Question: I work at an ambulatory s...

Question: I work at an ambulatory surgery canter. Many of our patients are awake during the skin prep and are highly uncomfortable when cold prep solution is used. the same of our staff members remind ofed stocking our prep sets and prep solutions In the blanket warmer. Our routine prep is povidone-iodine solution. I speculation that warming povidone-iodine prep solutions is not attract favor toed Is it acceptable to warm prep solutions?

Answer: mostly povidone-iodine skin prep solution consequences contain warning labels regarding warming. single in kind manufacturer of povidone-iodine skin prep effects does not recommend heating povidone-iodine before use. Their label contains the warning "Do Not Heat Prior to Application." Another manufacturer's skin prep solution result label reads, "Not to exce 104 [degrees] F"(1)

In a February 1999 literal sense to the AORN Center for Nursing Practice, Health Policy, and Research, a manufacturer representative states that a facility may pitch upon to warm preoperative prep solutions despite the performance warning label. Povidone-iodine, however, should and nothing else be warmed for a brief period (ie, up to sum of two units hours) in a controlled environment where the temperature can be digitally adjusted to a specific temperature between 37 [degrees] C and 47 [degrees] C (99 [degrees] F to 108 [degrees] F) Povidone-iodine must not ever be warmed in a microwave, autoclave, skillet of boiling water, or in a less degree than any other condition where the temperature cannot be controlled(2)

When povidone-iodine solution is heated, brace things can happen. Iodine can interact with dissolved oxygen resulting in a unadulterated decrease in iodine concentration, or evaporation of the water from the povidone-iodine solution can cause an increase in iodine concentration. When povidone-iodine solution is heated in a clos container, iodine can interact with dissolved oxygen resulting in a decreased concentration of iodine. If povidone-iodine is heated in an explain container such as a beaker or prep tray with a large expos surface area, however, sufficient evaporation of water may spring causing an increase in the iodine concentration. An increased iodine concentration could lead to patient skin reactions. Overheating the effect could result in thermal burns

Manufacturers' written recommendations for storage, heating, and befitting use of all skin prep solution performances should be followed. If the manufacturer has not provided specific instructions upon heating, the manufacturer should be contacted for clarification before any prepping solution is warmed.

Question: The anesthesiologists at the surgery canter where I work are pushing us to establish a "fast tracking" anesthesia redemption program. What is really meant through the term fast tracking? They say that this will save a fortune of money, is better for patients, and "everyone is doing it." I am disquieted about the patient risks associated with bypassing phase I postanesthesia care unit (PACU) and taking patients directly to the phase II PACU. I am also disturbed about staffing these two areas when we do not know beforehand haw many patients will be arriving in which area. What is AORN's opinion of "fast tracking," and can this be safely implemented?

Answer: The universal of "fasttracking" may be recent to some, but is becoming commonplace, especially in the ambulatory surgery arena. The bound fast tracking usually refers to the practice of bypassing phase I PACU and transferring the patient directly to phase II PACU from the OR.

Fast tracking is becoming popular with anesthesiologists because of recent advances in rapid-onset, fast-emergence general anesthetics (eg propofol desflurane, sevoflurane), bispectral index monitoring/the increased use of prophylactic put drugs intos for postoperative nausea and vomiting, and preemptive pain command With the use of these novel anesthesia techniques, patients can be completely awake and oriented with stable vital signs in the OR shortly after a brief surgical transaction with general anesthesia.(4) When done correctly, patients use up less time under anesthesia and have fewer complications, with les postoperative pain, nausea, and vomiting.

Financial considerations also contribute to the popularity of fast tracking. Fast tracking is seen as a way to improve efficiency in patient care and to decrease the amount of time that patients devote in phase I PACU. expenses can be reduced even more if patients can completely skip phase I and proce directly to phase II PACU. A 1997 meditation of five surgery centers claimed annual savings appropriate to a fasttracking program, ranging from $50000 to $158000 by facility.(5) These reported savings have generated a great deal of enthusiastic interest by way of facility administrators and managers.

The contemplation suggests that these savings can be achieved without compromising patient safety. more [i]or[/i] less PACU nurses, managers, and the American Society of PeriAnesthesia encourages (ASPAN), however, have been make uneasyed about reports that some programs are poorly conceived and administered and implemented too quickly, without adequate collaborative planning that includes input not no other than from anesthesia care providers, unless also from perioperative nurses and surgeon more [i]or[/i] less complain the PACU nurse's ability to advocate for the patient has been compromised and has accrueed in negative patient outcomes.(6)