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GESTIONE DELLO STRUMENTARIO NELLA COLECTOMIA LAPAROSCOPICA

of George Beltramme
Operating Theatre - Ceccarini Hospital - Riccione Rimini
Local Health

Presentation

Hello,
in these next 10 minutes I will show you how, in our reality, good organization shared between different shapes, together with a good management of surgical instruments - electronic and otherwise - has contributed to the optimization of time and actions, consequently, led to the making of:

• right hemicolectomy Left hemicolectomy
• = = =
• resection of rectum
• Amputation of the rectum (In Miles) =

Control all! In the surgery

control is a very important role and the nurse carries out a nearly constant and at different levels. In laparoscopic surgery
control is all .

1. control means Know
   Knowing the procedure, its stages, the maneuvers. Means knowing the material required, the instrument and its use
2. control means Provide
   predict the actions, the phases of the operation. It also means to think about potential problems to avoid them and the variables in order to anticipate
3. Control means not correct
   Where corrections lead to lose control and continuity of surgical
4. control means
   Optimize Optimize timing, functions, actions, use of the material and the instruments and the impact surgical patient. Optimize the learning and interaction between figures of different levels

The control is achieved with the attention and teamwork, with the accurate knowledge of the instruments, with the ongoing implementation and sharing .
In our experience, it came to control of a good standard that allows us to:

1. Packaging containers standard to the implementation of any intervention in laparoscopy
2. Prepare a single serving trolley, then restricting the control to a sterile area of \u200b\u200blimited size
3. Position and use the electronic equipment in a methodical and almost with a high level of nursing autonomy
4. Complete learning nursing figures contained in the very rapid and constant update
5. of procedural protocols

Question of Roles

control also means respecting the roles of nursing figures.

• Instrument - Arm
• Nursing Room (IDS) - The mind

In our reality, the instrumentalist has sold part of its importance for the nurse to leave her room. The latter was involved in the functions and tasks, making it clear the entire project director. If the instrument has the
local control intervention, the IDS has total control of the action, both before it is made, both during its development, and after. While in the traditional interventions
control was limited to the operative field and the involvement of the IDS was very content in Laparoscopic Surgery the operative field extends well beyond the sterile areas of the same and the involvement of the IDS is nearly constant and total, these being responsible for a variety of actions directly related to the intervention (position of the electronic instruments, patient positioning, lighting, recording media, etc.).
For these reasons we aim very accurate figures on the formation of government and a profound ability to control , which of course assumes that the same figure is able to play the role of tools and IDS.

Even before the instrument, which is the IDS must tune in to the surgery and the surgeon, in order to harmonize and streamline all procedures implemented in the field.

It is therefore worth remembering that the equipment:

1. subsidiaries and affiliates, together with the IDS, the preparation of materials necessary for carrying out the intervention
2. Consult the surgeon on the possible need for additional instruments to help completion of the intervention
3. Prepares the serving trolley
4. assists the surgeon in performing surgery and in maintaining the sterility of the operative field and that the

Nursing Room:

1. subsidiaries and affiliates, together with the instrument, the preparation of materials necessary for carrying out the intervention
Look
2. the surgeon on the possible need for additional instruments useful to the completion of surgery and / or the possible need for positional changes of the patient during surgery
3. Place, inspections, preliminary testing of electronic instruments and electro
4. Join correct positioning of the patient undergoing presurgical and check that the positional changes can be made safe for both the patient and the instruments
5. Inspect the instruments electronic / electro during surgery
6. make any multimedia recordings when they are absent fittings integrated
7. Restore the material and the instruments at the end of surgery, and check integrity and proper storage facilities

The

for carrying out an operation of laparoscopic colectomy, these four units are required:

1. Container surgical instruments
   Al order to respect the principle of control, we have observed that the packaging of standard containers (ie, acts on the completion of any variation of laparoscopic colectomy), allows a widely shared procedural standardization and a short training period.
   Our containers include specific tools for stage laparoscopic ed una dotazione minimale di strumenti per le fasi open dell'intervento. Eventuali ulteriori strumenti, vengono prelevati da altri container solo nel momento in cui, grazie al Controllo globale, venga suggerita la loro necessità. Questo fa si che possa essere circoscritto il numero di strumenti presenti sul campo operatorio, a favore di un controllo più lineare e semplice dell'intera dotazione, facilitando le azioni e le funzioni delle due figure infermieristiche coinvolte nell'intervento.
   Lo strumentario viene inserito nei container rigorosamente smontato e riconfezionato al momento della preparazione del carrello servitore. Ciò, oltre ad imporre una preparazione adeguatamente anticipata del suddetto strumentario, allows the instrument and the IDS to maintain control rigorous and clear of all surgical equipment
2. serving trolley
   In our experience, thanks to its accurate control phases of operations and a progressive optimization, has long been able to manage the entire operation without the need to prepare two separate trucks tools and aids.
   The truck is prepared to have two distinct areas: the area
   1. generic tools - where the instruments are set up for the open stage of colectomy
   2. the area of \u200b\u200blaparoscopic instruments - where the instruments are prepared for stage laparoscopic
   This architecture allows the tool to maintain tight control a restricted area of \u200b\u200bthe surgical field and not to lose control of its actions in areas not strictly adjacent to the operating field.
   
