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Game Changers in Surgery - June 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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References: 1. https://doi.org/10.1016/j.juro.2016.11.030. 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838256/) 3. Burlingame B, Davidson J, Denholm B. Guideline for positioning the patient. Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017. DOI:10.6015/ psrp.17.01.e1. 4. HC.Fletcher Preventing skin injury in the OR. OR Nurse. 2014; 8(3):29–34. 5. https://doi.org/10.1016/j.jclinane.2014.01.012. 6. Aronovitch S. Intraoperatively acquired pressure ulcers: are there common risk factors? Ostomy Wound Manage. 2007;53(2):57–69. 7. Black J, Fawcett D, Scott S. Ten top tips: preventing pressure ulcers in the surgical patient. Wounds Int. 2014; 54(4):14–18. 8. https://www.mnhospitals.org/Portals/0/Documents/ptsafety/ skin/OR-pressure-ulcer-recommendations.pdf. Accessed February 2, 2018. 9. https://doi.org/10.1016/j.jmig.2010.02.010. Positioning best practices have been performed in the United States in the last 14 years. 2 million+ robotic procedures 1.75 Only use evidence-based positioning products. Off-label use of items can put the patient at a higher risk for injury. 7,8 Apply adequate padding at all pressure points to minimize neuromuscular injuries and avoid extreme flexion, extension and abduction. Use foam padding under the patient's head to maintain head alignment. Tuck and secure the patient's arms at their sides. Avoid crisscrossed chest straps. This technique can place pressure on the shoulder area and result in significant skin and nerve injury. 9 Do not allow tape to come into direct contact with the patient's skin by using a barrier if tape must be used. Use positioning aides to help maintain the patient's position and prevent them from sliding, such as a padded chest strap or foot board. Adjust the robot console settings to allow for maximum ergonomic comfort prior to starting the procedure. Reassess the patient's position frequently during the procedure to ensure that the patient is still positioned correctly and to make necessary adjustments. Do not move the OR table or patient intraoperatively without undocking the patient and releasing and removing the instruments and robotic camera to avoid serious patient injury. Use disposable positioning products to minimize the risk of cross contamination. 1 2 12 11 10 9 8 7 6 5 4 3 Best practices Conduct a preoperative assessment to identify risks, develop a plan of care and implement interventions to prevent injury. The assessment should include: Procedure type Procedure length Patient tolerance level in required position Required surgical exposure Ability of the anesthesia provider to access the patient 4,5,6 Patient history Current skin condition 12 Patient positioning risks Robotic surgery Pressure and compression injuries Physiological effects Nerve injuries Increased intraocular pressures Skin tears and punctures Robot-assisted surgery procedures have become a dominant surgical method. 1 © 2019 Cardinal Health. All Rights Reserved. CARDINAL HEALTH, the Cardinal Health LOGO are trademarks of Cardinal Health and may be registered in the US and/or in other countries. Lit. No. 2MP19-952797 (05/2019)

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