Orthopaedic Surgery Manual 3rd Edition NATIONAL ASSOCIATION OF ORTHOPAEDIC NURSES Orthopaedic Surgery Manual 3rd Edition Nancy B. O'Connor, MSA, BSN, RN Content Editor Channahon, IL Production Credits Project Director: Tandy Gabbert, MSN, RN, ONC Project Assistant Director: Beth Kaiser Schafer, MS, RN Copy Editor: Donna Polydoros, BA Creative Designer: Patrick Williams Editorial Coordinator: Jessica M. Scott, MFA Legal Disclaimer The National Association of Orthopaedic Nurses (NAON) Orthopaedic Surgical Manual, 3rd Edition is intended to support and enhance the care of the orthopaedic patient during the perioperative experience. Information in this publication has been authored and peer-reviewed by experts in the field and reflects current evidence and research. The rapid pace of innovation and constant change in health care is evident in the operating room, where patient safety and outcomes are closely scrutinized. Changes in best practices are inevitable as current strategies are replaced by those with better results. Individual providers, teams, and facilities are accountable for using their own knowledge and expertise when determining the course of action in a patient care situation. The publisher, authors, contributors, and editors assume no liability for any injury or damage to persons or property from the use of instructions, products, methods, or other ideas in this book. Copyright © 2017 National Association of Orthopaedic Nurses 330 N Wabash Ave, Suite 2000 Chicago, IL 60611 800.289.6266 www.orthonurse.org All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage-and-retrieval system without the express written permission of the National Association of Orthopaedic Nurses. ISBN: 978-0-9790408-0-1 Table of Contents Chapter 1 - Overview of Perioperative Nursing...........................................1 Elizabeth A. Schuring, MSHCA, BSPA, RN, RNFA, CNOR I. Perioperative Nursing ................................................................................................2 II. Perioperative Patient Care Team .....................................................................................2 III. Perioperative RN Circulator ..........................................................................................3 IV. Scrub Person........................................................................................................5 V. First Assistant ........................................................................................................6 VI. Preparation and Care of the Patient During Operative Procedures...................................................6 VII. Perioperative Nursing Data Set .....................................................................................8 VIII. Clinical Aspects of Operative Pain..................................................................................9 IX. Geriatric Nursing Considerations . 10 X. Pediatric Nursing Considerations ...................................................................................11 XI. Perioperative Nursing: An Ever-Changing, Growing Specialty ..................................................... 12 Chapter 2 - Orthopaedic Aspects of the Operating Room................................15 Cheryl Mains, MBA, BSN, RN, ONC, CNOR I. Principles of a Clean Operating Room ..............................................................................16 II. Basic Room Equipment ............................................................................................18 III. Arthroscopy Equipment........................................................................................... 19 IV. Pneumatic Tourniquet . 19 V. Radiology Equipment .............................................................................................20 VI. Bone Cement .....................................................................................................23 VII. Pulse Lavage .....................................................................................................26 VIII. Casting ..........................................................................................................27 IX. Blood Salvage and Reinfusion.....................................................................................31 X. Pain Pumps . .32 XI. Bone Growth Stimulators .........................................................................................32 XII. Orthopaedic Implants ............................................................................................33 XIII. Specimens and Cultures . .34 Chapter 3 – Safety in the Operating Room ..............................................37 Julie A. Conrardy, MSN, RN, CNOR, CNS-BC I. Introduction........................................................................................................38 II. Staff Safety.........................................................................................................38 III. Patient Safety .....................................................................................................39 Table of Contents iii Chapter 4 - Positioning the Patient for Orthopaedic Surgery.............................41 Cheryl Mains, MBA, BSN, RN, ONC, CNOR I. Introduction........................................................................................................42 II. Nursing Activities Common to All Positioning......................................................................42 III. Standard Orthopaedic Positions...................................................................................44 IV. Considerations for Obese Patients.................................................................................52 Chapter 5 - Use and Care of Orthopaedic Instruments ...................................53 Teresa K. Velez, MEd, MSN, ARNP, FNP-C, CRNFA, CNOR, ONC I. Soft Tissue Instruments.............................................................................................54 II. Bone Instruments..................................................................................................58 III. Power Instruments ................................................................................................66 IV. Arthroscopic Instruments .........................................................................................68 Chapter 6 - Infection Prevention........................................................71 Mary Atkinson Smith, DNP, FNP-BC, ONP-C, RNFA, CNOR I. Highlights of Infection Prevention and Control .....................................................................72 II. Microorganisms Related to Surgical Site Infections ................................................................. 74 III. Elements of an Infection .......................................................................................... 74 IV. Risk Factor Assessment for Surgical Site Infection..................................................................75 V. Perioperative Antimicrobial Prophylaxis............................................................................76 VI. Clinical Quality Indicators Pertaining to Infection Prophylaxis......................................................76 VII. Surgical Care Improvement Project (SCIP) Measures ..............................................................77 VIII. National Action Plan to Prevent Health Care-Associated Infections ...............................................78 IX. Surgical Suite Structure ...........................................................................................78 X. Surgical Attire Policy...............................................................................................80 XI. Personal Protective Practices......................................................................................80 XII. Operating Room Structure .......................................................................................81 XIII. Surgical Site Preparation .........................................................................................81 XIV. Surgical Scrubbing...............................................................................................83 XV. Gowning and Gloving............................................................................................84 XVI. Draping and Maintaining Sterility................................................................................84 XVII. Patient Positioning ..............................................................................................84 XVIII. Surgical Technique .............................................................................................85 XIX. Maintenance of Sterile Field . .85 XX. Preparation and Processing of Surgical Instruments ..............................................................85 XXI. Postoperative Care . 89 XXII. Technology and Informatics ....................................................................................89 XXIII. Trends and Controversies.......................................................................................89 iv Orthopaedic Surgery Manual – 3rd Edition Chapter 7 - Bone and Tissue Grafts .....................................................91 Joseph A. Scaglione, BSN, RN, ONC, CTBS, RNFA, CNOR I. Introduction........................................................................................................92 II. Properties Related to Bone Grafting................................................................................92