Six Surface Disinfection Concepts
The puzzle of superior surface disinfection is never solved....
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By: John Kelly, IV
Published: 11/3/2015
Bleeding is part of a surgeon's world. We fear it and do whatever we can to avoid it. As a shoulder arthroscopist, even the slightest amount of oozing can make a routine case turn into Nightmare on Elm Street. Who's to blame for bleeding problems in the OR? Patients, anesthesiologists and surgeons can all contribute.
Well, 1 low-dose aspirin can transform a routine shoulder scope into a bloodbath. These oozers can be recognized by the diffuse punctate bleeding that peppers the surgical field. Despite the use of epinephrine in the irrigation bags, oozers morph the shoulder joint into the red tide. The only recourse for the surgeon is to increase the pump pressure to 1,000 atmospheres and work quickly.
Besides the aspirin/Plavix duo, another less celebrated bleeding inducer is fish oil. I had a patient who took so much fish oil with mercury that he could take his own temperature! In their quest to lower cholesterol, many well-meaning patients consume omega 3's without realizing their blood will become more slippery than a freshly mopped OR floor.
Add vitamin E, turmeric and garlic to the blood-thinning all-star list. Even ginger contains appreciable levels of salicylates! So much for adding spice to one's life. Excessive alcohol consumption can deplete vitamin K levels and may work better than warfarin in causing bleeding. Be wary of the patient who casually drinks, but has a dog named Coors.
Then there's lack of speed. If a surgeon spends 15 minutes simply getting into the shoulder joint, get reddy. If the surgeon is not quite familiar with anatomy, regularly visits well-vascularized areas and simply was unaware of a known venous plexus, call the Red Cross!
The swift and efficient win the day and negotiate even the most Plavix-laden shoulder. Thank God, all bleeding (usually) stops. I just wish it would never start.
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