my pt was burned in the OR

scribblerpnp · Jul 22, 2008

I agree that 2-3 hours may not have been long enough for it to blister and look like a real burn, even if it was a minor burn. A red line could have looked like a an indention from a sheet or something (sort of like when you take off really tight pants and you have those lines all over your belly- or is that just me).

If you had checked his epidural, most likely a blister burn would have stood out, but I could definately see how a red line might not.

I hope everything turns out for you OK. Hopefully it won't be a big deal. You weren't the one who burned him, so I don't think anything REALLY bad could happen, but I'm not a recovery nurse, os don't know for sure.

TakeTwoAspirin, MSN, RN, APRN · Jul 22, 2008

I would imagine that whoever put the grounding pad on the patient in the OR would be in more trouble than you. I am assuming that the burn was from the Bovie because the grounding pad was not placed securely. Whenever the pad is taken off in the OR, it is generally protocol for the OR staff to make sure that skin integrity has been maintained around the pad.

CritterLover, BSN, RN · Jul 22, 2008

i agree with scribbler.

i've worked a little bit of pacu (cross-training was required when i worked in a certain sicu), and i can't see where you would need to fret about this.

i'm sure you charted what you saw at the time you charted on him. if you charted his skin was intact -- it was, even if there was a burn in development at the time. they aren't always obvious when they start, which is why we "describe" what we see, rather than labeling it with a diagnosis ("burn") when we see it. plus, obvious signs of burns take time to develop. take sunburns, for instance. even when i've had a second degree sunburn (with blisters, etc), i usually didn't know until i took a shower the next morning.

it is unfortunate that he got a burn in the or, but please don't feel responsible for it.

(i am particularly sensitive to this, because one of my coworkers has taken to feeling responsible for any patient that codes in the hospital while she is working. there is a little more to it than that simplistic statement -- she does have some -- but not complete -- responsibility for certain -- but not all -- patients in the hospital [even ones not explicitly assigned to her], but she isn't responsible for every patient, all of the time. listening to her second-guess herself, all of the time, has become quite draining.)

along those lines, what happened to the patient before he/she came into your care is not your responsibility. what was found on your patient, after he/she was in your care, was not your responsibility. you did what you were supposed to do: charted your objective assessment, as it stood when you assessed your patient. that his/her condition changed after s/he left your care is not your problem (though your charting will help to pinpoint where the injury may have occurred).

those calls from "someone" looking into "something" that happened to a patient in you care can be quite scary. please, don't let them become anything more than they are at face-value -- an investigation regarding an incident that happened to a patient that had been in your care at some point. give info candidly and freely -- they aren't looking to "hang" you, they are trying to figure out what went wrong and are hoping to keep it from happening again.

(as an aside, part of my job is to investigate all non-icu, inpatient codes in my hospital. we had one of those this weekend -- they really aren't all that common, thankfully -- and even though the code itself happened on day shift [i work nights], i asked a bunch of questions to the night nurse after the fact [she had admitted the patient, just a few hours before she coded]. the info we get from that sort of thing is very helpful. in this instance,the patient had some significant chronic illnesses, and was admitted to the floor that takes care of patients with one of her admitting diagnoses, but does not take care of telemetry patients, because of some structural issues. of all of the questions i asked of this nurse -- and there were many -- none were asked with an intention to assign blame. maybe we need to speak with this physician about how, even though she likes the patients to be on "her" floor, she needs to assign patients that meet certain criteria to telemetry, rather than "her" floor? maybe we need to work harder with engineering to figure out a way to get telemetry capabilities on that floor? at any rate, the nurse i talked to had charted all that she needed to chart, and had done a very good job of it. that doesn't change my need to ask additional questions. her answers were very helpful to me, and helped me make some recommendations. so, a long way of saying -- try not to fret when you get questioned. i love our floor nurses, and take every opportunity to support them/sing their praises. i know i couldn't manage 11 patients. however, sometimes questions need to be asked. answering honestly is very helpful in figuring out what happened/trying to make improvements.)

core0 · Jul 22, 2008

and i somehow missed it. my guy had a liver ablation done. i am a new grad in the recovery room, i usually turn all of my pts to check their skin quickly. this guy had an epidural so i am almost certain i seen his back, he was a little red, but most pts are after lying on their backs in the or. this pt was with me for a few hours and was discharged by another nurse on my unit. when he arrived tot he floor the nurse noticed a fluid filled bubble from a burn. the next day the or nurse manager was hunting me down because she thought i was the one who noticed the burn.
so of course, the hospital has to investigate this. i am worried that i am ina whole bunch of trouble. i am praying that i documented that my pt's skin was intact. my theory is that he could have been burned and the skin was just red and blistered over time. i have had minor burns before and i dont remember the skin blistering right away. either way i look at it i am in the wrong because i only assessed his skin once. he was in the recovery room for at least 2 or 3 hours. my coworker who discharged him didnt see his skin becasue she just sent him to the floor. i honestly dont even remember his back or if i even looked at it. but, i know i routinely look at everyone, but nothing about him is standing out in my mind.
i guess i am posting to kind of vent, and seek advice. whats the worst that can happen to me? i am terrified that i will be pulled into court. i never thought i would be in this situation so soon..... thanks for listening everyone

