervene within the context of the health care system to assist the patient to achieve the highest attainable health (physiological, behavioral, and safety) outcomes throughout the perioperative experience.

The PNDS Model Related Articles

Beyea, S. C. (Ed.) (2000), Perioperative Nursing Data Set. Denver, CO: AORN, Inc.

Kleinbeck, S.V.M., (2000), Dimensions of Perioperative Nursing for a National Specialty Nomenclature, Journal of Advanced Nursing, 31(3), 529-535

Kleinbeck, S. V. M. (1999), Development of the Perioperative Nursing Data Set, AORN Journal, 70(1), 15-28

Rothrock, J. C., & Smith, D. A. (2000), Selecting the Perioperative Patient Focused Model, AORN Journal, 71, 1030-1037

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