Keep this concern in mind post-operatively, too. Patients are bound to
have some abdominal distention or pain after gallbladder surgery, but if
they're having pain, you need to get a sense of how serious it is. The
possibility of an undetected bowel injury should always be on your
radar.
8
Make sure everyone knows where the foot pedal is. It can hap-
pen. You're using an instrument with a foot pedal, and someone
inadvertently steps on it before the cord is connected to an
instrument, or while the instrument is still in the trocar on its way to
the target tissue. That's obviously concerning. Where is that energy
going to go? Make sure everyone knows where the pedal is and that
all instruments are holstered properly when they're not in use.
9
Take smoke evacuation seriously. We've only recently come to
understand how dangerous surgical smoke is. Thankfully, we
can attach filters that trap harmful chemicals in line with the
tubing. That's a big improvement over the long-standing practice of
opening a knob on a cannula or trocar to release dangerous smoke
out of the field and into the room. I suspect and hope that AORN's Go
Clear curriculum (aorn.org/goclear), which has been very well
received, will eventually achieve 100% compliance.
10
Understand the fire triangle. Whenever you have an igni-
tion source, combustible materials and oxygen, you have
the potential for an OR fire. And the higher the oxygen level,
the greater the risk. Be aware also of potential pools of alcohol com-
bined with electrosurgery in an oxygen-rich environment. OR fires are
rare, but they can be devastating.
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