- Email: [email protected]
Symposium travelers report on OR nursing in Greece
Hospitals in Afhens welcomed AORN sym-
Evangelismos Hospital where she is OR
posium
supervisor.
registrants.
Catherine
Papadaki,
second from left, gives a group a tour of
Symposium travelers report on OR nursing in Greece Each AORN member aftending the recent
gynecology, and urology. About two-thirds
international symposium in Greece visited one of the hospitals in Athens. Describing
of its beds are for surgical patients.
their impressions are Jeannie 1 Mozur, who visited the four-room Operating room suite at a children’s hospital, Nosokomion Pedos, and Sebastian Nicolo, who visited Aretaion
W e visited the operating room suite, intensive care unit, recovery room, nursery, research lab, and dialysis unit. We were led on the tour by Maria Tzelissi, director
Hospital. Ms Mozur is OR unit coordinator
of nurses.
at Crouse-Irving Memorial Hospital, Syracuse, NY, and presidenf of AORN of
Our first stop was the OR suite where we met Mrs Ann Reiger, OR supervisor, and Miss Sally Hill, of England. Miss Hill was at
Greater Syracuse. Mr Nicolo i s operafing room supervisor at Veterans Administrafion Hospital, Philadelphia, Pa, Aretaion Hospital i s a 250-bed university hospital which offers the following services: medical, psychiatric, surgical, obstetrics,
114
Aretaion to help instruct the nurses on open heart surgical
procedures and OR tech-
nique. While enjoying coffee, orange juice and cookies, we learned that nursing students
AORN Journal, Junuary 1974, Vol 19, N o 1
usually spend two weeks in the OR, but if
oxide sterilizer was available, but i t was not
their case study i s a surgical patient they have an opportunity to return. Surgery
used all the time.
usually begins at
7:30
am and i s over by
2:30 pm to enable the surgeons to have a siesta. The nurses cited the prohibitive cost and nonavailability of some items as their main problems. Traffic flow i s unidirectional with the three operating rooms forming a circle around the waiting room area, and nursing station. Two of the rooms are for general surgery, and one i s for open heart cases.
About 50 surgical cases are done per week. Of these, 30 are major cases. W e observed an exploratory
laparotomy for
carcinoma and a cholecystectomy. surgeons spoke
English which
All the
they had
learned while doing graduate work either in England or the US. They were most courteous, and either the surgeon or his assistant described
the procedure being
done. The chief of anesthesiology was a woman
did her graduate work in England. She
Mrs Reiger explained that a team from
who
Massachusetts General Hospital instructed them in open heart techniques. The room i s
told us she went into anesthesiology because
closed in July and August. The ICU-recovery
her brother, who i s a surgeon, asked her to. The hospital is
an all-anesthesiologist
room and endoscopy rooms are adjacent to the OR suite.
anesthesia staff, but each has a nurse as-
The operating room set-up was similar to those seen in the US. The overhead light,
anesthetic agents were used; however, few
made in Japan, had seven individual lights, with the satellite light attached.
Gomco
suction was used and electrosurgical units were German made. Sterile supplies are kept in drums. Forceps used to transfer supplies from the drum i s stored in alcohol. Some sterile articles, such as T tubes, airways and syringes are individually
signed to help set u p and get supplies they may need during the case. All types of explosive
agents
were
used. Monitoring
equipment and blood warmers are available
if needed during surgery. Most of the suture i s supplied in glass tubes, however, some came in sterile peelback packages. The nurses' table i s not cluttered with instruments. An ingenious instrument rack on the Mayo stand has ex-
wrapped in cloth and paper. Stored in
tended prongs to hold sterile instruments,
wooden cabinets in the operating room are
such as hemostats, kellys,
other sterile supplies and wrapped sterile
forceps for ready access by the nurse.
trays set up for general,
various procedures. In
few disposable items are used.
