Clinical Issues-March 2021.

Area of Science:

• Surgical patient management
• Medical device safety
• Infection control

Background:

• Management of surgical patients with continuous glucose monitoring devices and insulin pumps presents unique challenges.
• The use of leftover intravenous (IV) fluids for surgical site cleansing raises concerns about contamination and infection risk.
• Defining the scope of practice for a registered nurse (RN) first assistant (RNFA) is essential for safe surgical care.
• Utilizing surgical instruments in ways not specified by the manufacturer's instructions for use (IFU) can introduce risks.
• Patient repositioning, particularly transfers between prone and supine positions, requires specific techniques to maintain alignment and prevent injury.

Purpose of the Study:

• To highlight key considerations for managing surgical patients with insulin pumps and glycemic control devices.
• To evaluate the safety and efficacy of using leftover IV fluids for surgical incision site cleansing.
• To clarify the professional scope of practice for a certified surgical first assistant with RN licensure.
• To assess the risks associated with using surgical instruments outside of their intended manufacturer's instructions for use (IFU).
• To describe best practices for patient transfer and repositioning in the operating room, specifically from prone to supine positions.

Main Methods:

• Review of current literature and clinical guidelines related to glycemic control in surgical patients.
• Analysis of infection control protocols and potential breaches when using non-standard irrigation fluids.
• Examination of professional standards and legal definitions governing the role of the RNFA.
• Case study analysis or review of adverse events related to surgical instrument misuse.
• Observation and documentation of patient transfer techniques and the use of specialized positioning devices.

Main Results:

• Patients with insulin pumps require vigilant blood glucose level monitoring to prevent perioperative hyperglycemia or hypoglycemia.
• Using leftover IV fluids for wound cleansing is associated with an increased risk of surgical site infection and contamination.
• The RNFA's scope of practice is defined by licensure, certification, and facility policies, emphasizing patient safety.
• Deviating from manufacturer's IFU for surgical instruments can lead to instrument malfunction, patient injury, and compromised procedural outcomes.
• Proper use of positioning devices and adherence to alignment principles during patient transfers minimizes the risk of skin breakdown and nerve damage.

Conclusions:

• Effective management of surgical patients with glycemic control devices necessitates meticulous insulin therapy and glucose monitoring.
• Strict adherence to sterile field principles and avoidance of non-standard irrigation solutions are paramount to prevent surgical site infections.
• Understanding and practicing within the defined scope of practice for RNFAs ensures optimal surgical team function and patient safety.
• Compliance with manufacturer's IFU for all surgical instruments is critical for preventing adverse events and ensuring procedural integrity.
• Safe patient handling and repositioning techniques are essential components of perioperative nursing care, requiring specialized training and equipment.