Operating Room Medications

[morris_88]

My current hospital has followed the trend of developing hybrid ORs. The hybrid ORs are being used for multiple open vascular, endovascular cases, and Trans Aortic Valve Replacements (TAVR). The TAVRs involve endovascular personnel, invasive and noninvasive cardiology, and an open cardiothoracic team (standby). These procedures are new for everyone and working with that many departments can be stressful. I am an open cardiac nurse and our team is used as standby in the event that the procedure would convert to an open. I am the only registered nurse in the room and I am required to run the room and circulate for the procedure. I do not know enough of the endovascular equipment that is used or anything regarding the charting such as sheath size, placement time, removal time, closure device placement and time, TR band application and CCs used required for PCI. I have voiced multiple patient safety concerns to my supervisors and managers. The most recent was regarding the documentation of heparinized saline that is on the sterile field. The heparinized saline is used to flush sheaths, wet wires, etc. It is NOT injected into the patient. I had asked the college coordinator for endovascular how they documented the heparinized saline solution for all the other procedures that way I could document it correctly. Her answer was we do not document heparinized saline as a medication in any endovascular, cath lab, EP, room. So there is no record of it being used....period. It is not injected into the patient it is ONLY used as a flush for sheaths and to wet wires. I was wondering what others thoughts were on this... I find this to be disturbing... how can it not be documented. I have tried to research articles or situations like this but have I found nothing. Anyone have any suggestions or articles?????

[offlabel]

Documenting the volume of heparinized saline in these cases would be an educated guess at best. Sort of like blood loss. The main thing would be to make sure it was the dilute concentration of heparin...double check with another RN yada yada.....The patient gets 100 units heparin at least per kg for these cases IV after which an ACT is drawn, so whatever heparinization that occurs is being measured by the anesthetist and reversed accordingly. Just worry about the dilution of heparinized saline. The volume given...not so much. You don't record irrigation fluid as intake to the patient either, so this shouldn't be a big deal.

[MunoRN, RN]

Keep in mind that from a regulatory standpoint, whether or not something is considered a medication or not is defined by it's intended purpose. NS for instance can be both a medication and a device, it depends on how it's used. If it's used to treat a condition, dehydration for instance, then it's a medication. If it's used for device maintenance, such as flushing an IV, then it's considered to be a device. This is also true for using heparin to flush sheaths, wet wires, etc.

TAVRs are sort of infamous for the 'too-many-chiefs' problem, this is because the CV surgeon isn't actually involved just as back up, they are required to part of the physician team performing the TAVR. Due to the quirks of Physician regulatory rules, currently a CV surgeon must be involved in any valve replacement, even if it's a TAVR that is primarily if not soley performed by an interventional cardiologist.

[Rose_Queen, BSN, MSN, RN]

In our TAVRs, the OR nurse documents the same they would for an OR case. Documentation of anything the cath lab team does is documented by their circulator.

[dlzk123]

In my facility every medication has to be charted.There is an option to enter used as irrigation/flush/iv whatever.