Download MAJOR VASCULAR

PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 2, 2017 5:23 PM
Vascular SOC Page 1 of 6
NEW ENGLAND BAPTIST HOSPITAL
OPERATING ROOM
STANDARD OF CARE
VASCULAR SURGERY
I.
Surgical Group or Procedure
This standard of care may be used for the following surgical procedures:
*Abdominal Aortic Aneurysm
*Aorto-Femoral Bypass/Endarterectomy
*Aorto-Bifemoral Bypass/Endarterectomy
*Aorto-Iliac Bypass/Endarterectomy
*Aorto-Biiliac Bypass/Endarterectomy
*Femoral-Popliteal Bypass/Endarterectomy
*Femoral-(Posterior/Anterior) Tibial Bypass/Endarterectomy
*Femoral-Dorsalis Pedis Bypass/Endaterectomy
*Femoral-Femoral Bypass/Endarterectomy
*Femoral-peroneal Bypass/Endarterectomy
*Axillo-Bifemoral Bypass/Endarterectomy
*Arterial Embolectomy/Thrombectomy
*Carotid Endareterectomy(with or without shunt)
*AKA/BKA ,Trans metatarsal amputations
*Hip Disarticulation
*Portacaval Shunt/Splenorenal Shunt/Distal Splenorenal shunt (Warren shunt)
*Arteriovenous shunt/Arteriovenous Fistula
*Vein Ligation/Stripping
*Declotting A-V Fistula
PREOPERATIVE MANAGEMENT
1. Universal Standards are met
2. Room Set-up
a. Electric operating room table with X-ray attachments for major vascular (for intra-operative arteriogram)
Electric table preferred but may use regular operating room table with x-ray attachments
b. Beaver table for the Bookwalter retractor (if needed)
c. Gel pads on bed (full length) -not covered
d. Two armboards with padding. Arm table if needed for upper extremity procedures
e. Anesthesia screen with attachments
f. Thermal blanket unit
3. Equipment Considerations
a. Scale for weighing sponges to calculate EBL
b. Compression sleeve unit and tubing & compression sleeve(as ordered by physician)
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 2, 2017 5:23 PM
Vascular SOC Page 2 of 6
*contraindicated in patients with severe peripheral vascular disease (check with M.D.)
c Headlight (available as requested)
d. Electrosurgical unit with monopolar and bipolar cautery
e. Doppler probe box ( be sure it is charged) It is in Anesthesia workroom
f. Vascular cart in room or outside the door
g. X-ray gowns, lead shield, and cassette holder available
h Prosthetic availability--check inventory of vascular grafts-shunts-implants
i
Drugs:
1. Heparin available for the sterile field and for anesthesia; check dosage with physician
2. Papaverine available; check dosage with physician
3. Surgicel /Avitene/Gelfoam available
4. Protamine Sulfate for anesthesia (kept on daily medication exchange cart)
4. Miscellaneous
a. Check with physician regarding foley catheter insertion
b. Thermal blanket - Do not use High temp setting when treating patients with significant peripheral vascular disease (occlusive or
diabetic)
Do not apply heat to lower extremities during aortic cross-clamping. Thermal injury may occur if heat is applied to ischemic limbs.
c. Packaging of Limb for AKA/BKA
Prep table, save double wrappers from open kits (need 2 or 3), spread wrappers on prep table behind person passing off the extremity.
Scrub person places extremity on open wrappers. The circulator removes any clamps and wraps extremity in wrappers abnd secures with tape.
Place in red bag & attach Pathology slip. Thse specimen may go in a box but it doesn’t have to.
Nursing
Diagnosis/Problems
Desired Outcomes
Nursing Interventions
The patient will voice sources of anxiety and
verbalize and or demonstrate wayys to reduce
anxiety
a. Listen to the patient and family (if present) and encourage expression of feelings,
fears, and questions
b. Answer questions honestly. keep patient anfd family informed of impending tests and
procedures
c. Provide emotional support to patient and family: Introduce/suggest pastoral care
and/or support group therapy
d. Have anesthesia administer anti anxiety medications preoperatively as needed
e. Prepare patient for possible phantom sensations post amputation
PRE-OPERATIVE:
Anxiety/Fear related
to loss of limb
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 2, 2017 5:23 PM
Vascular SOC Page 3 of 6
INTRA-OPERATIVE:
Nursing
Diagnosis /Problems
Potential for Infection
Desired Outcomes
Perioperative primary nurse demonstrated
knowledge related to prevention of infection and
the patient is infection free.
Nursing Interventions
a.
Skin prep - Shave operative site after confirmation with physician using a razor, adhesive tape,
chux, and betadine solution. Consider using betadine scrub and cotton applicators as
necessary. Hibiclens can be substituted for betadine if patient has an allergy to iodine solution
b.
Devices present - If drains are present, drape with "1000 drapes," secure or change ostomy
devices as needed, empty continuous drainage bags and record on the nursing record.
Antibiotics:
1. Check with physician regarding administration of antibiotics
2. Check scheduled medications for intra-operative administration
3. Prepare antibiotic irrigations as ordered
Wound classification - Document appropriate classification according to the wound classification
policy and procedure
Documentation requirements:
1. Administration of antibiotics and/or antibiotic irrigation(s)
2. Break in technique
3. Observers present
4. Number of cultures sent to the lab
5.. Other interventions implemented to decrease potential for infection
General health – assess patient’s history as related to skin condition
c.
d.
e.
Potential impairment
of skin integrity
Patient's skin integrity is maintained
a.
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 2, 2017 5:23 PM
Vascular SOC Page 4 of 6
Nursing
Diagnosis /Problems
Desired Outcomes
Nursing Interventions
b.
INTRA-OPERATIVE:
c.
d.
Potential for Injury
Patient will be free of nerve palsy, foreign body,
chemical and electrical injury
Position - prepare the operating room bed prior to moving the patient onto it
(full body gel pad under patient prior to start of procedure)
1. Align and secure patient's hands and arms properly. ( If arms are placed by the patient's
sides, avoid compression of the ulnar, median or radial nerves)
2. When using armboards, the patient's arms should be abducted less than 90 degrees to help
prevent brachial plexus injury
3. Recheck position of extremities if the patient is repositioned
4. Monitor the position of the mayo tray throughout the procedure to help assure that it is not
causing compression on any of the patient's body parts.
5. Be sure that blankets and sterile drapes are not constricting patient's extremities.
( remind scrub person to lift and loosen drapes off extremities at regular intervals during
procedure)
Length of procedure - the following considerations should be applied to all patients regardless
of the length of the surgical procedure
1. Avoid pooling of prep solutions
2. Maintain dry and wrinkle-free linen
3. Protect open skin areas with the appropriate dressing material
4. Prevent constriction of linens and drapes on extremities
5. Protect patient’s skin from direct contact with tubing and/or cords(i.e., foley, bovie, etc.)
Documentation - document all nursing interventions implemented to decrease the potential for
impairment of skin integrity
1. Assessment (i.e., condition of skin prior to the surgical procedure)
2. Evaluation of interventions
a.
Electrical equipment - Check for damage (i.e., frayed wires, improperly grounded cords, etc.)
b.
Laser - If used for vascular surgery during laparotomies, the laser safety policy interventions will
apply
Transfusion - check need for and availability of blood prior to procedure
Counts 1. Instrument counts are performed each time a body cavity is opened, according to the
instrument count policy and procedure
2. Sponge and sharp counts are performed according to the sponge and sharp policy and
procedure
Power equipment - all electrical equipment must be checked by biomedical personnel before it is
used in the operating room
X-rays - patient's reproductive organs should be shielded with a lead apron if possible
Medications
1. Allergies must be checked prior to administration of any medication
2. Physician's order must be confirmed before administration of medication
3. Medication label and expiration date must be checked by the scrub and circulator nurse prior
to administration
c.
d.
e.
f.
g.
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 2, 2017 5:23 PM
Vascular SOC Page 5 of 6
Nursing
Diagnosis /Problems
Desired Outcomes
Nursing Interventions
INTRA-OPERATIVE:
Potential for Injury
(cont.)
Patient will be free of nerve palsy, foreign body,
chemical and electrical injury
h.
Documentation requirements
1. Electric - the following information should be documented on the nursing record:

