Help needed with THR surgical assignment

Marie_LPN, RN, LPN, RN · Oct 5, 2005

1) Why are patients undergoing major joint surgery ordered IV antibiotics to go with them to theatre?

To help prevent infection. It's also typically redosed after 3 hours. You also might want to include the total joint replacement protocol for the OR, since this is also part of infection prevention. Most use laminar air flow, and want the employees in shoes covers, impervious gowns, double-gloving, and either the hood-style hat over the regular hat, or spacesuits (our facility requires boot-style shoes covers taped onto pants and spacesuits). Also, the irrigation solutions used in the wound are typically an antibiotic solution as well (we typically use bacitracin 50,000 units/normal saline 1000 ml in the basin, and also in the Pulse Lavage).

Facilities vary, double check with the local OR for their policies on this, but they are also steps to prevent infection.

2) What should be checked before anti biotics are given to a patient?

Allergies to any medications, also check the IV site to make sure it's OK. It also depends on the antibiotic given for what else to check for such as how soon to give it, whether it needs gravity or a pump, etc.

MissJoRN, RN · Oct 7, 2005

We don't use quite the same joint protocol as Marie (although at least one of our surgeons would be in heaven!) We are extremely picky about sterility in a joint replacemtn though.

Why is there more concern about infection in an ortho procedure than, say, a vascular procedure?

Think of the perfusion... the body can't fight infection as well in bone. Osteomylitis is an ugly thing!

If there is colonization of hardware... it may need to come out. Patient gets another THR?? Don't want that!

The general idea is to get the prophylactic abx in the body as close (late) to incision time as possible, hence sending it to the OR vs giving in pre-op. You want your peak levels during the procedure.

But... (as an aside) back to perfusion... a tourniquet is used during a total knee so the abx would need to be in before the tourniquet is inflated or it will go everywhere but the op leg... then what's the point?

Same deal as anytime you give abx to any patient in any setting, remember your 5 rights. Sounds like your instructor threw you a "trick" question :)