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OR inservice in microneurosurgery
Edward S Connolly, MD Alvera M deLima, RN Mary L Rowland, RN
OR inservice in microneurosurgery The use of the operating microscope has placed new demands on OR personnel regarding the handling, storage, and cleaning of equipment and supplies; the setting up of operating rooms; and assisting at surgery. The following is a suggested training program for OR personnel involved in microneurosurgery. The basic program may be easily modified according to specific equipment used, specialization by the nursing staffs, and surgeons’ preferences.
Care and handling of the operative microscope. Although the types of microscopes used in operating rooms may vary, many facilities will have a Zeiss Mic I. Developed in 1952, it has unlimited modifications such as straight and angled eyepieces, various photographic equipment, still camera, automatic still cameras, 16 mm and 18 mm movie cameras, and television attachments. Many of the surgical houses which sell microscopes will give inservice training to the OR staff on the care and handling of each individual microscope. It is essential that OR personnel have a basic idea of the operation of the microscope. A list of attachments generally
452
used for different surgical procedures should be available in every operating room. OR personnel must know how to place the attachments and how to remove and store them. A check list should be used to verify the functioning of the scope, lamp light, focal length of lens, type of eyepiece, various arms, viewing tubes, and attachments before beginning a microneurnsurgical procedure. The use of equipment will vary from procedure to procedure. Draping of the microscope with various attachments must be taught so that drapes and time are not wasted and the microscope does not contaminate the field. All OR personnel should be taught the correct method of moving a microscope. Most microscopes tend to be topheavy and should be pushed, not pulled. Care must be taken to be sure all attachments are locked into place and are as close to the upright shaft as possible. When the microscope is not in use, it should be covered and some protection provided for the lenses. Cameras and viewing tubes should also be covered and stored in a protected place.
AORN Journal, September 1974, Vol 20, No 3
d+
Bipolar coagulator. The OR staff should be familiar with setting up the bipolar coagulator and the various forceps tips available and likely to be used during a procedure. Two points should be stressed concerning the bipolar coagulator. One, the foot switch should be placed in a comfortable position for the operating surgeon so that he does not have to balance on one foot or stand in an awkward position. Second, microirrigation should be set up, and two interchangeable microtips should be used so that one can be cleaned as the other is being used. A major problem with microcoagulation is the development of coagulum on the forceps requiring irrigation a t time of coagulation.
Recognition of various microinstruments. The OR personnel should develop a card catalog and photographs for the basic microneurosurgical instrument groups. They must also be familiar with the various sizes,
Edward S Connolly, MD, is chief of
the department of neurosurgery at the Alton Ochsner Medical Foundation Hospital, New Orleans. He is a graduate of the Creighton University School of Medicine, Omaha. Alvera M delima, RN, is a graduate of the Touro Infirmary School o f Nursing, New Orleans. She is operating room supervisor at the Alton Ochsner Medical Foundation Hospital. Mary L Rowland, RN, is a surgical technician instructor at the Alton Ochsner Medical Foundation Hospital. She graduated from the Robert B Green Memorial Hospital School of Nursing.
454
shapes, and types of microaneurysm clips and how each type clip is placed in and removed from its applier. The handling, cleaning, and storage of microinstruments. Microinstruments require special care in cleaning and handling because they are very precise and delicate and may easily be damaged. Microtipped instruments are easily bent or hooked. If the instruments are to be handwashed, they should be washed separately with special care given to small box locks. Most of the microinstruments are satin or dull finished, and tend to spot or stain more readily than the highly polished instruments. They should be cleaned immediately after use, and strong abrasive cleaners need not be used. If the ultrasonic cleaner is used, microinstruments should be opened and carefully placed in the open basket. Instruments should be placed in one layer without touching other instruments. Proper testing of the pH of the washing solution and the rinse water is important to avoid excessive staining or spotting of the instruments. All sharp pointed microinstruments should have their points checked with a magnifying glass after cleaning to be sure that no damage has been done to the point. If damage has occurred, these instruments should be repaired.
Technique of assisting at microsurgical procedures. To assist at microsurgical procedures, a basic understanding of the surgical procedure being performed is required. In addition, OR personnel should be aware of the limitations the operating microscope places on the mobility of the surgeon and the narrowness of his field of vision. Closed circuit television or side-arm smpe visualization
AORN Journal, September 1974, Vol 20, N o 3
for the scrub nurse will help her understand the requirements of microsurgery. Instruments must be placed in the surgeon’s hand in the position of use. The instruments and hand must be guided into the depth of the wound so that the surgeon does not have to remove his eyes from the microscope to see the instruments come into the microscopic field. Complete familiarization with microdips, aneurysm
clips, and their holders and facility a t handling microsutures are essential. OR personnel must be conscious of contamination of the operative field by the microscope or the surgeon whose attention is directed in a small visual field through the microscope. This outline has been presented in the hope that i t will be of help to OR supervisors in developing inservice training for personnel assisting with microneurosurgical procedures.
Patricia K Rogers honored a+ dinner AORN President Patricia K Rogers (center) i s presented with a silver tray at a dinner in her honor sponsored by the Northern Virginia AORN. At left i s Virginia State Senator Edward Holland, at the right, Cathy McClure, RN, head nurse in the OR at Fairfax Hospital and then chapter president.
the Board of Trustees; Frank D Whalen, administrator; Frank Whitesell, MD, chief of surgery; Timothy Kelly, MD, chief of medical staff; Margaret V Baker, RN, director of nursing; Bess Larson, OR supervisor. Pat Lund, district 8 president of the Virginia Nurses‘ Association, was also a guest.
Among guests from Arlington Hospital where Mrs Rogers is an instructor in the OR were Miss Helen Samuel, president of
The dinner concluded the chapter’s regional institute.
