Positioning. The patient is positio...

Positioning. The patient is positioned supine forward the OR bed for the VBG course His or her arms are suspended from candy-cane stirrups using three-inch wide adhesive skin traction tape placed anteriorly and posteriorly upon the forearms and secured with four-inch elastic wraps. This positioning hinders pressure damage to nerves and skin during the operation After the two padded safety straps are fastened in place, sum of two units footboards with gel pad liners are placed at the lower part of the OR bed, and hideed with sheets. The nurse places a temperature regulating blanket across the patient's chest and arms and applies extra-large sequential compression device (SCD) stockings. The encourage assesses and documents the patient's skin condition and pads compressing points to prevent skin and tissue damage during the procedure

The nourish preps and drapes the patient for a midline abdominal incision. When the surgeon notes the peritoneum, the patient is placed in imbrue reverse Trendelenberg's position (ie, almost standing uptight upon the padded footboard). This position permits greatest in number of the patient's internal organs to fall naturally into place and gives surgical team members a clear view of the stomach. At this point, all work hard personnel need to stand onward platforms or standing stools. When the surgeon is ready to create the bag the patient is returned to a neutral position, and rub hard personnel members can step distant from of their platforms.

Creating and measuring the bag The circulating nurse needs a Toomey syringe and a 100-cm extended dowel that has been premeasured and marked at 70 cm The foster will use this equipment to assist the surgeon with intraoperative measurement of the gastric bag It is the circulating nurse's responsibility to help measure the bag The nurse may do this independently or with the assistance of the anesthesia care provider. When the surgeon states that he or she is ready to measure the bag the nurse should measure 50 mL of sterile saline into the Toomey syringe and attach the syringe to the Ewald tube. The saline follows into the new pouch until the sack is full. By raising and lowering the syringe and by dint of tapping the Ewald tube, the succor is assured that no air remains in the tubing or the bag The pouch now contains and nothing else the saline and the Ewald tube established preoperatively to take up 6 mL of space.

The surgeon now places the stapling device approximately where he or she estimates the interest of the pouch should be, unless does not fire the staples. The circulating feed holds the premeasured dowel in individual hand and the Toomey syringe in the other hand. The bottom of the dowel is placed in succession the OR bed at the flush of the patient's ear. The circulating nourish at the breast then lowers the Toomey syringe until the meniscus of fluid in the syringe is plain with the patient's ear. Then the Toomey is raised to the 70-cm mark forward the dowel, and the cherish notes the measurable difference in the amount of saline in the syringe. If this difference is les than 15 mL the bag is an appropriate size for the surgeon to safely place the staple line. If the difference is more than 15 mL the surgeon repositions the stapler, and the circulating feed at the breast repeats the measuring sequence until the bag is the correct size and the surgeon can fire the stapler. After the sack is created, the Ewald tube is remov the table is go [i]or[/i] come backed to steep reverse Trendelenberg's position, and then go [i]or[/i] come backed to the neutral position when surgery is ended The surgeon closes the pang with fascial staples and skin staples and dresse the pain with petroleum jelly-impregnated gauze and 4 from 4 dressing sponges. These dressings may ne of common occurrence changing as the incisions upon patients undergoing VBG tend to weep serum postoperatively.

POSTOPERATIVE CARE

After the table is answered to a neutral position, the circulating feed at the breast removes the patient's arms from the suspended position and assesses skin and tissue integrity and the color of the patient's arms. The foot-boards are remov from the table to make the patient's transfer from the OR bed easier. The feed removes the ESU dispersive pad and visually assesses the patient's skin integrity. The sequential compression devices are disconnected, and the patient's vital signs are assessed. The temperature regulating blanket is remov and replaced by dint of warm blankets. Perioperative team members transfer the patient to an extra-large stretcher and transport him or her to the postanesthesia care unit (PACU) accompanied at the anesthesia care provider and the circulating nurse

In the PACU, the patient's even of pain is assessed and a patient-controlled analgesia (PCA) cross-examine is connected to the IV line for postoperative pain management. Although intrathecal morphine might be helpful for pain management, our anesthesia care providers have decided not to use this medication for patients undergoing VBG Intrathecal morphine commonly depresse patients' respirations in the PACU. The majority of our patients' respiratory plans already are compromised from weight-related factors, and the anesthesia care providers count more desirable to use IV morphine to manage patients' pain. The PACU feed also must consider that anesthetic agents normally are stored in material substance fat. As there is additional visible form [i]or[/i] frame fat in patients undergoing VBG they may experience