Axillary rolls

[shaomai]

Do any of you have access to any evidence-based practice of wrapping an axillary roll in a towel? I was taught not to place any material over a gel roll as for it defeats the purpose. I would appreciate any information. Thank you!

[Mr. & Mrs. RN]

We don't put anything over our ax rolls. The seams shouldn't come in contact with the patient. Old, ripped ones should get replaced.

[Rose_Queen, BSN, MSN, RN]

We don't put anything over our ax rolls. The seams shouldn't come in contact with the patient. Old, ripped ones should get replaced.

I'd like to know where you work where things get replaced. Where I work, it's ridiculous. In addition to "gel" chest rolls that are more ioban/opsite, our bean bags are also "patched" with foam tape. We got replacement chest rolls once- all of one pair. When we need up to five sets at a time, none of the bad ones got replaced at all. Oddly enough, the axillary rolls seem to be holding up the best- although they are probably the least used.

[fracturenurse]

Yup, good luck getting anything replaced in my OR either. Anyhow, one of the nurses at work told me it was in a recent AORN magazine, I think at the back where they do the questions. One of the reasons they were stating is that IV bags can burst, and if that happens causes "pooling." We all know how the AORN feels about pooling. Anyhow, we finally got some new ones after ours all disappeared. We will see how long before they get thrown out. I'm going to recommend the stockinette idea.

[elcue]

Thanks for the followup. Have a great weekend.

[GadgetRN71, ASN, RN]

I'd like to know where you work where things get replaced. Where I work, it's ridiculous. In addition to "gel" chest rolls that are more ioban/opsite, our bean bags are also "patched" with foam tape. We got replacement chest rolls once- all of one pair. When we need up to five sets at a time, none of the bad ones got replaced at all. Oddly enough, the axillary rolls seem to be holding up the best- although they are probably the least used.

I've worked in places like that. The place I'm in now is actually very good about replacing our equipment and positioning aids. The surgeons stay on them about stuff like that.

A bigger issue for us is keeping the stuff we buy in our department- we've had to resort to locked cabinets.

[Who?Me?]

"A bigger issue for us is keeping the stuff we buy in our department- we've had to resort to locked cabinets."

Ain't this the truth! I work at a small facility right now so weekends we are staffed "on call," so the house supervisors help themselves to supplies for the ED and ICUs. Can you not call supply like I would have too!?! Jeez. And I am sure that people in non-OR attire are walking through because what supervisor is going to bunny suit up or change out of their scrubs into ours to get a coude catheter or the laryngoscope?

[shodobe]

Well, you also have to think about how heavy a patient is. Gel ax rolls won't do a bit of good if the patient's weight compresses the roll to nothing. I see nothing wrong with using IV bags on smaller patients and much stiffer ones on very heavy patients. You really have to look at each situation and work with what you have. Don't get pidgeon-holed to rules that make no sense.

[RNOTODAY, BSN, RN]

axillary rolls or any other gel positioners are made to have nothing between them and the patient. This is per the manufacturer, because this was an issue where I work too.

[drums326]

Yeah, it's def. one of those annoying situations that we nurses are put in...when we know "what works," and institutions/organizations have to come up with some kind of policy when the issue is addressed. You probably know what's going to work best for the patient, so do what ya gotta do...

I have noticed that the few different Army hospitals I have worked at all have different positioning gear. If they have a nice gel roll I still go with webril or a pillow case. I like the idea of a stockinette, I will have to use that! I don't mind using an IV bag if I feel comfortable in the situation. Usually I see them used in neck/c-spine cases, and our surgeons like to place them themselves...which I make sure to chart!....after making sure it is indeed safe for the patient.

[PetiteOpRN]

When I have used gel ax rolls, they "burst" and the gel got all over the patient and the surgeon (while he was marking). Since then, no more gel rolls.

[ORnurse77433]

I always wrap whatever we use for ax rolls in some type of fabric. The last time I checked, the patients underarm functioned the same way mine does, and when I get warm I sweat. If the patient gets warm due to bair hugger, warm blankets, or other reasons, the moisture could get into gelpads if they have any breaks in them. To me it's an infection control issue, not comfort.

[periop]

Have any of you had any experience with a foam, rather than gel, support? Or one that is U-shaped that prevents the patient from falling back or forth?