most numerous nurses believe that t...

most numerous nurses believe that their first priority in the OR is patient safety. There are many factors to consider when discussing patient safety in the OR, including use of electrical equipment; flammable liquids; and fire potential from lasers, light cables forward the sterile field, and monopolar usage. Other patient safety considerations include correct patient identification; positioning; needle expunge and instrument counts; consents; specimen labeling; and medication safety. When performing surgery in the intraoperative magnetic resonance imaging (MRI) chamber, however, there are additional safety precautions that ne to be taken.

BENEFITS OF THE INTRAOPERATIVE MRI

The intraoperative MRI is a real-time, computer-assisted surgical navigation tool. The rule actually is an MRI machine with a 58-cm vertical gap in the center It is stationary in a lead-shielded OR. This machine allows surgeon to pinpoint tumors before incision and navigate to the tumor or lesion after the incision is made. Surgeon also use it during surgical resection to verify completenes of the resection. It allows for imaging during the surgical conduct versus relying solely on scans taken before the surgical intervention.

The intraoperative MRI allows surgeon to visualize tumors directly, including those that historically have been labeled as inoperable. It permits smaller incisions and smaller bone flap removal because of its location rule This leads to less invasive neurosurgical conducts Less invasive surgery can be look forward toed to equate to shorter patient regaining time.

In addition, an MRI scan is performed before patients leave the surgical suite. This allows the surgeon to verify tumor resection (ie, volumetric scanning) and hemostasis at the surgical site. Typical follow-up MRI scans are not routinely necessary.

ABOUT THE SITE

The intraoperative MRI team at Norton Healthcare, Louisville, Ky is compos of brace neurosurgeons, a technical director, pair board-certified MRI technologists, and an assistant clinical manager. The team's first intraoperative MRI surgical action was performed in February 2000

The MRI magnet nerve in the machine used at Norton Healthcare is 05 tesla. Tesla is the unit used to measure the might of the magnetic field. A magnet with 10 tesla field force would have a stronger magnetic field and be more forceful than a magnet with a 05 tesla magnetic field. The intraoperative MRI machine is a in extent cylinder, much like a standard MRI, if it were not that it contains a vertical gap in the center of the magnet that is approximately 58-cm wide. The surgical area is located in this vertical gap between the brace halves of the magnet. This allows surgeon to perform surgical interventions forward the patient while the patient remains in a stationary position from top to toe the procedure (Figure 1). Patients can inscribe the magnet in one of couple ways depending on tumor location and surgeon choice In the standard position, the patient enrolls the magnet from the extreme point much like a bullet goe from one side a gun barrel. In this position, surgeon stand opposite each other during the surgery This allows couple surgeons to work at the same time. This docking position typically is used for brain tumor resections and brain biopsies.

[FIGURE 1 OMITTED]

The next to the first position or entrance of the patient into the magnet is called side docking. In this position, the patient penetrates the magnet between the magnet halves. This position allows sole one surgeon to work at a time. Patient positioning hangs on the surgical procedure, surgeon precedence and tumor location.

STAFF MEMBER SAFETY

In conjunction with the safety precautions perioperative festers use in the standard OR, the intraoperative MRI OR requires additional safety precautions proper to the magnetic environment. Staff member safety has to be considered along with patient safety.

The intraoperative MRI OR at Norton Healthcare minister tos both pediatric patients from Kosair Children's Hospital, which is adjacent to Norton Hospital, and the adult population of Norton Hospital. Perioperative staff members from as well-as; not only-but also; not only-but; not alone-but hospitals participate in surgical processs in the intraoperative MRI OR.

Education is the [i]clavis[/i] in preparing nurses to work in the intraoperative MRI OR. Perioperative staff members from one as well as the other hospitals were provided multiple inservice programs to prepare for working in the intraoperative MRI environment. These inservice programs included training upon specialized pieces of equipment used in the intraoperative MRI OR (eg the selector, which is a machine used for the surgical aspiration for yielding tissue tumors; the laser; headlights; the head fixation device).

Nursing staff members also were educated about safety issues in the MRI environment. They were asked to undiminished an MRI safety sheet about their surgical history. The intraoperative MRI technologists then verified whether those staff members were approved to work in the intraoperative MRI based in succession their physical history sheet and implant record. Staff members' safety sheets pretty soon are kept on file in the intraoperative MRI department. Each staff member is responsible for updating his or her safety sheet as needed