Some of the shoe covers are disposable, and others were of cloth and covered up to the knees. There was no central supply for use by surgery, so the OR staff cleaned, selected
and Kocher's
The ICU-recovery room i s next to the OR suite. The patient stays in the area as long as necessary, from a few hours to days. The nurses' station is centrally and each room has one wall that to facilitate observation b y the staff. are allowed in the unit.
several located i s glass Visitors
and packaged their own instruments, sup-
Endoscopic examinations are done under
plies and gauze sponges. They even cut the
general anesthesia in a special room. A
4 x 4, and 4 x 8 inch
surgeon, who had just completed a gastroscopic examination, told us the patient
sponges in 2 x 2,
sizes. Most of the items are steam sterilized
by the afternoon shift who also prepare the rooms for the next day. A small ethylene
116
tolerated the exam better under a general, rather than local, anesthesia.
AORN Journal, January 1974, Vol 19, N o 1
In the nursery, babies are kept in plastic bassinettes, side-by-side. There were three Isolettes for premature infants. In the nursery there were two babies who had been abandoned by their mothers. One was four months old and the other was six months. There were about ten dogs and four pigs in the research unit. One of the dogs must have had a total laryngectomy because i t could not bark. The pigs were available for liver perfusions. The renal dialysis unit had 15 beds, plus two beds for kidney transplant patients. About 20 kidney transplants are done each year a t Aretaion. They have no home dialysis unit because it i s too expensive, and the doctor in charge feels it i s dangerous for the patient, and therefore, not recommended.
Sebastian Nicolo, RN
Two patients undergoing surgery in the same room with two different surgical teams i s enough to coniure an image of chaos and confusion. But this was not the case in the "dual procedure" we saw on our tour of surgery at Nosokomion Pedos. The cases were an orchiopexy and a herniorrhapy. The two scrub nurses worked independently, each with her own instrument table and no Mayo stand. Each surgeon had one assistant and one nurse anesthetist for each patient. There was also a circulating nurse for each case.
bolus was used to elevate his back so the hand could be placed in that space. W e were not sure why this was done. There was a minimum of noise and confusion, but plenty of action during the simultaneous cases: one in progress, one being completed, and another about to begin. The changeover was speedy and each team worked separately and efficiently with a dedicated surgical consciousness. An orderly helped with lifting, moving and positioning of patients and equipment. Anesthetic agents commonly used are oxygen, nitrous oxide, halothane and ketamine. Supply lines for nitrous, oxygen and suction originated from a floor module. The basic table setup consisted of the instrument pack, and a pack containing towels, lap sheets, sponges, tails, saline basin and cups, a towel with pre-cut 2-0, 3-0, and 4-0 silk suture, and a towel with assorted reusable needles. The packs were secured with pressure sensitive tape. They were assembled b y OR nurses in the workroom section of the OR suite. N o disposables were used, except intravenous solutions and saline for irrigation which came in plastic bottles. Cloth drapes and glass syringes were used. Catgut sutures were made in the US. Sponges, tapes and tails were cut from bolts of fine mesh gauze and meticulously folded into sizes required.
We were told that the dual procedure was a common practice for pediatric cases, with the exception of orthopedic cases which were done in a special room with only one case in progress at a time.
Sponges are not marked with radiopaque thread because, as one surgeon explained, the substance i s expensive and sponge counts are not done on routine pediatric cases, except for orthopedic cases. With a smile, he said, "We are very careful with sponges, so we do not need the radiopaque substance or the count.'*
When one of the above cases finished, a third case, a herniorrhaphy on an eightyear-old boy, began. An intravenous was infusing into his left hand. Instead of having the boy's other arm extended at his side, a
The solution used in prepping the skin was heated in a kettle on an electric hot plate in the substerilizing workroom between two operating rooms. There was a pungent odor of ether, but it was not established
118
AORN Journal, January 1974, Vol 19, N o 1
whether or not ether was used in the skin prep solution.
used in the near future for immediate postoperative care.
There was no decontamination between the three cases that we observed. We were told that the nurse anesthetist for the third case was a former scrub nurse who now worked under the supervision of the anesthesiologist.
The Greeks are interested and fairly well informed about political news in the US. For example, while touring the OR, an anesthesiologist took one of our nurses aside and inquired: "What do you think about Agnew?" Nine days later, on the Island of Mykonos, the proprietor of a fur and wares shop in a remote section told me, "Agnew is gone, he stuffed millions of drachmas in his pockets."
