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Spinal Fusion, Post-Op, Adolescent Idiopathic Scoliosis (AIS) — Intraoperative Considerations for OR Team — Clinical Pathway: Inpatient

Inpatient Clinical Pathway for Adolescent Idiopathic Scoliosis (AIS) Spinal Fusion Rapid Recovery — Inpatient

Intraoperative Considerations for OR Team

These guidelines guide nursing and support staff in the operating rooms to prepare for and manage AIS posterior spinal fusion surgeries.

Neuro-monitoring
  • Evaluate standard sensory and motor evoked potentials throughout case
  • Signals can be captured after positioning prone in otherwise healthy ambulatory adolescent
Infection Prevention
  • Limit traffic in/out of room
  • Instruments not opened until anesthesia induction near completion
    • Within 15 minutes of flipping prone
  • Implants open 1 hour before expected instrumentation
  • Dosing for Perioperative Antibiotics
  • Standard measures to prevent intraoperative surgical site infections
  • Surgical Site Infection (SSI)  , CDC and National Health Safety Network (NHSN) Definition
Surgical Skin Prep
  • Electric clipper if excessive hair
  • Chlorhexidine skin preparation
    • Full 3-minute dry time
  • Ioban™ drape
Spine Cavity Irrigation
  • Debride devitalized muscle
  • Wash with 3 L betadine + normal saline solution (NSS), then 3 L NSS
Drains and Wound Closure
  • Plastic surgery consult to close wound at surgeon's discretion
  • Large Jackson-Pratt® drains SubQ

 

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