Surgeons' Lounge: No IV, No NPO

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How Do You Handle Straight Local Cases?


local anesthesia RULES FOR LOCAL What are your clinical policies for patients receiving local anesthesia?

no IV, no npo
How Do You Handle Straight Local Cases?

What are your practices when doing straight local cases in your ORs? Do you start an IV, maintain NPO status and provide a monitor nurse?

"We do several local cases: No IV, no NPO," says Lorraine Gambol, manager of the Surgery Center of Chester County in suburban Philadelphia. "We put patients in a gown, shoe covers and a hat, and monitor their oxygen saturation. The circulator stays with patients until they leave the OR area."

At Rappahannock General Hospital in Kilmarnock, Va., they don't usually start an IV on a local procedure unless an antibiotic is ordered, says Perioperative Director Karen Fariss, RN. They place all local patients on a cardiac monitor and an RN dedicated to monitoring the patient monitors rate, rhythm, NIBP, respiration and SpO2 every 5 to 15 minutes, adds Ms. Fariss. "We do not routinely call anesthesia into a local case because that would be asking them to assume responsibility for a patient that they have not worked up," she adds.

A manager at a facility that does solely local cases doesn't start IVs or require patients to fast. "The circulator monitors vitals and oxygen saturation every 15 minutes during the procedure and in recovery for 20 to 30 minutes or until vitals are stable," she says.

"No IV unless antibiotics are needed. Always have a nurse dedicated to monitoring the patient. Most of our locals are in the afternoon at the end of a general line so we allow patients to eat a light breakfast but otherwise follow ASA NPO guidelines," says Andy Beck, RN, BSN, CAPA, director of surgical services at Providence Surgery Center in Missoula, Mont.

One facility says it uses saline locks on everyone. "We've had too many cases where anesthesia is called for and we have no IV access," says the administrator. "It's also a patient safety guideline for us."

— Dan O'Connor

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