location of dispersive ground pad

whether site was shaved or not

serial number of cautery unit used

type of cautery (monopolar or bipolar) and settings used
2. Laser - complete laser log and document laser procedure performed on nursing record
3. Transfusions 
sign blood bank slip to confirm that the blood/blood product was checked by two
people

in the event of a suspected transfusion reaction: complete a Transfusion
Investigation Form (may be obtained from the PACU or blood bank) and assist the
anesthesia personnel in completing this form
4. Counts

document instrument, sponge and sharp counts, as applicable, according to the
count policies and procedures

record any sponge, packing or other objects deliberately left in the patient in the
Drains/Packs section of the nursing record
4. X-rays - check portable, C-arm, or N/A as appropriate
5. Medications - medications administered or dispensed by the circulating nurse must be
documented on the nursing record

Record the name of the medication, dose, route, or not applicable, the time it was
given and how much was administered.

Irrigations with drug additives (i.e., Heparin, antibiotics, etc.) should be documented
in the irrigation section of the nursing record
6. Document implants, i.e. vascular grafts on O.R. perioperative record under
Implants and in the progress notes.(Fill out appropriate documents included
with the device)
`
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 2, 2017 5:23 PM
Vascular SOC Page 6 of 6
Nursing
Diagnosis /Problems
Desired Outcomes
Nursing Interventions
POST-OPERATIVE:
Promote and/or
maintain a safe
environment
preventing potential complications during patient
transfer from the operating room
a.
b.
c.
d.
e.
f.
g.
h.
Original 11/93
Revised: 11/94, 10/98
Revised: 7/04, Maria Herbert RN, Joanne Cassiani RN, CNIV
Reviewed: 12/01
Authors: Kathleen St. Cyr, RN, CNIII
Assess
1. Skin condition - check dependent pressure sites for:

redness

bruising

rashes

other alterations in skin integrity
Assist
1. Anesthesia team during the patient's emergence from anesthesia
Secure Drains and Tubes
1. Observe for patency
Maintain the position of the safety strap until the patient is transferred to their bed or stretcher
Have adequate help available to insure safe transfer of patient from OR table to patient
stretcher of bed
Remain with the patient until they are transferred to the PACU, Bond Center or nursing unit.
Communication points to be highlighted in report should include any pertinent information to
promote the continuity of nursing care (i.e., allergies, drains, and lines present, etc.)
Special considerations for equipment management and clean up
1. Universal precautions should be followed for every surgical procedure
2. Terminal cleaning if contact precautions in use