Download Abdominal Surgery SOC

PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 12, 2017 8:47 PM
NEW ENGLAND BAPTIST HOSPITAL
OPERATING ROOM
STANDARD OF CARE
MAJOR ABDOMINAL SURGERY
I.
Surgical Group or Procedure
This standard of care may be used for the following surgical procedures:
*Cholecystectomy (with or without operative cholangiogram)
*Cholecystectomy with Common Bile Duct Exploration (with or without
Choledochoscopy)
*Biliary Surgery
*Small or Large Bowel Resection
*Appendectomy
*Spleenectomy
*Pancreatic Surgery
*Gastric Surgery
*Ventral Herniorraphy
*Lumbar Sympathectomy
*Miles' Resection
*Partial Hepatectomy
*Intra-Abdominal Hemorrhage
*Total Abdominal Hysterectomy
*Bilateral Salpingo-oophrectomy
*Myomectomy
*Salpingostomy / Salpingectomy
*Radical Pelvic Dissection
*Pelvic Exoneration
PREOPERATIVE MANAGEMENT
1. Universal Standards are met
2. Room Set-up
a. X-ray table (for cholecystectomy or biliary surgery)
b. Beaver table (for the Bookwalter retractor)
c. Thermal blanket unit
d. Compression sleeve unit
3. Equipment Considerations
a. Compression sleeves
b. Stirrups, table attachments and padding for popliteal area (for Miles' resection)
c. Headlight (available as requested)
d. Scale for weighing sponges to calculate EBL
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 12, 2017 8:47 PM
4. Miscellaneous
a. Foley catheter as indicated
b. Compression sleeves(as ordered by the physician)
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 12, 2017 8:47 PM
Major Abdominal Surgery SOC
2 of 5
Nursing
Diagnosis /Problems
Desired Outcomes
Nursing Interventions
INTRA-OPERATIVE:
Potential for Infection
Perioperative primary nurse demonstrated
knowledge related to prevention of infection and
the patient is infection free.
a.
b.
c.
d.
e.
Potential impairment of
skin integrity
Patient's skin integrity is maintained
a.
b.
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.
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
Position - prepare the operating room bed prior to moving the patient onto it
1. Align and secure the 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 o help
prevent brachial plexus injury
3. Recheck position of extremities if the patient is repositioned
4. Place safety strap 2 inches above the patient's knees
5. 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
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 12, 2017 8:47 PM
Major Abdominal Surgery SOC
3 of 5
Nursing
Diagnosis /Problems
Desired Outcomes
Nursing Interventions
INTRA-OPERATIVE:
Potential impairment of
skin integrity (cont.)
Patient's skin integrity is maintained
c.
d.
e.
Potential for Injury
Patient will be free of nerve palsy, foreign body,
chemical and electrical injury
a.
b.
c.
d.
e.
f.
g.
h.
Padding - protect all body parts with the potential for compression (from positioning, personnel
and instruments)
1. Place gel pads under pressure or reddened areas or bony prominences
2. Place pillow under knees to relieve pressure on the lower back as necessary
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
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
Electrical equipment - Check for damage (i.e., frayed wires, improperly grounded cords, etc.)
Argon beam coagulator 1. Contraindications - (gas embolus)

Patients with right to left cardiac shunting

Patients with atrial septal defect

Patients having a circumcision
2. Level of Gas 
If the % pressure displayed in either tank reads less than 20%, replace tank before
use
Laser - If used for general 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 must be performed each time a body cavity is opened, according to the
instrument count policy and procedure
2. Sponge and sharp counts must be 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 check 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 circulated to nursing
prior to administration
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 12, 2017 8:47 PM
Major Abdominal Surgery SOC
4 of 5
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
i.
Documentation requirements
1. Electrosurgical - the following information must 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, bipolar or GSU) 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 should be
documented on the nursing record

Record the name of the medication, dose, route, or not applicable

Irrigations with drug additives (i.e., Heparin, antibiotics, etc.) should be documented
in the irrigation section of the nursing record
PLEASE NOTE: This on-line, read-only version of this
Policy & Procedure is the OFFICIAL copy.
May 12, 2017 8:47 PM
Major Abdominal Surgery SOC
5 of 5
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.
Original: 5/91
Revised: 8/93, 6/94,
Revised: J. Cassiani RN, CNOR, CNIV 7/04
Reviewed: 9/98, 12/01
Authors:
Kimberly O'Brien, RN, CNOR, CN III
Pauline Robitaille, RN, MSN, CNOR
Lois Johnson, RN, CNII, CNOR
Assess
1. Skin condition - check dependent pressure sites for:

redness

bruising

rashes

other alterations in skin integrity
Assist anesthesia during the patient's emergence from anesthesia
Secure drains and tubesand observe for patency
Maintain the position of the safety strap until the patient is transferred to their bed or stretcher
Remain with the patient until they are transferred to the PACU, SDC 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