Dear Members of the Quality Management Dept.,
Thank you for asking me to provide a response with additional information needed to complete your review of the issue of the case.
As to the indication for use of a previous surgical site for insertion of Veress needle this was chosen as this was the best site for the docking, and placement of the ports for the laparoscopic procedure to be completed. It is important to note that this was a previous laparoscopic incision site, i.e. a site of a 10 millimeters trocar. Thus in my experience of more than 25 years of performing laparoscopy surgery I have consistently used a previous laparoscopic incision sites doing redo laparoscopic surgery. Over this time I estimate that I have put in approximately twenty-thousand trocars for the thousands of patients that I operate on. It is rare to see adhesions at previously laparoscopic port site and therefore it is our standard health practice. As way of note this was off the midline in the left upper quadrant so it adhere
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Finally, review of the literature reveals in a systematic literature review they recommended that the veress needle not be inserted in the midline. They also note that vascular injuries could be fatally if not recognize.
In addition, we were asked to come in an identify the number attempts made for the insertion of veress needle per protocol we were off the midline and at a previous laparoscopic incision site and we attempted three times each time with a negative water drop test. Then we moved a little bit more lateral to a new incision site and at this time we attempted one time and were able to successfully place the veress needle and successfully do the water drop which indicated that the veress needle is free within the peritoneal cavity insufflation and place our additional
Venipuncture involves several important steps with which the medical assistant must be thoroughly familiar before attempting the procedure. (Proctor, D., Adams, A. (2014). Kinn’s the Medical Assistant: Applied Learning Approach, 12th Edition.). When Margaret was given the requisition form for Mr. James Brown. She
Then after threading a catheter through the needle, the anesthesiologist will withdraw the needle and leave the catheter i...
It is essential to make sure that the patient is fine once the procedure has been finished and prior to them leaving. If there have been no complications, then the patient will most likely be ok. Nevertheless make sure that the site has stopped bleeding and that they are not feeling faint. If there was any complications, for example, hitting an artery, haematoma or fainting, then make sure you follow the process for dealing with the complication and let the patient know what they need to do if any symptoms
Yacopetti, N., Davidson, P., Blacka, J., & Spencer, T. (2013). Preventing contamination at the time of central venous catheter insertion: a literature review and recommendations for clinical practice. Journal Of Clinical Nursing, 22(5/6), 611-620. doi:10.1111/j.1365-2702.2012.04340.x
First, you must obtain all of the necessary supplies: gloves, alcohol or Betadine preps, a tourniquet, tape, an appropriately sized IV catheter, a bag of IV solution, the IV tubing, and gauze pads. While obtaining the supplies, you should inform the patient that IV catheter placement is necessary, and why. Do not lie to the patient and tell him or her that it is a painless procedure. Instead, be honest with them and explain that the initial puncture feels like a sharp pinch on the skin and that the pain and discomfort associated with the IV placement is only temporary. You may find it helpful to demonstrate to the patient the amount of pain to expect by pinching the skin on the back of their hand. This is especially helpful for younger patients or patients who are more concrete in their thinking.
The needle is usually inserted into in a vein close to the elbow, the wrist, or placed on the back of the hand. IV infusion works effectively because gravity pushes the fluid down through the IV tubing into the patient's vein. The higher the bag is hung, the greater the gravitational pressure on the IV fluid to flow downward through the tubing. To get enough pressure for gravity to force the fluid into the vein at a constant rate, the IV bag needs to be hung high. So, all IV bags must be hung above the ...
If there is a driveline emerging from the abdomen, the paramedic should not cut, bend, or twist it since this is the direct connection to the power source to the pump. Ther pareamedic should begin his/her assessment with the routine steps of assessment; however, when the paramedic gets to step C, the process will change. Though some VAD’s produce a pulsating flow of blood throughout the body, a larger number of devices use a continuing flow creating a non-pulsating continuous flow. Therefore, these patients will not have a pulse when assessed in the conventional manner. Also, attempting to take a blood pressure reading with a manual cuff does not produce an audible
I was able to change central line sterile dressing and hung IV normal saline my preceptor gave me a good complement. In lab we practice IV and helped me to perform with confidence. I helped with monthly recapping.
administered to prevent clots and perhaps continues post-op. If such a patient is not given
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The three areas of the tutorial I notice that I am confident in, is Phlebotomy, part 1: Collection tutorials on Venipuncture Process 2, 3, and 4. The Venipuncture Process 2 tutorial explains step by step processes for performing a venipuncture is by identifying the patient, checking the order form and assembles equipment, washing your hands and putting on gloves. The Venipuncture Process 3 tutorial explains when locating a patient’s vein make sure you clean the puncture site, apply the tourniquet, and stabilize the vein without touching the area. The Venipuncture Process 4 tutorial explains after stabilizing the vein, remove the need’s cap and insert the needle at a 15 to 30-degree angle and insert the needle with the bevel facing up. I am
Post-operative care includes checking the vital sings every four hours or more frequently as needed and reporting any abnormalities to the physician. Aggressive pain management as mentioned earlier is important in patients who have had a total knee replacement. There an accurate assessment of the patient’s pain level is the initial step in the management of pain in these patients. The patient should be advised to report if the pain goal is not been met. It is important for patients who have had a total knee replacement to ambulate early to prevent the formation of deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore the nurse with the advice of the surgeon and the physical therapy team has to assist the patient to start ambulating soon after the surgery. Also part of the nursing intervention to prevent DVT and PEs includes making sure that the patient is on chemical and mechanical prophylaxis. This will be discussed further in the complications section below. Indwelling Foley catheters are usually placed during a total knee replacement surgery. Part of the nursing intervention will also include making sure that the catheter is removed once it is no longer needed to prevent catheter associated urinary tract infection (CAUTI) (Parker
After almost one hour of “tube procedure connections”, I got up to go to the restroom with an IV pole following my s...
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...
Quality standard is a document that giving requirements, conditions, procedure or characteristics that can be used again and again to guarantee that materials, products, process and services are fit for their purpose.