Dear Members of the Quality Management Dept.,
Thank you for asking me to provide a response with additional information needed to complete your review of the issue of the case.
As to the indication for use of a previous surgical site for insertion of Veress needle this was chosen as this was the best site for the docking, and placement of the ports for the laparoscopic procedure to be completed. It is important to note that this was a previous laparoscopic incision site, i.e. a site of a 10 millimeters trocar. Thus in my experience of more than 25 years of performing laparoscopy surgery I have consistently used a previous laparoscopic incision sites doing redo laparoscopic surgery. Over this time I estimate that I have put in approximately twenty-thousand trocars for the thousands of patients that I operate on. It is rare to see adhesions at previously laparoscopic port site and therefore it is our standard health practice. As way of note this was off the midline in the left upper quadrant so it adhere
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Finally, review of the literature reveals in a systematic literature review they recommended that the veress needle not be inserted in the midline. They also note that vascular injuries could be fatally if not recognize.
In addition, we were asked to come in an identify the number attempts made for the insertion of veress needle per protocol we were off the midline and at a previous laparoscopic incision site and we attempted three times each time with a negative water drop test. Then we moved a little bit more lateral to a new incision site and at this time we attempted one time and were able to successfully place the veress needle and successfully do the water drop which indicated that the veress needle is free within the peritoneal cavity insufflation and place our additional
Then after threading a catheter through the needle, the anesthesiologist will withdraw the needle and leave the catheter i...
Venipuncture involves several important steps with which the medical assistant must be thoroughly familiar before attempting the procedure. (Proctor, D., Adams, A. (2014). Kinn’s the Medical Assistant: Applied Learning Approach, 12th Edition.). When Margaret was given the requisition form for Mr. James Brown. She
It is essential to make sure that the patient is fine once the procedure has been finished and prior to them leaving. If there have been no complications, then the patient will most likely be ok. Nevertheless make sure that the site has stopped bleeding and that they are not feeling faint. If there was any complications, for example, hitting an artery, haematoma or fainting, then make sure you follow the process for dealing with the complication and let the patient know what they need to do if any symptoms
Kelly, L.J., Young, B., & Ellis, G. (2013). The experiences of nurses who insert central venous access devices. British Journal of Nursing, 22(2), p. S4-S11).
Post-operative care includes checking the vital sings every four hours or more frequently as needed and reporting any abnormalities to the physician. Aggressive pain management as mentioned earlier is important in patients who have had a total knee replacement. There an accurate assessment of the patient’s pain level is the initial step in the management of pain in these patients. The patient should be advised to report if the pain goal is not been met. It is important for patients who have had a total knee replacement to ambulate early to prevent the formation of deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore the nurse with the advice of the surgeon and the physical therapy team has to assist the patient to start ambulating soon after the surgery. Also part of the nursing intervention to prevent DVT and PEs includes making sure that the patient is on chemical and mechanical prophylaxis. This will be discussed further in the complications section below. Indwelling Foley catheters are usually placed during a total knee replacement surgery. Part of the nursing intervention will also include making sure that the catheter is removed once it is no longer needed to prevent catheter associated urinary tract infection (CAUTI) (Parker
The needle is usually inserted into in a vein close to the elbow, the wrist, or placed on the back of the hand. IV infusion works effectively because gravity pushes the fluid down through the IV tubing into the patient's vein. The higher the bag is hung, the greater the gravitational pressure on the IV fluid to flow downward through the tubing. To get enough pressure for gravity to force the fluid into the vein at a constant rate, the IV bag needs to be hung high. So, all IV bags must be hung above the ...
