AORN journal
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Proper adherence to infection control precautions, including appropriate selection and use of personal protective equipment (PPE), is of significant importance to the health and well-being of perioperative personnel. Surgical masks are intended for use as a barrier to protect the wearer's face from large droplets and splashes of blood and other body fluids; however, surgical and high-filtration surgical laser masks do not provide enough protection to be considered respiratory PPE. ⋯ Filtering facepiece respirators greatly reduce a wide size range of particles from entering the wearer's breathing zone and are designed to protect the user from both droplet and airborne particles. Every health care worker who must use a respirator to control hazardous exposures in the workplace must be trained to properly use the respirator and pass a fit test before using it in the workplace.
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During the initiation of a new robotic surgery program, a quality improvement team explored different techniques for positioning patients in the lithotomy and steep Trendelenburg position during robot-assisted procedures. Concerns associated with placing patients in the steep Trendelenburg position include the patient slipping toward the head of the bed and experiencing hemodynamic changes that may result in a rise in blood pressure, increased intraocular and intracranial pressures, and difficulty with ventilation, particularly in patients with a high body mass index. ⋯ The quality improvement team evaluated and compared two positioning devices: an air-inflated positioning device and high-density foam padding. Both methods allowed personnel to position the patient without compromise; the surgeons performing the robot-assisted procedures preferred the high-density foam padding.
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Randomized Controlled Trial
Effect of preoperative forced-air warming on postoperative temperature and postanesthesia care unit length of stay.
Unintended hypothermia in the surgical patient has been linked to numerous postoperative complications, including increased risk for surgical site infection, increased oxygen demands, and altered medication metabolism. The lack of literature on the subject was part of the impetus for perioperative nurses in one hospital to conduct a quality improvement project to evaluate the effectiveness of preoperative warming on patients' postoperative temperatures. We randomly assigned 128 patients to either a group that received a forced-air warming blanket preoperatively or a group that did not. Our results showed that prewarming patients before surgery did not have an effect on patients' postoperative temperatures.
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Comparative Study
A comparison of warming interventions on the temperatures of inpatients undergoing colorectal surgery.
This study compared the effects of two different warming interventions in the preoperative setting on the preoperative, intraoperative, and postoperative temperatures of patients undergoing colorectal surgery in an inpatient setting. The study was performed to determine whether prewarming patients for at least 30 minutes would result in postoperative temperatures of 36° C (96.8° F) or higher within 15 minutes of their arrival in the postanesthesia care unit. ⋯ One reason may be that all the patients were warmed with a forced-air warming device before induction in the OR. Our study does not recommend a specific intervention for a prewarming strategy but indicates that prewarming may contribute to normothermia in the immediate postoperative period.
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A malignant hyperthermia (MH) crisis is a medical emergency. To give the patient the best possible chance for a successful outcome, a swift, coordinated, multidisciplinary team response is necessary. ⋯ An MH response plan should be developed to guide a multidisciplinary team during an MH crisis. This plan should be tailored to the needs of the individual health care organization and practiced and refined during periodic simulations of MH episodes, such as MH mock drills.