Intraoperative (Intraop) Complications
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Outline
Overview
- Intraoperative complications
- Issues that occur during surgical procedure
- Key to decreasing risk
- Know
- Possible complications
- Actions to prevent
- Know
- Examples
- Issues related to
- Positioning
- Fluid imbalance
- Perioperative hypothermia
- Anesthesia
- Surgical errors
- Issues related to
Nursing Points
General
- Positioning injuries
- Due to
- Improper positioning
- Inadequate padding
- Lack of positioning devices
- Can result in
- Shearing
- Pressure injuries
- Nerve injury
- Various parts of body
- Deep vein thrombosis (DVT)
- Due to
- Impaired tissue/skin integrity
- Due to
- Prolonged moisture on skin
- Prep
- Perspiration
- Blood
- Surgical irrigation solutions
- Urine/feces
- Prolonged moisture on skin
- Can result in
- Tissue breakdown
- Due to
- Fluid imbalance
- Due to
- Excessive blood loss
- Urine output issues
- Fluid shifts
- Preoperative NPO status
- Stress response of surgery
- Can result in
- Hypovolemia
- Need for blood products
- Electrolyte disturbances
- Hypovolemia
- Due to
- Anesthesia complications
- Malignant hyperthermia
- Due to
- Anesthesia medication reactions
- Can result in
- Patient death
- Due to
- Respiratory complications
- Due to
- Loss of reflexes
- Can result in
- Aspiration
- Due to
- Malignant hyperthermia
- Perioperative hypothermia
- Due to
- Wet/cold prepping agents
- Anesthesia
- Exposure of skin/organs
- Cold OR environment
- Use of cold IV/irrigation solutions
- Extremes in ages
- Blood/fluid loss
- Can result in
- Patient discomfort
- Shivering
- Platelet dysfunction
- Coagulopathy
- Increased vasoconstriction
- Increased risk of infection
- Extended PACU stay
- Patient discomfort
- Due to
- Surgical errors
- Due to
- Wrong procedure
- Wrong site
- Retained surgical item
- Can result in
- Sentinel event
- Serious physical/psychological injury
- Death
- Sentinel event
- Due to
Assessment
- Assess
- Type of surgery
- Positioning needs
- Availability of positioning devices
- Length of procedure
- Warming devices
- Positioning needs
- Type of anesthesia
- History of reactions
- Patient
- Age
- Comorbidities
- Type of surgery
Nursing Concepts
- Safety
- Tissue/skin integrity
- Thermoregulation
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Transcript
Hey guys! I’m excited to talk to you a little about the complications that can occur to our patients during surgery!
So what are intraoperative complications? Basically guys these are issues that can occur not before or after but during the surgery. So our goal as perioperative nurses is to always keep our patients safe so with this in mind we are always looking to decrease intraoperative surgery complications. So the key to doing this is having an idea of what these common complications are and ways that we can prevent these issues, if there are any.
So guys listed here are some examples of intraoperative complications. These issues can be related to positioning, tissue and skin integrity, fluid imbalance, perioperative hypothermia, anesthesia reactions, and surgical errors.
Let’s take a look at positioning injuries. These injuries can be due to improper positioning or not maintaining proper body alignment of the patient, inadequate padding, and lack of or improper use of positioning devices. These issues can result in shearing, pressure issues, nerve injuries in various body parts especially extremities, and blood clots. Be sure to check out the lesson we have on intraoperative positioning for more details!
Ok guys so what about impaired tissue and skin integrity? These can occur in surgery because of prolonged moisture on the skin of the patient. This can be a result of the patient perspiring, pooling of the prepping or cleaning agents used on the skin. Impaired skin integrity can also occur if the patient ends up laying in blood or irrigation solutions that are used during surgery. In addition guys sometimes anesthesia can cause a patient to lose control of their bladder or bowels so this may result in the patient urinating during the procedure if a catheter is not requested. Guys it is important to be cognizant of these things as they can all result in tissue breakdown if it is not recognized in a timely manner.
Ok so remember anesthesia is a big deal with surgery. It is obviously an amazing thing because it allows our patients to withstand surgery without pain but there also can be some intraoperative complications associated with it. What are these? So one of them is malignant hyperthermia, an issue that can occur to certain patients because of anesthesia medications. If this complication isn’t recognized immediately it can be fatal to the patient. Guys check out the lesson we have specifically on malignant hyperthermia. Also guys with general anesthesia there is a loss of reflexes which can create respiratory complications like aspriation during surgery. Check out the lesson we have specifically on preoperative nursing priorities and general anesthesia.
Ok perioperative hyporthermia is a big one to our surgical patients! So why does this occur? Well this can happen for various reasons including the fact that our prepping or cleaning agents are wet and cold, anesthesia can decrease a patient’s body temperature, during surgery there is a necessary exposure of the patient’s skin and organs, the OR environment is typically colder than is comfortable to patients, and there is often blood and fluid loss. What can happen to the patient because of perioperative hypothermia? Well guys this is a significant complication because there are a lot of negative consequences including platelet dysfunction, coagulopathy, increased vasoconstriction which can increase the risk of infection, discomfort to the patient, and increased stays in the PACU and even hospital.
Finally guys although as a surgical nurse it’s not fun to talk about the intraoperative complications or surgical errors on this slide but it is definitely necessary to bring attention here to prevent it from occurring! So what surgical errors am I speaking of? So a few intraoperative complications that can occur are wrong-site surgery, wrong-procedure surgery, or even a retained surgical item. So I just want you to know there are various checks and balances in place to prevent these complications from occurring and that is why it is so critical to follow them and not cut any corners. So these surgical errors can result in what we call “sentinel events” or events that cause serious physical or psychological injury to the patient or even death.
So when we are considering the possibility of intraoperative complications we can assess a few different things to help decrease the risk of these complications. So guys assess the type of surgery your patient is having including the positioning needs and also the length of the procedure to have available warming interventions. Also guys assess your patients surgical and anesthesia history to assess for any previous reactions and your patient’s age and comorbidities to provide patient-centered care. And finally assess that everyone is on the same page in reference to the right patient, right site, and right surgery. Check out the lesson on intraoperative nursing priorities for more detailed information.
Ok so what nursing concepts can we apply to intraoperative complications? Thermoregulation and tissue and skin integrity are a couple of complications that are associated with surgery. Recognizing what common complications are can increase the safety of our surgical patients.
Ok let’s look at some key points! Intraoperative complications are issues that occur during surgery. It is important to know what complications can occur to we can perform actions to reduce the risk. Positioning complications can occur due to positioning the patient poorly, inadequate padding which can lead to shearing, pressure and nerve injuries. Impaired skin and tissue integrity can occur due to excess moisture from perspiration, prep and blood pooling which can lead to tissue breakdown. Fluid imbalances can occur due to excessive blood loss and fluid shifts which result in hypovolemia and electrolyte imbalances. Anesthesia complications that can occur are related to malignant hyperthermia and aspiration which can be fatal to the patient. Perioperative hypothermia can result from a cold OR environment, blood loss, skin and organ exposure, which increases the risk of infection, coagulopathy, platelet dysfunction and discomfort. Surgical errors can occur with wrong site or wrong surgery procedures which is considered a sentinel event.
Okay guys I hope you enjoyed this lesson on intraoperative complications! Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!
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