Transcript Essential O.R. Awareness - The University of Texas at Dallas

Essential IONM
O.R. Awareness
For IONM Interns and Observing Students
By Diana Chen
Copyright © 2007 by Diana Chen. All rights reserved.
Ideal Candidates
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Observing students:
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Should have successfully completed IONM Part 1
past Mid-term exams.
Intern
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Should have successfully completed Functional
Human NeuroAnatomy, IONM Part I and/or Part II.
Attire
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Change in locker room:
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Before O.R. entry must wear mask with shield
(unless eye glasses are worn)
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Scrubs (shirt-pant set) will be provided
Shoe covers, place over sneakers
Hair cap, conceal all hair strands
Wash your hands well
Bring a combination lock, if desire
Interns: also wear gloves in O.R.
Must wear lead apron if C-arm present, or stand
behind someone who is.
Introduction
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Observing Students and Interns:
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Must call Head Surgical Nurse 30-60 min. prior to surgery
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After getting dressed check-in at the Nurses Station
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Write your name and Surgeon you will observe
Upon entering O.R. must introduce yourself to Circulating
Nurse as “student with NeuroTrend”
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Patient must approve of your presence
Staff awareness
Finally Introduce yourself to NeuroTrend Technologist
Environment Zone
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Observing students: Semi-restricted zone
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Must wear full scrub attire and mask
Permitted 5 feet away from Patient and 3 feet away from
Sterile tables.
Interns: Restricted zone
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Full scrub attire, mask and gloves
Work permitted near (>12 inches) sterile setup
If Sterile Surgical group begins to approach Patient zone,
Intern must allow Tech to resume, if further work is to be
done.
Sterile Equipment
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Tables with blue sheets
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Any Instrument with transparent plastic
covering, for example:
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Trays on top contain sterile items
C-arm
Microscope
Anesthesiologists Table
Patients bed/linens
Access Revoked
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Observing students and Interns know that you could
be asked to leave by:
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Head Nurse
Circulating Nurse
Surgical Team
Causes:
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Entering without proper attire, must have mask on
Disturbing interruptions
Crossing any prohibited zones
Doing anything you are not there to do, unless asked by
any of the above persons or the Technologist.
Persons in O.R. during Surgery
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Surgical Team
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Surgeon
Physician’s Assistant
Scrub Nurse
Anesthesilogist
IONM Technologist (and you)
Circulating Nurse
Radiologist
Brain Imaging Specialist, if needed
Hardware Representative
Basic IONM tools
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Surface and/or Needle electrodes
3M Tape
Pods for leads (# depends on case need)
Stimulators (depends on case need)
Pre-amp box
Junction box
Internet connection/PC
Printer, if not electrically stored
Folding table
Basic Surgical tools
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Cutting
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Scalpels
Scissors
Bone cutters
Powered drills
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Tissue forceps
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Hemostats; control bleeding
Crushing
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Artery clamp
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Irrigating (always cold)
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Monopolar
Bipolar
Suturing
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Skull clamp
Non-crushing Vascular Clamps
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Electrocautery (hand held or
foot pedal) Low Voltage heat
produces very fast, result
vaporized tissue. Hi Voltage
pulse AC current, heat
produces slower, causes blood
coagulation
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Clamping
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Exposing and Retracting
Grasping
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Internal staplers
Skin staplers
Viewing
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Microscope with Monitor
Common IONM Modalities
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SSEP
MEP
BAER
EMG (free run and triggered)
EEG
TceMEP
Spinal Cord Nerves and their Innervated
Muscles
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C3-C4; Trapezius (neck muscles)
C4-C5; Rhomboids (diaphragm)
C5-C6; Biceps and Deltoid
C7-C8; Triceps and long muscles of forearm
C8-T1; Abductor Pollicis Brevis, First Dorsal
Interosseous (fine hand movements)
L1-L2; Iliopsoas (flexors of thigh)
L3-L4; Vastus Lateralis
L4-L5; Anterior Tibialis
L5-S1; Gluteus Maximus, Hamstring
S1-S2; Gastrocnemius (plantar flexors of ankle)
S2-S4; Anal Sphincter
Supplementary info
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Nerves vs. Vertebrae
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Cranial 8:7
Thoracic 12:12
Lumbar 5:5
Sacral 5:5
Coccyx 1:4
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Sensory & Motor
innervation of reflexes
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Bicep reflex; C5, C6
Brachioradialis reflex; C6
Tricep reflex; C7
Finger reflexes; C8
Knee reflex; L3, L4
Adductor reflex; L2
Cremasteric reflex; L1,L2
Plantar reflex; L5
Ankle reflex; S1
Anal reflex; S4, S5
SSEP Nearfield/Farfield (NF/FF)
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Median/Ulnar
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EP: NF, peripheral nerve
N13: NF, stationary
record ref., cervical
P14: FF, subcortical
N18: FF, subcortical
N20: NF, cortical
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Tibial/Peroneal
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PF: NF, peripheral nerve
N34: FF, subcortical
record ref. from Fpz
P37: FF, cortical
IONM Basics
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Stimulating electrodes placed close to
nerves:
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(-) Cathode: black; active
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(+) Anode: red
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Depolarizes in one direction, away from anode
Placed 3 cm distal to cathode
Ground: green
Recording electrodes
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From nerves
From brain waves
For Your Use
Student Obligation Part I
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Visit www.ASET.org Each student
participating must read and understand the
following competencies:
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National Competencies for Performing
Intraoperative Physiological Monitoring
ASET Position Statement on
Electroneurodiagnostic Technologists in the
Operating Room
The Role of Electrodiagnostic Technologists in the
Operating Room
Student Obligation Part II
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HIPPA (Health Insurance Portability and Accountability Act)
Regulations Each student participating must understand this regulation
is the Law.
Highly summarized:
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Patient information is not to be discussed in the presence of anyone that is
not in the O.R. and even then Patient name should not be used in the
conversation ever!
Patient record should never leave the users location.
Do not ever write down or exchange any Patient Identification data.
Pre and Post surgery do not discuss a surgery case in ear shot of family
members or public persons period.
Violators of the Law go to JAIL! For more detailed information visit:
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http://www.hipaaps.com/what.html
http://www.hhs.gov/ocr/hipaa/finalreg.html
Signature of Compliance
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Before entering any Hospital we will need you to
sign a Student Obligation’s Checklist indicating you
agree and understand all items on the checklist.
Turn the form in, in exchange for scrubs.
If your going to be absent for your appointed date,
please email in advance or call Diana Chen.
Thank you for your interest