process.
Around 50% of our spinal procedures involve neuromonitoring, and
it's used during posterior procedures such as a spinal fusions or
tumor removals. Before patients are even transferred from stretcher
to table, tiny EEG needles are inserted into strategic areas — feet,
calves, thighs, abdomen, anal sphincter, and in the arms (location
varies by patient) — and a certified neuromonitoring technician will
monitor the electrode signals for the duration of the case from a lap-
top right in the OR. These techs are looking to make sure the signal
goes all the way through the connected areas. If there's an impinge-
ment or excess pressure on one of the EEG-connected locations, the
signal won't pass all the way through the body. In these situations, the
tech will call it out to our physicians, and we'll make adjustments
before there's any damage done.
Hold your course
Getting everyone onboard with our new positioning protocol was no
small task. With any major change to your processes, there's going to
be that faction of people saying, "Wait a minute here, we've been
doing it for years this way. Why do we have to stop now?" It's up to
surgical facility leaders to take charge and say, "Well, this is how we're
doing it now." Trust me, it's worth the initial growing pains. Before we
changed course, we were constantly repositioning patients in the
prone position and causing too many unnecessary skin tears in the
process. Now, it's not uncommon for us to go through an entire proce-
dure without repositioning a patient — and our injuries have
decreased as a result.
OSM
8 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 9
Ms. Lawyer (denise_m.lawyer@lvhn.org) is a staff nurse at Lehigh Valley
Hospital in Allentown, Pa.