There was an adequate intercom system between the rooms. In the OR workroom, the instruments passed through a washer via a conveyer belt. Workroom sinks were equipped with forced air guns to thoroughly clean the lumen of instruments. There were three autoclaves: two steam, and one ethylene oxide.
A four-bed area was the recovery room. The area was being equipped with a cardioscope monitor and other equipment to be
The tour was led by Helen Kehayara, assistant director of nurses, who spoke English. Before leaving we had refreshments with the OR team, including the pleasant and gracious OR supervisor, Papa Niki. Whether American or Greek, we were able to communicate well because of our mutual interest in OR nursing.
Jeannie L Mozur, RN
Heaf may prevent pulmonary emboli A Boston scientist dashed cold water on the common practice of using ice packs to prevent formation of blood clots in leg veins, which set the stage for many in-hospital deaths. Studies on healthy volunteers by Jay D Coffman, MD, Boston University Medical Center, suggest that the application of heat to the calf of the leg speeds up blood flow markedly, making it potentially a much better clot-preventing measure.
These clots may lead to phlebitis, but the greater danger i s that the clots may break loose to form emboli. Tests in 20 normal subjects showed that cool water ( 5 O O F ) applied to the leg markedly slowed the speed of venous blood flow and "should not be used," Dr Coffman said. By contrast, heat (105OF) applied directly to the calf substantially increased blood flow from ankle to groin. Dr Coffman also tested heparin and
did not detect any significant effect on In a report to the 46th annual scientific sessions of the American Heart Association, Dr Coffman explained that a slowing of blood flow in leg veins i s thought to be a major cause of clots. Particularly vulnerable are postoperative patients and those requiring considerable bed rest.
120
the speed of venous blood flow. Concluded Dr Coffman: "There i s a basis for applying local heat rather than ice packs in the treatment of phlebitis and that local heat should be further studied as a means of preventing venous blood clots and pulmonary emboli in high-risk patients."
AORN Journal, January 1974, Vol 19, N o 1
Evangelismos Hospital where she is OR
posium
supervisor.
registrants.
Catherine
Papadaki,
second from left, gives a group a tour of
Symposium travelers report on OR nursing in Greece Each AORN member aftending the recent
gynecology, and urology. About two-thirds
international symposium in Greece visited one of the hospitals in Athens. Describing
of its beds are for surgical patients.
their impressions are Jeannie 1 Mozur, who visited the four-room Operating room suite at a children’s hospital, Nosokomion Pedos, and Sebastian Nicolo, who visited Aretaion
W e visited the operating room suite, intensive care unit, recovery room, nursery, research lab, and dialysis unit. We were led on the tour by Maria Tzelissi, director
Hospital. Ms Mozur is OR unit coordinator
of nurses.
at Crouse-Irving Memorial Hospital, Syracuse, NY, and presidenf of AORN of
Our first stop was the OR suite where we met Mrs Ann Reiger, OR supervisor, and Miss Sally Hill, of England. Miss Hill was at
Greater Syracuse. Mr Nicolo i s operafing room supervisor at Veterans Administrafion Hospital, Philadelphia, Pa, Aretaion Hospital i s a 250-bed university hospital which offers the following services: medical, psychiatric, surgical, obstetrics,
114
Aretaion to help instruct the nurses on open heart surgical
procedures and OR tech-
nique. While enjoying coffee, orange juice and cookies, we learned that nursing students
AORN Journal, Junuary 1974, Vol 19, N o 1
usually spend two weeks in the OR, but if
oxide sterilizer was available, but i t was not
their case study i s a surgical patient they have an opportunity to return. Surgery
used all the time.
usually begins at
7:30
am and i s over by
2:30 pm to enable the surgeons to have a siesta. The nurses cited the prohibitive cost and nonavailability of some items as their main problems. Traffic flow i s unidirectional with the three operating rooms forming a circle around the waiting room area, and nursing station. Two of the rooms are for general surgery, and one i s for open heart cases.
