No IV in the OR?

We have a new orthopedic surgeon that insists we do not use an IV for some of the “simpler” procedures that are performed in the operating room. These are usually quick trigger finger releases or carpal tunnels. There is no sedation, just local. What experience do you have with these cases? How do you document them? We have a separate circulating RN for the procedure and another RN for the patient. This is new to us. We have always had IV access before and are comfortable giving and monitoring patients with IV sedation. It is the “no IV” that is troubling us.

A: For all locals, we do not place an IV. Just like going to the dentist for a filling, they do not place an IV before giving local.

A: I would consult with anesthesia to determine if this would meet their guidelines. I realize that anesthesia is not involved in the case as it is a straight local but they are ultimately responsible for emergency care if it were to arise in these patients. I have always had policies that stated all patients going to surgery would have IV access even if it were just a saline lock. I do not believe there is a hard and fast rule, but I would definitely get anesthesia to sign off on the practice. If anesthesia is comfortable I would then document that in a policy or guideline just so everyone is on the same page.

A: We do not place an IV for a local procedure unless there is conscious sedation involved.

A: No patient should ever go to surgery without an IV. Do you have a policy to cover your practice?

Dreadlocks in the OR

Is it acceptable to have dreadlocks in the OR? Can one scrub with dreadlocks?

A: I would consider dreadlocks in the same manner I do any hair. It must be
contained within the surgical cap. If
contained, scrubbing should be fine in
my opinion.

A: As long as everything is secure within the bouffant.

A: As long as all the hair is clean and can be covered, I don’t think we should discriminate because of hairstyle.

Lunch Relief

When staff purchase lunch instead of bringing a lunch they often take more time. Is this fair? Is this a common situation? How does one remedy this situation?

A: That is very common and the organization has to choose its path of enforcement.

A: We give 45 minute lunches. The staff do not get any afternoon break, so we combine this into the lunch.

A: Time allotted for lunch is per your policy. Be consistent.

A: Lunches and breaks are 30 and 15 minutes for all regardless of where they obtain their meal.

A: OR charge nurse assigns lunches and breaks based upon case load – taking into consideration “built-in” breaks and lunches when staff are between cases.

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