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How Do You Measure Up? - October 2013 - 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.

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Page 59 of 118

OS_1310_part2_Layout 1 10/7/13 10:26 AM Page 60 R E G I O N A L A N E S T H E S I A that Horner's syndrome from your interscalene block is common and inconsequential, may think poorly of your block — even if it was a complete success in your eyes. Ensure the catheter can be placed without delaying surgery. A dedicated block area is ideal. Also remember you must document that the surgeon actually "requested" the catheter in order to be paid for it. Establishing that he wanted the block can additionally prevent you from being thrown under the bus if complications occur, and help you when requesting more equipment or support. 3. Use the right equipment A quality ultrasound machine can significantly decrease CPNB placement time and increase success. Your machine should afford easy visualization of anatomy for placement of your most common blocks. Make sure you can record ultrasound images of your blocks, associated with patient data and filed in the patient chart or stored electronically in case of a billing audit. Don't forget to choose appropriate probes. For example, a curvilinear probe is a wise investment if you do a lot of blocks that require deeper needle insertion, such as sciatics or infraclaviculars. There are multiple needles designed to improve ultrasound visualization, so trial and choose wisely. Don't forget that the crux of CPNB is the infusion. Pick an infusion device that works best for your practice and patient population. Today's options vary in design, programmability, ease of use and price. Once you choose an infusion device, you must decide whether to fill them at your facility, or order them prefilled. 4. Choose your local anesthetic wisely Choosing a local anesthetic involves both initial injection during placement and subsequent infusion via the catheter. The majority of anesthesiologists infuse 0.2% ropivacaine (Naropin) via the catheter at pre-deter6 0 O U T PAT 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 | O C T O B E R 2013

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