sure you're not missing something. Although most often used to moni-
tor the integrity of the spinal cord, somatosensory evoked potential
(SSEP) monitoring while patients are under general anesthesia can
also detect peripheral nerve conduction abnormalities that indicate
peripheral nerve stress and the potential for injury.
"Peripheral nerve stress is definitely a concern," says Ms. Cramer.
"We use intraoperative neuromonitoring to identify potential disrup-
tion to the nerve and to know when the instrumentation could be
compressing it. If we note changes, a tech notifies the surgeon. It's all
about preventing permanent nerve damage. The most important thing
you can do is try to get patients in the most neutral of positions.
Neutral neck, neutral hips, neutral knees."
"We often reposition arms or legs based on neuromonitoring abnor-
malities," says a CRNA.
Monitoring might also help if legal issues arise. "In a court of law, it's
important to provide the critical values [should an injury occur]," adds
another facility manager.
The right OR equipment can help, too. Some newer spine tables are
hinged mid-table, allowing for ranges of ideal flexion and extension with
total spine access across cervical, thoracic and lumbar procedures.
Under pressure
To prevent pressure injuries, be sure to thoroughly assess skin before
and after surgery, and pad, pad, pad during surgery.
"Pad everything," says Ms. Cramer. "We pad every part of the body
that's weight-bearing. You want to put a barrier between it and the
table, arm board or cradle."
"Use memory foam mattresses and padding under all bony promi-
nences," says an RN from the Northeast. "When patients are in prone
positions, you need to protect everything, including toes, foreheads,
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