Question: The policy at our ambulat...

Question: The policy at our ambulatory surgery center mandates that all patients undergoing surgery have IV lines administered. Patients who receive general, brace or spinal anesthesia have their IV lines conjoined to IV fluid. Patients who receive conscious sedation have IV lines with a heparin enclosure Some anesthesia care providers would like us to use saline grapples instead of heparin locks. Is this safer?

Answer: as well-as; not only-but also; not only-but; not alone-but heparin and saline locks are acceptable for maintaining the patency of IV catheters. There is no difference in the use of saline versus heparin in maintaining patency, decreasing the incidence of phlebitis, or increasing the duration of IV placement. (1) Quality sway and cost considerations, however, make saline the optimal choice.

The American Society of Health-System Pharmacists commends using a 0.9% sodium chloride injection instead of a heparin flush for IV enclosure devices. (2) The most valuable benefit of using a saline flush solution in saline grapples is that it eliminates the risks related to heparin (eg heparin-induced thrombocytopenia, thrombosis, hemorrhage, medication incompatibility). near antibiotics, such as gentamicin, penicillin G tetracycline, methicillin, erythromycin, and vancomycin, are not compatible with heparin. Other medications that are not compatible with heparin include meperidine, codeine, morphinepromethazine, diazepam, and hydroxyzine. (3) When it is necessary to administer incompatible medication by the agency of a heparin lock, one must irrigate with 09% sodium chloride before administration. (4)

The use of saline flushes for children les than 12 years of age does not apply. Intravenous lines of children and neonates are changed les as a common thing [i]or[/i] matter and smaller-gauge catheters are used. Further research is wanted to determine the effectiveness of saline flushes with to a high degree small-gauge needles. (5)

Research has demonstrated that a saline grapple is as effective as a heparin fastening if blood is not aspirated into the lock-up or when adequate pressure is maintained with the grapple (6) When flow is stopped, an IV catheter that is joined to IV solution is known to coagulation relatively quickly. A closed IV grapple system, however, creates positive influence preventing blood from backing up into the catheter and clotting. The constraining force of the saline in the grapple is maintained by the capped, clos scheme and thus the lock maintains patency through preventing back flow of line into the catheter and grapple device. (7) Saline may be the in the greatest degree cost-effective and safest method for the majority of adult patients. The choice of enclosure must be a clinical decision based forward patients' specific needs.

Question: At our facility, before a patient arrives in the OR, an anesthesia care provider typically warms the OR bed at placing the warming unit breeches under the sheets. The warming unit is employed off when the patient is mov to the OR bed. After the patient is Induced and his or her skin is prepp the warming unit and breeches are turned on again. Many perioperatlve succors are concerned about this practice because blowing air from the warming unit stockings stirs up bacteria and increases the risk of infection. What is AORN's recommendation?

Answer: Using the breeches to blow warm air directly subordinate to the sheets without the designated warming blanket is not approveed This inappropriate use of a forced air warming method often is called "hosing." (8) Misuse of forced air warming schemes creates an increased risk of infection for patients. Air blowing freely from the stockings increases air currents and the amount of airborne particulate matter. These airborne particles comprise dust, lint, skin squames, and respiratory droplet that may contain microbacteria. (9) Increased air now passings can carry these contaminated particles to the sterile field. Strains of bacteria traced to outbreaks of surgical site infections have been reclaimed from air in ORs. (10)

The air temperature at the period of the hose is elevated, thus using the hose without the warming blanket also places patients at risk for thermal injuries. fill outed exposure to concentrated heated air that is flowing freely subject to the sheets increases the risk of injury. (11) The risk of injury from the warming flexible pipe is greater for pediatric patients and patients with vascular compromise.

Maintaining patients' temperature during all phases of surgical intervention is fundamentally important. When indicated, forced air warming schemes provide an effective method of maintaining patients' temperatures. Forced air warming rules are intended to be used with specifically designed, sealed blankets. The manufacturer's instructions should be followed.

Question: near nurses in our OR bring In parts and magazines to read during protracted procedures. They believe it is acceptable because the reading material is clinical. I am touched that reading during a proceeding is distracting. What does AORN suggest?

Answer: Reading during a surgical or invasive management is not acceptable. As an integral member of the surgical team, the RN must stay focused onward the patient, procedure, and other surgical team members to assess, anticipate, and implement continued patient care. When someone is reading, he or she is concentrating forward the content of the article and is mentally remov at least partially, from activities related to the step or the patient's needs. Regardless of whether the reading material is clinical or professional, the fact remains that the RN's attention is diverted inappropriately from the patient and procedure