- Email: [email protected]
Response to Eyeliner Article
AORN JOURNAL
JUNE 1986. VOL. 43, NO 6
Letters to the Editor
A ward for Excellence Hooray for the AORN “Award for excellence reflects achievement” article in the March Journal. Professional jealousy must stop so we can become our own leaders-not physician’s shadows. MARILYN TOMEY,RN GREENFIELD, IND
The RN as OR circulator
I
n an era of cost containment and avoidance of a rapid rate of increase in health care costs, one requirement for health care professionals is to assure that quality prevails. This is no less so in the operating room, where we have the capability of performing procedures and unusual feats, many of which are a result of our increasing scientific and technological discoveries that serve mankind well. At periodic intervals, almost predictable ones, there are those outside of the operating room and surgical service environment who question the need for a circulating professional nurse. Still others, in the name of cost containment, are suggesting that nursing auxiliaries are appropriate for circulating duties. We have a responsive model in the health care delivery system of coordinated care on behalf of the patient being served. It is in the operating room. How often have we struggled with the problems inherent in achieving coordinated patient care throughout the health care system? In recent times, one response has been the emergence of the ombudsman to assure coordinated and holistic 1204
care. We continue to note an increase in malpractice suits for a variety of reasons. At this critical juncture in health care, why tamper with that which works on behalf of people whom we serve? The circulating nurse, who is a professional, is central to the process of coordinated and responsive care on behalf of the patient undergoing a surgical procedure. In an environment charged with tension where an assurance of a good operative outcome becomes the overriding concern of the entire surgical team, the circulating nurse emerges as the guardian of that commitment. I fear the intrusion of outsiders upon an unknown scene. As they make ill-conceived judgments in the interest of costs, quality of care is compromised. Such a judgment is better left to the professionals. VERNICEFERGUSON, RN, MA
Ms Ferguson was AORN’s keynote speaker at the 33rd annual AORN Congress held in Anaheim, Calg March 9 to 14.
Response to Eyeliner Article I enjoyed the article on permanent eyeliner in the March issue. I was the first patient to have this surgery at my institution. At that time, the procedure was done with only local injections and no relaxant. We now do the procedure with 10 mg of diazepam orally one hour before surgery. An IV is started just before the start of the procedure, and between 2 mg and 5 mg of diazepam is given IV before the injection of local anesthesia.
AORN JOURNAL
Since I had my eyeliner done one year ago, there has been a new development. At the time of my surgery, it was suggested that if a dot was misplaced, a saline injection into the site of the original dot would remove the error; this proved unsuccessful in most cases. A new flesh-colored pigment has now been developed that can be reapplied over mistakes. I had this procedure done and it proved successful. I am a strong advocate of this procedure, and
J U N E 1986. VOL. 43, NO ti
feel a strong commitment to helping people have a better self-image. TINAHUGHES,RN, CNOR NURSEMANAGER, OR/RR EMERSONHOSPITAL CONCORD,MASS Letters
10
the editor are welcome. All such letters
will be shortenedledited at the discretion of the editor. Please include your title and place of employment in your letter.
Breast Milk Traps Drugs With the resurgence of breast-feeding, mothers should be warned that their milk serves as a “trap” for many drugs, according to the March Harvard Medical School Health Letter. The drugs may accumulate in mother’s milk at relatively high concentrations; however, even small amounts can affect a baby, especially a premature infant or a newborn. Some of the commonly used drugs known to enter the breast milk are listed below. Caffeine: Although only small amounts pass into breast milk, it can cause irritability and wakefulness. Alcohol: Milk levels are approximately the same as simultaneous blood levels. Alcohol should be used with caution. Nicotine: Nicotine may cause vomiting, diarrhea, rapid heart rate, and restlessness in the infant. Acetaminophen: Small amounts are excreted into breast milk, but appear to be harmless. Aspirin: Breast-feeding should be avoided for one hour after a dose because it may inhibit blood-clotting activity in the infant. Antihistamines, decongestants: Many of these products used for colds or asthma have been associated with crying, poor sleeping, and irritability when given to infants. Cough syrups with iodine: These may affect thyroid function of infants and should be avoided. Antibiotics: These may induce alteration of the 1206
normal bacterial contents of the baby’s large intestine. Ergotamine: When taken for migraine by the mother, sufficient quantities may be passed to the infant to cause vomiting, diarrhea, or convulsions. Barbiturates: These may cause sedation. Opiates: Breast-feeding should be avoided for three to four hours after a dose is taken. Benzodiazepines (diazepam, chlordiazepoxide): Avoid these medications because they may accumulate in infants. Cimetidine: Its use should be avoided because it may suppress stomach acidity in the infant. Marijuana: This could affect the infant’s level of alertness. Amphetamines, cocaine: Not generally recommended at any age; in infants, they may cause poor sleeping and irritability. Theobromine: This is contained in high amounts in chocolate and can produce irritability in sensitive infants.
