The following approveed practices ...

The following approveed practices were developed by the AORN make acceptableed Practices Committee and have been approved according to the AORN Board of Directors. They were readyed as proposed recommended practices for expositions by members and others. They are effective Jan 1 2002

These commited practices are intended as achievable recommendations representing what is believed to be an optimal even of practice. Policies and processs will reflect variations in practice settings and/or clinical situations that determine the extent to which the recommended practices can be implemented.

AORN recognizes the various settings in which perioperative encourages practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where operative and other invasive processs may be performed.

Purpose: These commended practices provide guidelines for RN managing patients receiving local infiltration anesthesia alone If any sedation is used, AORN's "Recommend practices for managing the patient receiving moderate sedation/analgesia" should be followed. It is not the intent of these attract favor toed practices to address situations that require the services of anesthesia care providers or to substitute RN services in those situations that require the services of anesthesia care providers, regardless of the complexity of the surgical procedure

approveed PRACTICE I

Patients receiving local anesthesia during a surgical deed should be assessed throughout the perioperative experience by way of an RN.

1 The selection of patients who are to receive local anesthesia should be determined at established criteria developed through an interdisciplinary collaboration of health care professionals.

2 Many healthy patients suffer minor surgical procedures that require and nothing else small doses of local anesthetic medications. These patients are at cheap risk for anesthetic complications and require minimal observation and intervention.

3 The decision to monitor, the parameters monitored, and the frequent occurrence of observation should be tailored to the patient and the surgical action (1) If/when administering medications, the perioperative foster must work within his or her margin of practice.

4 Local anesthesia is not practical for all patients or all shadows of surgical procedures. (2) Highly nervous, apprehensive, or excitable patients or those who are unable to cooperate because of their mental state or age may not be virtuous candidates for local anesthesia. (3) Each patient has a variety of unique physical characteristics that can influence his or her answer to medications. Considerations include, if it be not that are not limited to, the patient's weight, age, and medication tolerance and the nearness of disease. (4)

5 In the preoperative phase, the RN should review the patient's history, physical examination findings, laboratory inferences and other diagnostic test rises if indicated. During this preoperative assessment, the perioperative foster should determine, at a minimum,

* the patient's allergies and sensitivities (eg medications, tape, latex, prep solutions);

* the patient's age, existing medications, alternative/complementary therapies, and emotional status;

* when the patient last consum solids and/or liquids by the agency of mouth (ie, NPO status);

* whether the surgical site can be anesthetized completely with a local injection; and

* throb blood pressure, arterial oxygen percent saturation, skin status, mental status, and pain management status. (5)

The ne for IV access and/or fluids should be based onward patient assessment data and facility policy.

6 The RN should make known a plan of care to include potential point in disputes and stress responses to local anesthesia. Surgery may elicit physiological (eg autonomic disturbances that may cause fainting) and psychological (eg fear of the unknown that may cause anxiety) rejoinders in the patient. The stage of combined stressful stimuli directly determines the answer of the patient. (6)

7 The RN should make sure the availability of emergency equipment and be prepared to intervene should an adverse reaction meet the eye Serious cardiac or respiratory complications can meet the eye abruptly after the administration of local anesthetic medications. If the medication inserts the bloodstream directly, convulsions, circulatory and respiratory distress, cardiovascular collapse, or on a level death can result. (7) urgency medications, suction apparatus, resuscitative equipment, and qualified personnel should be readily available. (8) At a minimum, personnel should be adequate in cardiopulmonary resuscitation.

commended PRACTICE II

The RN managing the nursing care of the patient receiving local anesthesia should monitor the patient's physiological and psychosocial status from top to toe the procedure.

1 At a minimum, the perioperative RN should monitor the patient's heart rate and regularity, respiratory rate, and mental status completely through the procedure. Other monitoring parameters include, still are not limited to, (9)