About 50 surgical cases are done per week. Of these, 30 are major cases. W e observed an exploratory
laparotomy for
carcinoma and a cholecystectomy. surgeons spoke
English which
All the
they had
learned while doing graduate work either in England or the US. They were most courteous, and either the surgeon or his assistant described
the procedure being
done. The chief of anesthesiology was a woman
did her graduate work in England. She
Mrs Reiger explained that a team from
who
Massachusetts General Hospital instructed them in open heart techniques. The room i s
told us she went into anesthesiology because
closed in July and August. The ICU-recovery
her brother, who i s a surgeon, asked her to. The hospital is
an all-anesthesiologist
room and endoscopy rooms are adjacent to the OR suite.
anesthesia staff, but each has a nurse as-
The operating room set-up was similar to those seen in the US. The overhead light,
anesthetic agents were used; however, few
made in Japan, had seven individual lights, with the satellite light attached.
Gomco
suction was used and electrosurgical units were German made. Sterile supplies are kept in drums. Forceps used to transfer supplies from the drum i s stored in alcohol. Some sterile articles, such as T tubes, airways and syringes are individually
signed to help set u p and get supplies they may need during the case. All types of explosive
agents
were
used. Monitoring
equipment and blood warmers are available
if needed during surgery. Most of the suture i s supplied in glass tubes, however, some came in sterile peelback packages. The nurses' table i s not cluttered with instruments. An ingenious instrument rack on the Mayo stand has ex-
wrapped in cloth and paper. Stored in
tended prongs to hold sterile instruments,
wooden cabinets in the operating room are
such as hemostats, kellys,
other sterile supplies and wrapped sterile
forceps for ready access by the nurse.
trays set up for general,
various procedures. In
few disposable items are used.
Some of the shoe covers are disposable, and others were of cloth and covered up to the knees. There was no central supply for use by surgery, so the OR staff cleaned, selected
and Kocher's
The ICU-recovery room i s next to the OR suite. The patient stays in the area as long as necessary, from a few hours to days. The nurses' station is centrally and each room has one wall that to facilitate observation b y the staff. are allowed in the unit.
several located i s glass Visitors
and packaged their own instruments, sup-
Endoscopic examinations are done under
plies and gauze sponges. They even cut the
general anesthesia in a special room. A
4 x 4, and 4 x 8 inch
surgeon, who had just completed a gastroscopic examination, told us the patient
sponges in 2 x 2,
sizes. Most of the items are steam sterilized
by the afternoon shift who also prepare the rooms for the next day. A small ethylene
116
tolerated the exam better under a general, rather than local, anesthesia.
AORN Journal, January 1974, Vol 19, N o 1
In the nursery, babies are kept in plastic bassinettes, side-by-side. There were three Isolettes for premature infants. In the nursery there were two babies who had been abandoned by their mothers. One was four months old and the other was six months. There were about ten dogs and four pigs in the research unit. One of the dogs must have had a total laryngectomy because i t could not bark. The pigs were available for liver perfusions. The renal dialysis unit had 15 beds, plus two beds for kidney transplant patients. About 20 kidney transplants are done each year a t Aretaion. They have no home dialysis unit because it i s too expensive, and the doctor in charge feels it i s dangerous for the patient, and therefore, not recommended.
Sebastian Nicolo, RN
Two patients undergoing surgery in the same room with two different surgical teams i s enough to coniure an image of chaos and confusion. But this was not the case in the "dual procedure" we saw on our tour of surgery at Nosokomion Pedos. The cases were an orchiopexy and a herniorrhapy. The two scrub nurses worked independently, each with her own instrument table and no Mayo stand. Each surgeon had one assistant and one nurse anesthetist for each patient. There was also a circulating nurse for each case.