   
3. Column Video
   The video column is a complex, consisting of sections and components that increase the need for control exclusively by the IDS. This person shall:
   
   
   • Place the column - in agreed locations, ensuring accessibility to the surgical and anesthetic to the area, mantenendo il controllo sulla sua visibilità da parte del chirurgo operatore e della equipe chirurgica
   • Controllare e testare la colonna prima dell'intervento - procedendo alla verifica:
     1. del livello della CO ² nella bombola, o dell'effettiva erogazione della medesima in caso di impianti centralizzati
     2. dell'effettiva erogazione del gas, avviando l'insufflazione
     3. dei parametri di insufflazione (litri/minuto in avvio, pressione endoaddominale)
     4. delle ore di esercizio effettuate dalla fonte luminosa
     5. dell'effettivo funzionamento dei presidi di acquisizione immagini
   • Azionare le componenti della colonna in corso di intervento - procedendo per fasi:
     1. Accensione delle apparecchiature solo dopo che siano avvenuti i collegamenti delle cavetterie e tubolature, al fine di evitare traumi alle strumentazioni
     2. Azionamento delle strumentazioni di acquisizione multimediale
   • Variare le impostazioni delle componenti in corso di intervento - Incremento graduale delle prestazioni della strumentazione (incremento dei litri/minuto nella erogazione della CO ² )
   • Spegnere e ripristinare la colonna a conclusione dell'intervento - procedendo a spegnere le singole unità prima della disconnessione dei cavi e delle tubolature
4. electrical equipment
   These instruments are entirely the prerogative of the IDS must:
   1. Place to the appropriate electrical distance from the surgical field, while maintaining accessibility to its control panels and the same operating field
   2. Proceed to Checkout effective functioning
   3. Proceed to check the values \u200b\u200bof exercise
   4. Connect all the probes so that the cables are not subjected to traction or inadvertent disconnections
   5. Check and ensure that they are near streams of water (needed for washing endocardial)
   6. off at the end of intervention tools and place them in safe areas and protected

Intervention

The surgery colectomy (in any of the possible variations) involves the execution and control several steps and actions.
In principle, the following rules:

1. Prepare the instruments according to a protocol, avoiding customizations. This promotes the standardization and control by the whole team (including surgeons), as well as learning techniques from all staff. And 'the team doctor / nurse that customizes the intervention on the conditions / needs of the patient, not vice versa!
2. Place the instruments electronic / electro first entry in the patient's room, so that now define the spaces and routes to be used in order to allow staff to have a extended control over the entire operating room and to move freely and safely, without having to find the most suitable path and fast
3. Start intervention only when the conditions are more favorable to those control. It 'a principle that should the entire team and avoid delays and corrections
4. Follow the action closely, both by the instrument by which - above all - the IDS. The first will limit the control only surgical field and the second will maintain an adequate level of control widely over the surgery. It 's more simple and cost effective to maintain a medium value of continuously monitored, rather than recover the lost control
5. Check continuously and at regular intervals, all electronic equipment / electro. It 'a task that relates to both the figures involved in the act surgical nursing. It 's a control especially important in the positional changes of the patient, to prevent the cables and pipes subjected to traction or accidental breakage / disconnections.
6. Check insufflation of CO 2 especially in the early stages of the production of peritoneal chamber. In case of difficulty with anesthesia type, it can be remedied by the rapid withdrawal of inflation
7. Standardize the movements and actions in order to maintain control on the conduct of the operation, save time, effort and reduce the impact of chronological intervention on the patient.
8. Publish now stable at about changes in procedures and conventions regarding the conduct of the operation. Draw up immediately in writing and attenervicisi so repetitive and shared.

Conclusioni

E' risaltato in modo pressochè ossessivo il termine "Controllo" e non è un caso; perchè nulla deve essere lasciato al caso od allo svolgimento spontaneo degli eventi. Per quanto possibile, e per far si che le figure professionali infermieristiche traggano beneficio e interesse dal proprio operato, è necessario che abbiano il controllo su se stesse, ancor prima che su tutto il resto.
Affinchè chi non può controllare (il paziente), possa affidarsi al controllo di noi tutti.

Grazie