I'm curious about the procedure. Usually ablations are done either laproscopically or in IR. Was this a resection? With an ablation you can have RF burn through or you can have a burn at the site if the insulation breaks. Also the burn may not be a burn. If this is at the site of the bovie pad it can also be reaction to the adhesive. I've seen this more often than a real burn from the bovie pad. It looks just like a burn (ie blisters etc). It usually takes 4-6 hours to fully develop. I would also agree with the other posters that obvious signs of a burn can take several hours to develop.

David Carpenter, PA-C

morte, LPN, LVN · Jul 22, 2008

I'm curious about the procedure. Usually ablations are done either laproscopically or in IR. Was this a resection? With an ablation you can have RF burn through or you can have a burn at the site if the insulation breaks. Also the burn may not be a burn. If this is at the site of the bovie pad it can also be reaction to the adhesive. I've seen this more often than a real burn from the bovie pad. It looks just like a burn (ie blisters etc). It usually takes 4-6 hours to fully develop. I would also agree with the other posters that obvious signs of a burn can take several hours to develop.
David Carpenter, PA-C

i, too, was wondering about an allergic reaction.....good luck

Mara123RN · Jul 22, 2008

A pressure ulcer will also form a blister, before it becomes a crater.

ava'smomRN · Jul 22, 2008

thanks everyone. it was supposed to be a lap ablation but they converted to an open. the nurse manager from the or was concerned about someone not grounding the pt properly or something wet under him which would have broke the grounding.

MassED, BSN, RN · Jul 22, 2008

and i somehow missed it. my guy had a liver ablation done. i am a new grad in the recovery room, i usually turn all of my pts to check their skin quickly. this guy had an epidural so i am almost certain i seen his back, he was a little red, but most pts are after lying on their backs in the or. this pt was with me for a few hours and was discharged by another nurse on my unit. when he arrived tot he floor the nurse noticed a fluid filled bubble from a burn. the next day the or nurse manager was hunting me down because she thought i was the one who noticed the burn.
so of course, the hospital has to investigate this. i am worried that i am ina whole bunch of trouble. i am praying that i documented that my pt's skin was intact. my theory is that he could have been burned and the skin was just red and blistered over time. i have had minor burns before and i dont remember the skin blistering right away. either way i look at it i am in the wrong because i only assessed his skin once. he was in the recovery room for at least 2 or 3 hours. my coworker who discharged him didnt see his skin becasue she just sent him to the floor. i honestly dont even remember his back or if i even looked at it. but, i know i routinely look at everyone, but nothing about him is standing out in my mind.
i guess i am posting to kind of vent, and seek advice. whats the worst that can happen to me? i am terrified that i will be pulled into court. i never thought i would be in this situation so soon..... thanks for listening everyone

is having a burn a common thing? What type of surgery was this person having or had done? What if this person had a reaction to tape or adhesive.... if you normally look at a person's skin in recovery and don't recall anything out of the norm, then I would assume you'd recall if there was anything unusual for you to have noted - and you would have noted it. Were you to document q hour or something sooner than once while in recovery? I work in a different setting, so I don't know about epidurals and how often you have to check the site... yada yada... but I guess it all depends on how bad the burn was - or the blister.... pulled into court, though? I wouldn't think you would - it's not like YOU CAUSED it in the first place - you recover the patient and don't place anything hot on them (not like a BEAR hugger to cause burns...) Likely occurred in the OR, no?

MassED, BSN, RN · Jul 22, 2008

I would imagine that whoever put the grounding pad on the patient in the OR would be in more trouble than you. I am assuming that the burn was from the Bovie because the grounding pad was not placed securely. Whenever the pad is taken off in the OR, it is generally protocol for the OR staff to make sure that skin integrity has been maintained around the pad.

with this info., sounds like the OP would be in the clear.... but the OR staff is more in the "hot" seat, so to speak...

TakeTwoAspirin, MSN, RN, APRN · Jul 22, 2008

Although fairly uncommon, burns in the OR are a well-known (and extensively documented/researched) hazard and one for which the OR team should be well trained in preventing.

If you are interested in the technology of Electro Surgical Units, and how burns occur, the following is a really informative site: http://www.valleylab.com/education/poes/index.html

Faeriewand, ASN, RN · Jul 23, 2008

my daughter got a sever sun burn after spending all day at the beach and swiming on her front. Her back legs were very burned. She did not blister until the next morning. But wow what huge blisters they were. So you see blistering does take time to form.