The following commited practices we...

The following commited practices were developed by the AORN make acceptableed Practices Committee and have been approved by dint of the AORN Board of Directors. They were not awayed as proposed recommended practices for commentarys by members and others. They are effective Jan 1 1999

These make acceptableed practices are intended as achievable recommendations representing what is believed to be an optimal horizontal of practice. Policies and acts 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 numerous exemplars of settings in which perioperative suckles 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 suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive surgeries may be performed.

Purpose: Endoscopic minimally invasive surgery has evolv from a diagnostic modality to a widespread surgical technique. This evolution occurr suitable to the reported benefits of endoscopic surgery compared to the benefits of conventional surgical proceedings for patients. These recommended practices provide guidelines to assist perioperative personnel in reducing risks to patients during endoscopic surgery

make acceptableed PRACTICE I

Potential patient injuries and complications associated with endoscopic surgery should be identified, and practices that restore the risk of injuries and complications should be established.

Interpretive statement 1:

The perioperative supply with nourishment should understand the goals and objectives of endoscopic minimally invasive surgery

Rationale:

Nursing knowledge, technologic skills, and a thorough preoperative patient assessment provide the basis for establishing an appropriate plan of care for the patient undergoing endoscopic surgery(1)

Interpretive statement 2:

Patient monitoring should include vital fluid pressure, electrocardiogram, temperature, oxygen saturation, and extremity tidal carbon dioxide ([CO.sub.2]).

Rationale:

When [COsub2] is used for insufflation, conclusion tidal [CO.sub.2] is closely monitored suitable to the increased risk of hypercarbia. The patient is observ for subcutaneous emphysema.(2) Although endoscopic manner of proceedings are minimally invasive, hypothermia can be caused by means of [CO.sub.2] insufflation. Thermal loss from [COsub2] is known to fall out at a rate of 03 [degrees] C by 40 L to 50 L of gas.(3) Uncontroll bleeding can befall and be undetected due to limited visibility.(4)

Interpretive statement 3:

Specific positioning devices should be provided to confident the patient and provide safety in accordance with AORN's "Recommend practices for positioning the surgical patient."(5)

Rationale:

Exaggerated positioning may be used during endoscopic surgery to displace intracavity organs and enhance visibility for surgical team members. Positioning devices should be readily available before moving the patient onto the OR bed.

Interpretive statement 4:

All patients should be prepp and draped for an unclose procedure.

Rationale:

The patient is prepared should performance of an spread procedure become necessary.(6)

Interpretive statement 5:

Instruments and supplies for an expand procedure should be readily available. When it is necessary to renew to an open procedure, the conversion should be accomplished efficaciously.

Rationale:

It may be necessary to transform to an open procedure at any time. Prior preparation resolve intos anesthesia time and increases OR efficiency.(7)

Interpretive statement 6:

Endoscopes and endoscopic instruments (eg biopsy forceps, graspers) used for endoscopic surgery should be sterile. diocese AORN's "Recommended practices for the use and care of endoscopes."(8)

Rationale:

Endoscopes and endoscopic instruments that inscribe sterile body cavities are classified as critical items and should be enthralled to a sterilization process before use.(9)

Discussion:

In practice settings where technology for sterilization of endoscopes is not available, endoscopes and other heat-sensitive items should receive high-level disinfection immediately before each use. The Association for Professionals in Infection restrain and Epidemiology guidelines state that immersion for a minimum of 20 minutes in 2% glutaraldehyde solution at 20 [degrees] C (68 [degrees] F) after precleaning with an enzymatic cleansing is sufficient.(10) The availability and use of disinfectants in the health care field is dynamic. As newer disinfectants become available, selection should be guided by way of the information in the scientific literature.

Interpretive statement 7:

Endoscopic trocars should adapted safety criteria established for the practice setting.

Rationale:

The principally frequent catastrophic patient injury involves trocars. Organ and duct trauma may occur by excessive use of urgency during the insertion of