Surgery on the patient stretcher

[rquinn0111]

I work with a surgeon who occasionally asks to do minor foot surgeries (mostly I&Ds) on the patient stretcher. The reasoning is to save time moving the patient over to the OR bed.

I couldn't find a policy on this practice; does anyone have any insight into this practice? Right now my biggest concern is the patient receiving a bovie burn because a part of their body is touching the metal side rails of the stretcher.

[jeckrn, BSN, RN]

The burns should not be an issue if the patient is properly grounded.

[springchick1, ADN, RN]

I guess I would be more concerned about leaving the patient on the dirty bed AFTER the procedure. Why would the doctor want to risk re-infecting the patient? It doesn't take that long to move a patient over.

[jeckrn, BSN, RN]

The ones I have seen have been podiatry cases and they were simple cases and only done in the OR instead of the clinic is the health of the patient.

[rquinn0111]

No, you're right it doesn't take long to move a patient. However, for this surgeon it is.

[rquinn0111]

I was worried that the path of least resistance could possibly be the metal railing, however you're right that the bovie pencil shouldn't work if the grounding pad doesn't receive the current back.

[Rose_Queen, BSN, MSN, RN]

I've only been involved in surgeries/potential surgeries on beds/litters in extremely unstable patients. One was a patient with angioedema where anesthesia brought her to the OR for awake fiberoptic scope assisted intubation and had a general surgeon on standby in the room to do an emergency trach. Because of the edema, she couldn't lie flat and the OR bed didn't raise up high enough for her to be comfortable. For some of the other very unstable patients, it was for trach surgery (we don't use a bovie anyway because of the oxygen) who were so unstable that rolling them to slip the transfer board under to slide over would have been disastrous. Other than that, we move all the surgical patients to the OR bed.

[FurBabyMom, MSN, RN]

I've only been involved in surgeries/potential surgeries on beds/litters in extremely unstable patients. One was a patient with angioedema where anesthesia brought her to the OR for awake fiberoptic scope assisted intubation and had a general surgeon on standby in the room to do an emergency trach. Because of the edema, she couldn't lie flat and the OR bed didn't raise up high enough for her to be comfortable. For some of the other very unstable patients, it was for trach surgery (we don't use a bovie anyway because of the oxygen) who were so unstable that rolling them to slip the transfer board under to slide over would have been disastrous. Other than that, we move all the surgical patients to the OR bed.

Scenarios like these are essentially the only types of scenarios and cases that I've been in where we haven't moved our patient to an OR table. Though some of our emergent trachs are brought in while resuscitation is ongoing (usually respiratory codes), we'll do their procedure (without additional sedation on board), sedate them well, etc. Fresh trachs have to go at minimum to stepdown, and if they're otherwise unstable they go to an ICU bed - often we'll manage the patient in the OR, get the ICU bed (if they didn't come from ICU), move them to the ICU bed and then transport to the ICU. Or a few of us go to help transfer on arrival to ICU. Depends on their staffing, ours, and our patient's needs.

I will say - when we did eyes, those patients were on a special stretcher due to the length of cases and case needs. No bovie though - generally bipolar if anything or pencil cautery.

[/username, BSN, RN]

I've seen open heart surgery in an ICU bed in the patient's room, nbd.