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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4 6 O U T P AT 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 | A P R I L 2 0 1 4 thetic for skin and test dose, labels, sterile probe covers and ultrasound gel can be included. Customized trays can be economical and time-effi- cient versus individual supply collection. You can add catheter-securing devices to your kit. • Elastomeric pumps. These non-mechanical balloon pumps infuse local anesthetics based on the stretch of the balloon mechanism generated by filling the balloon reservoir. Reliability of infusion rates has become increasingly consistent with these pumps. The anesthesia provider decides the local anesthetic concentration and volume, as well as the length of time the catheter is to stay in place. Most pumps are filled to volumes of around 400ml and last 2 to 3 days. Pumps may be adjustable or fixed-rate. Most pumps are disposable and are discarded at the time of catheter removal. The portable pump doesn't interfere with the ambulation of the patient. Removing the catheter and pump is so simple that the patient or caregiver can usually do so. • Monitoring. Monitor all patients undergoing ultrasound-guided regional anesthesia. Follow the same guidelines for sedation and gener- al anesthesia in the block area as in the operating arena, including ASA monitoring guidelines for sedation. An adequate source of oxygen and the ability to provide positive pressure ventilation are standards of care. Keep bag valve masks and all age-appropriate intubation and ventilation supplies immediately available. Monitor and document continuous pulse oximetry, EKG and non-invasive BP, as well as respiration and cognitive status. Monitor patients for a minimum of 30 to 45 minutes after block placement for local anesthetic toxicity. Trained nurses must continuously attend patients throughout this time. Have a crash cart anywhere blocks are performed. • Lipid rescue kit. Although the intravascular injection of local anesthetic is very uncommon, when it does occur, it is a life-threaten- ing event. Intralipids are a must at the bedside. Keep 2 500cc bags of R E G I O N A L A N E S T H E S I A OSE_1404_part2_Layout 1 4/4/14 2:38 PM Page 46