Instruments
What instrument is this?
Crile, snap, curved hemostat
What must you always check before moving a patient from bed to bed?
The brake
What piece of equipment has an energy box that the green monopolar cautery pen is attached to?
The bovie machine, AKA the F10 generator in every room (its blue)
Give me 3 examples of information that you may want to have knowledge of prior to going to PreOp
Past medical hx
Past surgical hx
Allergies
Labs (especially if T&S needed)
How many time outs are there in a case, assuming there is no spinal being done by anesthesia?
3
Sign-In/In Room
Pre-Incision
Final Timeout
What does an organized pan look like when breaking down back table?
Heavy instruments on bottom, all sharp ends to one side, fragile instruments together and on top, nothing in the pan that didn't come up in the pan
How many patient identifiers are used in timeouts? What are they?
At minimum, two.
Patient Name
H#
DOB
Tall piece of equipment equipment with a light and image box
Laparoscopic tower
Most frequently forgotten items in preop that delay in-OR times
SCD, mistral air, type and screen, correct BP cuff,
Who must be present for the Sign-in timeout? Assuming only one service line.
The primary surgeon, anesthesia, the scrub, and the circulator
Name the instrument most at risk of being left in the body when closing large wounds at the muscle
Ribbon or malleable
When helping with intubation what is the most important step by the RN once the tube is placed
Holding it in place at the lip/teeth until they tape it
What piece of equipment is used in tandem with the consoles, tower, and patient cart.
The DaVinci Xi Robot
Give at least 3 examples of what should be provided in report, written or verbal to PACU when you drop the patient. What should you be doing physically to help PACU while providing this information?
Allergies
Surgical site appearance
Local used
Lines/drains/tubes
Preferred language
Special personal belongings
While providing this info you should be helping PACU RN attach leads.
3 things covered in Final Timeout
Counts completed and accurate
Specimen names of N/A charted
PACU instructions
Wound classification/closing type
What do we do with all instruments at the end of the case? Describe cart organization and next steps.
Tons of preklenz, instruments in correct pans, cover "open carts", deliver to decontam
What should be considered or at least verified with the surgeon before patient prepping and draping on any case 3-4hrs or greater?
A foley
2 pieces of equipment that should always be in the OR
Bovie, harmonic, insufflator, neptune, anesthesia machine, a bed of some type, fire extinguisher
What should you be verifying about a patient bed, mid case and for PACUs sake
Bed type: inpatient, stretcher, ortho, ICU, etc. I.E. what is the patient plan after the case
Most frequent mistake in the final timeout that is not properly discussed resulting in potential poor outcomes for the patient?
Not verifying specimen and its route. We often lose micro specimen to path then they cannot be tested
Describe the difference between SPD and Materials Management, give an example of something we might call them each for, how do you reach them?
Sterile Processing vs single use/ordered items
SPD for green wrapped, metal cans, and/or blue wraps. Materials for single use opening items (usually white packaging)
Vocera: Call "SPD supervisor" "Call Jaime Perez"
What is the leading cause of fires in the OR?
Prep that has pooled and/or not allowed its dry time and then cautery. additionally open oxygen can rapidly grow this fire. How long is dry time for chloraprep (a prep containing alcohol)?
What piece of equipment is used to visualize the inside of the vaginal canal and uterus? Used to shave down fibroids and polyps
The hysteroscope machine
Name 4 absolute must verifies in PreOp interview.
There are more than 4....
Patient info on bracelet (at least 2 identifiers, check all 3)
Consent x2 (anesthesia and surgeon)
Surgeon site initials
Allergies
What is missing on the AORN timeout sheet that should always be discussed? Hint: on the field
Any medications on the field