JUNE 1986. VOL. 43, NO 6
Letters to the Editor
A ward for Excellence Hooray for the AORN “Award for excellence reflects achievement” article in the March Journal. Professional jealousy must stop so we can become our own leaders-not physician’s shadows. MARILYN TOMEY,RN GREENFIELD, IND
The RN as OR circulator
I
n an era of cost containment and avoidance of a rapid rate of increase in health care costs, one requirement for health care professionals is to assure that quality prevails. This is no less so in the operating room, where we have the capability of performing procedures and unusual feats, many of which are a result of our increasing scientific and technological discoveries that serve mankind well. At periodic intervals, almost predictable ones, there are those outside of the operating room and surgical service environment who question the need for a circulating professional nurse. Still others, in the name of cost containment, are suggesting that nursing auxiliaries are appropriate for circulating duties. We have a responsive model in the health care delivery system of coordinated care on behalf of the patient being served. It is in the operating room. How often have we struggled with the problems inherent in achieving coordinated patient care throughout the health care system? In recent times, one response has been the emergence of the ombudsman to assure coordinated and holistic 1204
care. We continue to note an increase in malpractice suits for a variety of reasons. At this critical juncture in health care, why tamper with that which works on behalf of people whom we serve? The circulating nurse, who is a professional, is central to the process of coordinated and responsive care on behalf of the patient undergoing a surgical procedure. In an environment charged with tension where an assurance of a good operative outcome becomes the overriding concern of the entire surgical team, the circulating nurse emerges as the guardian of that commitment. I fear the intrusion of outsiders upon an unknown scene. As they make ill-conceived judgments in the interest of costs, quality of care is compromised. Such a judgment is better left to the professionals. VERNICEFERGUSON, RN, MA
Ms Ferguson was AORN’s keynote speaker at the 33rd annual AORN Congress held in Anaheim, Calg March 9 to 14.
Response to Eyeliner Article I enjoyed the article on permanent eyeliner in the March issue. I was the first patient to have this surgery at my institution. At that time, the procedure was done with only local injections and no relaxant. We now do the procedure with 10 mg of diazepam orally one hour before surgery. An IV is started just before the start of the procedure, and between 2 mg and 5 mg of diazepam is given IV before the injection of local anesthesia.
AORN JOURNAL
Since I had my eyeliner done one year ago, there has been a new development. At the time of my surgery, it was suggested that if a dot was misplaced, a saline injection into the site of the original dot would remove the error; this proved unsuccessful in most cases. A new flesh-colored pigment has now been developed that can be reapplied over mistakes. I had this procedure done and it proved successful. I am a strong advocate of this procedure, and
J U N E 1986. VOL. 43, NO ti
feel a strong commitment to helping people have a better self-image. TINAHUGHES,RN, CNOR NURSEMANAGER, OR/RR EMERSONHOSPITAL CONCORD,MASS Letters
10
the editor are welcome. All such letters
will be shortenedledited at the discretion of the editor. Please include your title and place of employment in your letter.
Breast Milk Traps Drugs With the resurgence of breast-feeding, mothers should be warned that their milk serves as a “trap” for many drugs, according to the March Harvard Medical School Health Letter. The drugs may accumulate in mother’s milk at relatively high concentrations; however, even small amounts can affect a baby, especially a premature infant or a newborn. Some of the commonly used drugs known to enter the breast milk are listed below. Caffeine: Although only small amounts pass into breast milk, it can cause irritability and wakefulness. Alcohol: Milk levels are approximately the same as simultaneous blood levels. Alcohol should be used with caution. Nicotine: Nicotine may cause vomiting, diarrhea, rapid heart rate, and restlessness in the infant. Acetaminophen: Small amounts are excreted into breast milk, but appear to be harmless. Aspirin: Breast-feeding should be avoided for one hour after a dose because it may inhibit blood-clotting activity in the infant. Antihistamines, decongestants: Many of these products used for colds or asthma have been associated with crying, poor sleeping, and irritability when given to infants. Cough syrups with iodine: These may affect thyroid function of infants and should be avoided. Antibiotics: These may induce alteration of the 1206
normal bacterial contents of the baby’s large intestine. Ergotamine: When taken for migraine by the mother, sufficient quantities may be passed to the infant to cause vomiting, diarrhea, or convulsions. Barbiturates: These may cause sedation. Opiates: Breast-feeding should be avoided for three to four hours after a dose is taken. Benzodiazepines (diazepam, chlordiazepoxide): Avoid these medications because they may accumulate in infants. Cimetidine: Its use should be avoided because it may suppress stomach acidity in the infant. Marijuana: This could affect the infant’s level of alertness. Amphetamines, cocaine: Not generally recommended at any age; in infants, they may cause poor sleeping and irritability. Theobromine: This is contained in high amounts in chocolate and can produce irritability in sensitive infants.