Site Marking

Surgery *should* be using some sort of marker that is not easily removed by the prep (chloraprep, betadine, whatever you use). Perhaps you can get some of these from their source (SPD, Sterile Processing, Central Material, Materials Management, etc at your hospital).

OR,

our facility's alternative is to use a blank wrist band.

After the site is identified by the MD, write the pertinent information on the band attach it to the pt's wrist.

Must be attached by us and removed by us before the pt leaves the room.

Troublesome?

Yes, that's why we don't use that system.

We use the marker (still visible after scrub).

Yes, but sometimes one side or the other should NOT be used as access, d/t recent site surgery, diminished or absent femoral pulse, localized infection, recent iliac or fem stent placement, hip fx, etc.

Although we RNs "work up" the pts before each case and find these things out, the MDs SHOULD be aware as well, and JCAHO decrees THEY should be the ones to mark the site of entry. it's a collaborative effort, in our practice.

In a few cases we have used the brachial or radial artery. These decisions about which site to use *should* be decided before the pt rolls into the room, and the MD *should* mark the site.

Yes, in 95% of caths we do use the right fem. But there's always one pt that, for one reason or another, would have been injured if we'd gone for the routine side.

Right, I do agree: as "all roads lead to Rome," either femoral artery will get one to the heart!

I think JCAHO's requirement is eye-rolling as well, but we comply. :)