Outpatient Surgery Magazine

OR Excellence Awards 2015 - September 2015 - 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.

Issue link: http://magazine.outpatientsurgery.net/i/568943

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Page 152 of 168

1 5 3 S E P T E M B E R 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E Resistance should be minimal during threading. Keep in mind that sig- nificant resistance usually means the catheter is obstructed and coil- ing, instead of threading. 9. As I remove the Touhy needle, I advance a few extra centimeters of catheter slack to further prevent dislodgement with future leg movement. Ultimately the catheter depth marking at the skin will be between 10 to 15 centimeters. 10. I perform a test dose injection with 3 ml of 1.5% lidocaine with 1:200,000 epinephrine and use ultrasound visualization to confirm proper extravascular catheter tip location in the adductor canal. 11. Lastly, I wipe the ultrasound gel off the leg, apply liquid adhesive widely, apply skin sealant to the insertion site to reduce leakage, coil the catheter around the insertion site, apply several steri-strips, and apply a large clear plastic dressing to ensure that the lower margin of the dressing remains proximal to the eventual lower margin of the tourniquet and avoids interfering with the surgeon's sterile field. OSM Dr. Winchester (brandon@blockjocks.com) is the regional anesthesia fellowship director at Andrews Institute for Orthopedics & Sports Medicine in Gulf Breeze, Fla., and the co-founder of blockjocks.com. that requirement. Searching for a definitive definition of emergence, a U.S. District Court found none. That lack of clarity, it said, meant that AAKC's interpretation of the rule, while "opportunistic," was nonetheless plausible. So it dismissed the case. Interestingly, however, the court may have nudged open the possibility of another complaint by acknowledging that the failure of anesthesiologists to be present dur- ing extubation might have made a more compelling argument that they weren't "personally (participating) in the most demanding aspects" of cases. But the former employee raised that issue too late in the legal process for it to be considered in this case. — Jim Burger

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