There have been an incidents of prolonged hospital stay due to central line infections putting patients at risk for mortality, morbidity, and increase in medical cost. When central lines are placed at bedside or in interventional radiology, the inserter is required to document the steps and sterile procedure that took place in the electronic health record. Furthermore, with weekly and as needed dressing changes, nurses are required to use central line bundles and document what was used (ex: Chloraprep, biopatch, tegaderm, etc.) to track how the dressing was done. From these documented records, staff can gather data and measure the compliance of sterile procedure. Additionally, if a patient with a central line develops a fever without an unknown cause physician will order blood culture from the central line if catheter-related infection is suspected. If the test comes back positive, the team will initiate antibiotics immediately. By integrating electronic health records it can assist in CLABSI prevention strategies, raise the standard for best practices, and essentially reduce central line infections. With the quarterly results of CLABSI in our unit, CVC committee have re-educated the staff on appropriate dressing changes using sterile technique, transitioned to a different end
"It was the summer of 1969: Man took his first walk on the moon. Nearly 450,000 people gathered in upstate New York to witness the historic Woodstock concert. And Doris and Don Fisher opened the first Gap store in San Francisco" (Gapinc.com 2007). Today, Gap Inc. is one of the world's largest specialty retailers, with more than 3,100 stores and fiscal 2006 revenues of $15.9 billion. Gap Inc. operates four of the most recognized apparel brands in the world Gap, Banana Republic, Old Navy and Piperlime. Every day, Gap Inc. looks for new ways to connect with customers around the world, providing value to their shareholders and to make a positive contribution in the communities where Gap Inc. does business. Gap Inc brands have a simple, common purpose: "to make it easy for people to express their personal style" (Gapinc.com 2007). Gap Inc. constantly evolves each brand to better meet their customers' needs through innovative and inspiring design; through convenient and engaging store experiences; and by communicating with people in a way that connects to how consumers live, work and play. Gap Inc. involves total quality management through out policies and procedures. In the following information explains how Gap Inc. uses TQM (total quality management), what made Gap Inc. the way it is today, and implementations on total quality management.
administered to prevent clots and perhaps continues post-op. If such a patient is not given
First, you must obtain all of the necessary supplies: gloves, alcohol or Betadine preps, a tourniquet, tape, an appropriately sized IV catheter, a bag of IV solution, the IV tubing, and gauze pads. While obtaining the supplies, you should inform the patient that IV catheter placement is necessary, and why. Do not lie to the patient and tell him or her that it is a painless procedure. Instead, be honest with them and explain that the initial puncture feels like a sharp pinch on the skin and that the pain and discomfort associated with the IV placement is only temporary. You may find it helpful to demonstrate to the patient the amount of pain to expect by pinching the skin on the back of their hand. This is especially helpful for younger patients or patients who are more concrete in their thinking.
The three areas of the tutorial I notice that I am confident in, is Phlebotomy, part 1: Collection tutorials on Venipuncture Process 2, 3, and 4. The Venipuncture Process 2 tutorial explains step by step processes for performing a venipuncture is by identifying the patient, checking the order form and assembles equipment, washing your hands and putting on gloves. The Venipuncture Process 3 tutorial explains when locating a patient’s vein make sure you clean the puncture site, apply the tourniquet, and stabilize the vein without touching the area. The Venipuncture Process 4 tutorial explains after stabilizing the vein, remove the need’s cap and insert the needle at a 15 to 30-degree angle and insert the needle with the bevel facing up. I am
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...
After almost one hour of “tube procedure connections”, I got up to go to the restroom with an IV pole following my s...
MEMORANDUM To: Red Cross Board of Directors and Senior Executive Leadership Team From: Aziza Anderson, Director Blood Programs Subject: Strategic Quality Improvement Plan 2016 Date: May 11, 2016 Due to recent FDA warnings of potential criminal charges and the Red Cross’s Blood Program continuous failure to comply with mandated regulations, I have issued a strategic Continuous Quality Improvement Plan to improve the efficiency, quality, standards and compliance of all Blood Programs throughout the United States. Continuous Quality Improvement Plan and Input from Stakeholders
I have 10 years of experience completing Quality Assurance reviews and customer service for Embassy Management LLC. In this role, I maintained positive working relationships with personnel across the Embassy Company while conducting Quality Assurance reviews for various programs, which included Residential Supported Living/Community Protection, Licensed homes, Employment programs, and Employee files. During QA reviews of programs, I gathered data and compiled reports. Helped identify systemic issues and developed plan of actions. Updated review tools to ensure compliance with state regulations, laws, and external and internal company policies. I am proficient interviewing to gather information during reviews. My co-workers considered me an