456
AORN Journal, September 1974, Vol 20, N o 3
OR inservice in microneurosurgery The use of the operating microscope has placed new demands on OR personnel regarding the handling, storage, and cleaning of equipment and supplies; the setting up of operating rooms; and assisting at surgery. The following is a suggested training program for OR personnel involved in microneurosurgery. The basic program may be easily modified according to specific equipment used, specialization by the nursing staffs, and surgeons’ preferences.
Care and handling of the operative microscope. Although the types of microscopes used in operating rooms may vary, many facilities will have a Zeiss Mic I. Developed in 1952, it has unlimited modifications such as straight and angled eyepieces, various photographic equipment, still camera, automatic still cameras, 16 mm and 18 mm movie cameras, and television attachments. Many of the surgical houses which sell microscopes will give inservice training to the OR staff on the care and handling of each individual microscope. It is essential that OR personnel have a basic idea of the operation of the microscope. A list of attachments generally
452
used for different surgical procedures should be available in every operating room. OR personnel must know how to place the attachments and how to remove and store them. A check list should be used to verify the functioning of the scope, lamp light, focal length of lens, type of eyepiece, various arms, viewing tubes, and attachments before beginning a microneurnsurgical procedure. The use of equipment will vary from procedure to procedure. Draping of the microscope with various attachments must be taught so that drapes and time are not wasted and the microscope does not contaminate the field. All OR personnel should be taught the correct method of moving a microscope. Most microscopes tend to be topheavy and should be pushed, not pulled. Care must be taken to be sure all attachments are locked into place and are as close to the upright shaft as possible. When the microscope is not in use, it should be covered and some protection provided for the lenses. Cameras and viewing tubes should also be covered and stored in a protected place.
AORN Journal, September 1974, Vol 20, No 3
d+
Bipolar coagulator. The OR staff should be familiar with setting up the bipolar coagulator and the various forceps tips available and likely to be used during a procedure. Two points should be stressed concerning the bipolar coagulator. One, the foot switch should be placed in a comfortable position for the operating surgeon so that he does not have to balance on one foot or stand in an awkward position. Second, microirrigation should be set up, and two interchangeable microtips should be used so that one can be cleaned as the other is being used. A major problem with microcoagulation is the development of coagulum on the forceps requiring irrigation a t time of coagulation.
Recognition of various microinstruments. The OR personnel should develop a card catalog and photographs for the basic microneurosurgical instrument groups. They must also be familiar with the various sizes,
Edward S Connolly, MD, is chief of
the department of neurosurgery at the Alton Ochsner Medical Foundation Hospital, New Orleans. He is a graduate of the Creighton University School of Medicine, Omaha. Alvera M delima, RN, is a graduate of the Touro Infirmary School o f Nursing, New Orleans. She is operating room supervisor at the Alton Ochsner Medical Foundation Hospital. Mary L Rowland, RN, is a surgical technician instructor at the Alton Ochsner Medical Foundation Hospital. She graduated from the Robert B Green Memorial Hospital School of Nursing.
454
shapes, and types of microaneurysm clips and how each type clip is placed in and removed from its applier. The handling, cleaning, and storage of microinstruments. Microinstruments require special care in cleaning and handling because they are very precise and delicate and may easily be damaged. Microtipped instruments are easily bent or hooked. If the instruments are to be handwashed, they should be washed separately with special care given to small box locks. Most of the microinstruments are satin or dull finished, and tend to spot or stain more readily than the highly polished instruments. They should be cleaned immediately after use, and strong abrasive cleaners need not be used. If the ultrasonic cleaner is used, microinstruments should be opened and carefully placed in the open basket. Instruments should be placed in one layer without touching other instruments. Proper testing of the pH of the washing solution and the rinse water is important to avoid excessive staining or spotting of the instruments. All sharp pointed microinstruments should have their points checked with a magnifying glass after cleaning to be sure that no damage has been done to the point. If damage has occurred, these instruments should be repaired.
Technique of assisting at microsurgical procedures. To assist at microsurgical procedures, a basic understanding of the surgical procedure being performed is required. In addition, OR personnel should be aware of the limitations the operating microscope places on the mobility of the surgeon and the narrowness of his field of vision. Closed circuit television or side-arm smpe visualization
AORN Journal, September 1974, Vol 20, N o 3
for the scrub nurse will help her understand the requirements of microsurgery. Instruments must be placed in the surgeon’s hand in the position of use. The instruments and hand must be guided into the depth of the wound so that the surgeon does not have to remove his eyes from the microscope to see the instruments come into the microscopic field. Complete familiarization with microdips, aneurysm
clips, and their holders and facility a t handling microsutures are essential. OR personnel must be conscious of contamination of the operative field by the microscope or the surgeon whose attention is directed in a small visual field through the microscope. This outline has been presented in the hope that i t will be of help to OR supervisors in developing inservice training for personnel assisting with microneurosurgical procedures.
Patricia K Rogers honored a+ dinner AORN President Patricia K Rogers (center) i s presented with a silver tray at a dinner in her honor sponsored by the Northern Virginia AORN. At left i s Virginia State Senator Edward Holland, at the right, Cathy McClure, RN, head nurse in the OR at Fairfax Hospital and then chapter president.
the Board of Trustees; Frank D Whalen, administrator; Frank Whitesell, MD, chief of surgery; Timothy Kelly, MD, chief of medical staff; Margaret V Baker, RN, director of nursing; Bess Larson, OR supervisor. Pat Lund, district 8 president of the Virginia Nurses‘ Association, was also a guest.
Among guests from Arlington Hospital where Mrs Rogers is an instructor in the OR were Miss Helen Samuel, president of
The dinner concluded the chapter’s regional institute.
456
AORN Journal, September 1974, Vol 20, N o 3