bolus was used to elevate his back so the hand could be placed in that space. W e were not sure why this was done. There was a minimum of noise and confusion, but plenty of action during the simultaneous cases: one in progress, one being completed, and another about to begin. The changeover was speedy and each team worked separately and efficiently with a dedicated surgical consciousness. An orderly helped with lifting, moving and positioning of patients and equipment. Anesthetic agents commonly used are oxygen, nitrous oxide, halothane and ketamine. Supply lines for nitrous, oxygen and suction originated from a floor module. The basic table setup consisted of the instrument pack, and a pack containing towels, lap sheets, sponges, tails, saline basin and cups, a towel with pre-cut 2-0, 3-0, and 4-0 silk suture, and a towel with assorted reusable needles. The packs were secured with pressure sensitive tape. They were assembled b y OR nurses in the workroom section of the OR suite. N o disposables were used, except intravenous solutions and saline for irrigation which came in plastic bottles. Cloth drapes and glass syringes were used. Catgut sutures were made in the US. Sponges, tapes and tails were cut from bolts of fine mesh gauze and meticulously folded into sizes required.
We were told that the dual procedure was a common practice for pediatric cases, with the exception of orthopedic cases which were done in a special room with only one case in progress at a time.
Sponges are not marked with radiopaque thread because, as one surgeon explained, the substance i s expensive and sponge counts are not done on routine pediatric cases, except for orthopedic cases. With a smile, he said, "We are very careful with sponges, so we do not need the radiopaque substance or the count.'*
When one of the above cases finished, a third case, a herniorrhaphy on an eightyear-old boy, began. An intravenous was infusing into his left hand. Instead of having the boy's other arm extended at his side, a
The solution used in prepping the skin was heated in a kettle on an electric hot plate in the substerilizing workroom between two operating rooms. There was a pungent odor of ether, but it was not established
118
AORN Journal, January 1974, Vol 19, N o 1
whether or not ether was used in the skin prep solution.
used in the near future for immediate postoperative care.
There was no decontamination between the three cases that we observed. We were told that the nurse anesthetist for the third case was a former scrub nurse who now worked under the supervision of the anesthesiologist.
The Greeks are interested and fairly well informed about political news in the US. For example, while touring the OR, an anesthesiologist took one of our nurses aside and inquired: "What do you think about Agnew?" Nine days later, on the Island of Mykonos, the proprietor of a fur and wares shop in a remote section told me, "Agnew is gone, he stuffed millions of drachmas in his pockets."
There was an adequate intercom system between the rooms. In the OR workroom, the instruments passed through a washer via a conveyer belt. Workroom sinks were equipped with forced air guns to thoroughly clean the lumen of instruments. There were three autoclaves: two steam, and one ethylene oxide.
A four-bed area was the recovery room. The area was being equipped with a cardioscope monitor and other equipment to be
The tour was led by Helen Kehayara, assistant director of nurses, who spoke English. Before leaving we had refreshments with the OR team, including the pleasant and gracious OR supervisor, Papa Niki. Whether American or Greek, we were able to communicate well because of our mutual interest in OR nursing.
Jeannie L Mozur, RN
Heaf may prevent pulmonary emboli A Boston scientist dashed cold water on the common practice of using ice packs to prevent formation of blood clots in leg veins, which set the stage for many in-hospital deaths. Studies on healthy volunteers by Jay D Coffman, MD, Boston University Medical Center, suggest that the application of heat to the calf of the leg speeds up blood flow markedly, making it potentially a much better clot-preventing measure.
These clots may lead to phlebitis, but the greater danger i s that the clots may break loose to form emboli. Tests in 20 normal subjects showed that cool water ( 5 O O F ) applied to the leg markedly slowed the speed of venous blood flow and "should not be used," Dr Coffman said. By contrast, heat (105OF) applied directly to the calf substantially increased blood flow from ankle to groin. Dr Coffman also tested heparin and
did not detect any significant effect on In a report to the 46th annual scientific sessions of the American Heart Association, Dr Coffman explained that a slowing of blood flow in leg veins i s thought to be a major cause of clots. Particularly vulnerable are postoperative patients and those requiring considerable bed rest.
120
the speed of venous blood flow. Concluded Dr Coffman: "There i s a basis for applying local heat rather than ice packs in the treatment of phlebitis and that local heat should be further studied as a means of preventing venous blood clots and pulmonary emboli in high-risk patients."
AORN Journal, January 1974, Vol 19, N o 1