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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 67 of 118

OS_1310_part2_Layout 1 10/7/13 10:26 AM Page 68 R E G I O N A L A N E S T H E S I A probes in a sterile sleeve. Use sufficient gel and try to make a smooth, bubble-free interface between the sleeve and the probe so as not to diminish visualization. We suggest a tissue adhesive (Dermabond, for example) where the catheter exits the skin; it acts as a barrier against infection and leaks, and helps prevent catheter migration. Make sure you remove all blood, local anesthetic and ultrasound gel, and consider Mastisol Liquid Adhesive to ensure that the dressing stays firmly in place. We use a statlock device to hold the catheter in place, and then apply sterile Tegaderm transparent dressings. Remember to secure catheters away from the surgical or tourniquet field, or uncomfortable places for the patient. With proper attention and routine, leaks, infections and accidental pulls should be minimal. 7. See your patient in PACU Visit patients in the PACU to assess catheter function and overall patient satisfaction, and to reiterate instructions. If a catheter is not working, troubleshoot and remedy the problem — by replacing the catheter, performing a rescue single shot, or simply removing the catheter and using other modes of analgesia. If the nerve block impedes normal motor activity (a femoral catheter, for example), make sure a sling or knee immobilizer is in place. Give the patient written instructions on block, infusion device and safety issues, and ensure he can contact someone at all times for concerns. Finish by reviewing other prescribed pain medications and how they should be taken. The goal is clear communication, patient safety and patient satisfaction. 8. Keep good documentation to help troubleshoot In the busy environment that most anesthesia providers work in, we can do multiple procedures back to back without much of a break. When you place a CPNB, however, you must absolutely track these 6 8 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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