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I would like to know how other facilities position their women for Da Vinci robot gyn cases to keep them from sliding off the head of the bed when the bed was placed in extreme Trendelenberg position. We originally used the 'u'shaped shoulder supports that attached to the bed, but patients developed brachial plexis injuries secondary to the supports and the apparent pressure of their shoulders against the supports. So we went to the eggcrate foam across the chest and the tape over the eggcrate. The anesthesia provider stated that for this to be effective, the tape would have to be so tight that it would impede chest expansion during the case indicating that even this would not keep the patient on the bed. Another thing we do is to put the patient on a mattress sized gel pad with no sheet over it. The thought behind this was that the patient would "stick" to the gel pad and that and the tape over the eggcrate across the chest would keep her in place. My first concern was the possibility of shearing injury to the back and hips of the patient as gravity would 'pull' her body towards the head when she was put in Trendelenberg position, but that the skin that was stuck to the gel pad would remain in place causing a separation of tissue along the horizontal plane, thus the shearing effect. I would appreciate any thoughts and ideas out there and suggestions for alternative positioning techniques. Thanks

Regarding positioning for Da Vinci robot gyn cases, we originally used the 'u'shaped shoulder supports that attached to the bed, but patients developed brachial plexis injuries secondary to the supports and the apparent pressure of their shoulders against the supports. So we went to the eggcrate foam across the chest and the tape over the eggcrate. The anesthesia provider stated that for this to be effective, the tape would have to be so tight that it would impede chest expansion during the case indicating that even this would not keep the patient on the bed. My main concern was that the patient was placed directly on a mattress sized gel pad with no sheet over the top. The thought behind this was that the patient would "stick" to the gel pad and that and the tape over the eggcrate would keep her in place. My first concern was the possibility of shearing injury to the back and hips of the patient as gravity would 'pull' her body towards the head when she was put in Trendelenberg position, but that the skin that was stuck to the gel pad would remain in place causing a separation of tissue along the horizontal plane, thus the shearing effect. I would appreciate any thoughts and ideas out there. Thanks

In our merged hospital system, we are in a quandry about DVT therapy with the question being sequential vs. uniform compression. Each vendor is representing his technology as effective. I would like input from all you nurses about how your institution decided on which DVT sleeve and system to use and the clinical issues you see with the effects of your decision. Thanks.

i would like to know if anyone is using either the clearlink or interlink iv tubing and what your preference might be. also, are you experiencing any increase in infection or irritation in the patients where you are using either type of tubing. thanks.

I work at a hospital that has two call teams on per night, a general call team that consists of 2 professionals and a heart call team that consists of 3 professionals. If a general call case requires a team of 3 members, one of the heart call team members is scheduled to be called in also. Everyone gets $3.00/hr to be on call, and time and a half if they have to come in. Heart call team members are on call every other week, a week at a time. General call team members are on call once or twice a week with the heart team whose week it is and one of that team covering that third call slot. We are rarely offered the next day off and it is not assumed that you will get it whether you work or not.

I need suggestions or current practice methods on another issue. Our hospital currently does not have a Pyxis system and the pharmacy is currently investigating having one installed. But I'm told that Pyxis is not functional in the operating room. I am interested in what is being done in other operating rooms and what works for you. We have an open cart with our floor stock of meds. And some have come up missing. So we are looking to increase security and effeciency of the system. I am open to suggestions to other processes. Thanks.

Thanks. I have contacted AORN, but they don't guarantee a reply for 7-14 days and I need suggestions sooner than that. I fully agree with all the suggestions and reasons that have been given so far. I think it is a very unethical practice that could do more harm than good.

Could you all please give me suggestions as to what your policies or current practices are when one of the team has a family member having surgery. What is your position on having that family member on the OR team who is operating on that family member. I've got a nurse (team leader) who insists on participating on her father's total knee replacement surgery because she doesn't feel anyone else is competent to do the case. Are there any resources out there for support against this practice? Ethically I don't feel it is the right thing to do, but we currently do not have a policy addressing this practice. Thanks.

Instrumentation is one of many parts of OR nursing. The more you work with the instrument and learn what each is used for it will become second nature. And, lenawa is right. I've got one surgeon who calls a fine, round tip vascular forcep a "bugger picker." This same surgeon calls vessel loops "rubber bands." And they may call the same instrument something different depending on what case they are doing. It takes a good strong 6 months to begin to feel comfortable in the OR. give yourself some time.