Second OpinionsStraight local cases in ASC

Straight local cases in ASC

What are your practices when doing straight local cases in an outpatient OR? Is it your policy to start an IV, maintain an NPO status, and/or provide a monitor nurse? We are being challenged by a physician to do none of the above, and are interested to hear about other facilities' clinical practices.

Started by: Carol Hathaway (OR Manager/Supervisor) at October 23, 2014 (11:23 am)

Comments and Responses

 

What about an ASA 3 patient with A-fib, CAD, h/o acute MI, coronary atherosclerosis, hypothyroidism, s/p CABG, stented coronary artery at 2am on a Saturday without available anesthesia in the OR? I know this is an outpatient surgery forum...

Patricia Justice (Other) at November 3, 2019 (2:56 pm) [last edited on November 3, 2019 (2:59 pm)]

We do a lot of straight local cases. They only get monitored if they have cardiac problems such as arrhythmias. They never get IV's. We do most of our hand surgery wide awake without anesthesiologists; just lidocaine and epinephrine in the finger. This has now been shown to be safe.
Dentists have been giving lidocaine and epinephrine in their offices without monitoring for over 60 years with an extremely safe track record. Anyone reading this would have received lidocaine and epinephrine at their dentist and would not even think that monitoring was necessary there. It is just common sense.

Donald Lalonde (Other) at January 25, 2015 (8:47 pm)

We have quite a few local procedures. Patients intended for local anesthesia are assessed preop to determine if they meet selection criteria (are they a nervous Nellie or ASA 4 etc). We usually do not start an IV unless an antibiotic is ordered. All local patients are placed on a cardiac monitor and have rate, rhythm, NIBP, respirations, and SpO2 monitored every 5 - 15 minutes by an RN dedicated to monitoring the patient. After the procedure, the patient is assessed and discharged to self care when preoperative status is met and patient meets discharge criteria (usually just a couple of minutes in the room). If a problem comes up, we take the patient to the PACU and the surgeon is responsible to direct care.
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, has not had a plan for care, and has given consent for their care.

Karen Fariss (OR Manager/Supervisor) at October 23, 2014 (3:29 pm)

We do not required IV or NPO. The circulator monitors vitals every 15 minutes during the procedure and monitored in recovery for 20-30 minutes or until vitals are stable. We monitor O2 sats during the procedure as well. Local is all we do and no issues with TJC on our P&P's

L. King (Administrator/Director/Manager/Owner/Executive Officer) at October 23, 2014 (1:19 pm)

We do several local cases. No IV, No NPO. Patients are put in a gown, shoe covers, and hat and O2 sats are monitored. Circulator stays with until patient leaves OR area.

Lorraine G. (Administrator/Director/Manager/Owner/Executive Officer) at October 23, 2014 (1:19 pm)

We use saline locks on everyone. Had too many cases where anesthesia is called for and we have no IV access. Also a patient safety guideline for us.

M. SMITH (Director, Surgical Services/Director of Nursing) at October 23, 2014 (1:13 pm)

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.

Andy Beck (Administrator/Director/Manager/Owner/Exec. Officer) at October 23, 2014 (12:58 pm)

We do 10+ locals a day and we do exactly what JB noted above.

Martin Moskovitz (Medical Director/Chief Surgeon) at October 23, 2014 (12:56 pm)

We do many "local" cases. We do not require an IV or NPO. The circulator monitors vitals q 15 mins and we do monitor O2 sats.

J. Brallier (Director, Surgical Services/Director of Nursing) at October 23, 2014 (12:54 pm)

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