INTRAOPERATIVE CARE

Definition

The term "intraoperative" refers to the time during surgery. Intraoperative care is patient care during an operation.

Activities such as monitoring the patient's vital signs, blood oxygenation levels, fluid therapy, medication transfusion, anesthesia, radiography, and retrieving samples for laboratory tests, are examples of intraoperative care. Intraoperative care is provided by nurses, anesthesiologists, nurse anesthetists, surgical technicians, surgeons, and residents, all working as a team.

Purpose

The purpose of intraoperative care is to maintain patient safety and comfort during surgical procedures. Some of the goals of intraoperative care include maintaining homeostasis during the procedure, maintaining strict sterile techniques to decrease the chance of cross-infection, ensuring that the patient is secure on the operating table, and taking measures to prevent hematomas from safety strips or from positioning.

Precautions

Patients undergoing surgery most often are given some type of anesthesia. The administration of general anesthesia has a relaxing effect on the patient's body, which can suppress cardiovascular function or heighten cardiovascular irritability. It may also result in respiratory depression, loss of consciousness, paralysis, and lack of sensation. These effects, some of which are intentional for the period of the surgery, mean the patient is in a very vulnerable position. It is the responsibility of the health care team in the operating room to maintain the patient's safety and yet facilitate surgery.

Guidelines for monitoring patients undergoing general anesthesia call for continuous observation of the patient by the nurse assigned to the patient. Ventilation should be assessed by continuous auscultation of breath sounds, and oxygenation should be monitored by continuous pulse oximetry. Continuos electrocardiograph (ECG) showing the patient's cardiac function should be in place, and the patient's heart rate and blood pressure should be monitored at least every five minutes. A means to monitor the patient's temperature must be available immediately for use. In case of an emergency backup personnel who are experts in airway management, emergency intubation, and advanced cardiac life support (ACLS) must be available. An emergency cart containing the necessary supplies and equipment must be immediately accessible. The ACLS equipment should be checked daily to ensure proper function.

Total analgesia is a goal of general anesthesia in order to facilitate surgery. This means that the patient does not have the normal "pain" sensations that warn of potential injury. The health care team must keep this in mind when they are positioning the patient for a surgical procedure. Although it may be necessary for a patient to be positioned in an unusual way for access to a particular area during surgery, care must be taken to ensure that the patient's body is in proper alignment and that joints and muscles are not in such an unnatural position that they will be damaged if they remain in that position for a lengthy procedure. Areas of the operating table that come into contact with the patient's bony prominences must be padded to prevent skin trauma and hematomas.

During a surgical procedure many instruments, drapes, and sponges are used. Also, a multitude of care providers may be working in the operative field performing different tasks. These factors, combined with the complexity and length of some surgical procedures, may provide extensive opportunity for patient trauma from equipment malfunction or the failure of the surgical team to avoid using full weight on the sedated patient. Additionally, it is the responsibility of the nurses working in the operating room to maintain an accurate count of all sponges, instruments, and sharps that may become foreign bodies upon incision closure. Nurses who fail to make accurate counts can be held legally liable.

Most surgical procedures are invasive and compromise a patient's skin integrity. This increases the risk of infection. To decrease the risk, strict asepsis (sterile technique) must be followed at all times.

Description

Intraoperative care includes the activities performed by the health care team during surgery that ensure the patient's safety and comfort, implement the surgical procedure, monitor and maintain vital functions, and document care given. The intraoperative time period can vary depending on the complexity of the surgery being performed.