Perioperative nursing in Hysteroscopies

Marie_LPN, RN, LPN, RN · Dec 1, 2005

Well, the way it is where i work, it's surgeon preference as to whether an I and O is kept.

The surgeons that use the fluid management system want the I and O recorded. Since we use computer charting, it is recorded there (a box is on the program for it). Nothing is put on paper.

DRSRN1948 · Dec 1, 2005

Thanks for responding. The system we are researching just uses a pump system and either 1L or 3L bags. They tell me they don't do official recording just a note pad during the procedure then they pitch it. I would like to know if institutions really function like that. With all of the charting and recording we have to do, it seems like the perioperative area is a little lax. Anyway thanks for your help. DRSRN1948

Marie_LPN, RN, LPN, RN · Dec 1, 2005

The system (cannot remember the name of the machine right now) we use for fluid management records an I an O on the machine, and after a double check by the nurse, those numbers are documented in with the rest of the charting.

I had forgot to add earlier that when fluid management isn't used, the nurse documents how much fluid is left in the bottle, and how much fluid is in the suction cannister that was connected to the pouched under-butt drape.

sweet31eve · Dec 1, 2005

In our facility it is the Circulators role to keep an accurate count of I & O during hysteroscopies. We do have flow sheets in our Gyn Cart in the OR. I know that many RNs do not do use these, but do keep track on a scratch paper. If we have a discrepency at all we inform the surgeon throughout the procedure.

Another way to find out about this protocol is to try to visit the AORN website. There you should be able to find out Recommended Policies and Procedures in the Perioperative Setting. Another idea is to talk to the company that provided/ sold the hysteroscopy equipment to the OR and find out what there instructions or recommendations were re. I&O.

This is a procedure where I&O is essential and in my opinion, innacurate track can lead to danger. (Which is apparently what happened in the case you are reviewing.)

Hope this helps.

DRSRN1948 · Dec 2, 2005

Thanks for responding. I've tried the equipment company and they weren't to helpful. Itried AORN policies and procedures but found little info. I'll just keep hunting. Maybe a clinical educator will reply with some input. Thanks again. :rolleyes:

callbabe · Jan 8, 2006

I have a question, how do you record the fluid used as irrigant during hysteroscopy procedures? Do your facilities have standardized flow sheets to keep up with the irrigant I/O and does it go into the patient's record? I am doing some legal nurse consultant work and have not seen any information on how nurses keep these records. I'm not trying to hurt any nurses, just help protect them. Thanks for any information.

The facility were I work now for some 22 years documents on the page where the irrigation fluids are written how much was used and how much was returned. Good collection is the clue. And gravity flow is important. Pressure infusion is dangerous. If you have a uterine perforation and do not know it you could have liters in the abdomen and not even know it. You should have an equal amount in that you have out. There is a safe limit like 1000-1500ml that you can have in with minimal problems but even that is pushing it. Bottom line you should document accurate I&O. Omissions are negligent. If I can answer any other questions, feel free.

jwk · Jan 10, 2006

The facility were I work now for some 22 years documents on the page where the irrigation fluids are written how much was used and how much was returned. Good collection is the clue. And gravity flow is important. Pressure infusion is dangerous. If you have a uterine perforation and do not know it you could have liters in the abdomen and not even know it. You should have an equal amount in that you have out. There is a safe limit like 1000-1500ml that you can have in with minimal problems but even that is pushing it. Bottom line you should document accurate I&O. Omissions are negligent. If I can answer any other questions, feel free.

All good points.

You'll rarely get equal I/O's BUT you darn well better be recording them and KEEPING UP throughout the case. Hanging multiple bags during the case and trying to figure I/O's at the end is asking for a disaster. At 1000cc deficit (or imbalance or whatever you want to call it) you should consider terminating your procedure. Our absolute limit is 1500cc, no argument, no discussion, the procedure is aborted at that point, whether the surgeon wants to stop or not. And you don't have to have a perforation to get in trouble - a lot of fluid can go out through the os and tube, ESPECIALLY when using pressurized or roller pump systems (I don't know why these are still marketed and used, but they are). If there is ANY question as to your fluid balance, STOP!

callbabe · Jan 10, 2006

All good points.
You'll rarely get equal I/O's BUT you darn well better be recording them and KEEPING UP throughout the case. Hanging multiple bags during the case and trying to figure I/O's at the end is asking for a disaster. At 1000cc deficit (or imbalance or whatever you want to call it) you should consider terminating your procedure. Our absolute limit is 1500cc, no argument, no discussion, the procedure is aborted at that point, whether the surgeon wants to stop or not. And you don't have to have a perforation to get in trouble - a lot of fluid can go out through the os and tube, ESPECIALLY when using pressurized or roller pump systems (I don't know why these are still marketed and used, but they are). If there is ANY question as to your fluid balance, STOP!

Hey I agree for the most part, I have a reputable sales rep from a very good company telling my surgeons 1500 is ok, we do use gravity to by the way. The majority, 90% of our cases only last about 20 min. unless they are resecting something. Our fliuds usually are equal. under pressure fluid will take the easiet path, like the tube,os or perf.

jwk · Jan 10, 2006

Hey I agree for the most part, I have a reputable sales rep from a very good company telling my surgeons 1500 is ok, we do use gravity to by the way. The majority, 90% of our cases only last about 20 min. unless they are resecting something. Our fliuds usually are equal. under pressure fluid will take the easiet path, like the tube,os or perf.

Sales reps told us sufenta was just "a little more potent than fentanyl". Hey sales rep, why isn't my patient awake yet? I only gave them 2cc of sufenta!!!

Sales reps are there for one reason, and it ain't because they're great clinicians. Ask you sales rep if they carry malpractice insurance. Reputable, good company, BFD! They'll be nowhere in sight when your surgeon gets sued.