Hamstring tendon graft for anterior cruciate ligament reconstruction - Home Study Program

AORN Journal,  Oct, 2002  by Deborah M. Boni,  George E. Herriott

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OPERATING ROOM PREPARATION

Nursing staff members work cooperatively with the surgeon and anesthesia care provider to ensure efficient and complete OR setup so the patient has a positive surgical outcome. The nurse also interfaces with sales representatives to ensure availability of specialty supplies, if needed. The scrub person verifies that all supplies and instruments have been obtained and function correctly. The circulating nurse verifies that all videotaping equipment, including the printer for arthroscopic images, is in working order before the patient enters the room. The OR suite also should have a pneumatic tourniquet preset at 300 mm Hg or 10 mm Hg higher than the patient's systolic pressure. A well-padded leg holder for the nonsurgical leg, such as a low lithotomy stirrup, is needed to prevent unnecessary pressure on muscles and bony prominences.

A fluid infusion pump is used to provide distention of the surgical knee during the procedure. Two 3-L bags of normal saline solution are hung from the fluid pump. A large back table is used for basic orthopedic and arthroscopic instruments (Table 2). The grafting instruments, such as the graft preparation board, endoscopic ligament button holder, and vein strippers are placed on a separate, small back table that the surgeon or assistant uses to prepare the hamstring tendon graft.

INTRAOPERATIVE PATIENT CARE

After the circulating nurse checks the patient into the OR suite, OR team members cooperatively double check the informed consent form and ensure that the patient has identified the surgical knee by initialing it. When all team members are in agreement, the anesthesia care provider administers the anesthetic agent. The anesthesia care provider either anesthetizes the patient using an endotracheal tube and general anesthesia or places an epidural catheter and administers a regional anesthetic. The circulating nurse, anesthesia care provider, and surgeon reposition the patient so that the popliteal space is approximately 2 inches beyond the break in the OR bed. The foot of the bed then is lowered. The surgeon applies a tourniquet cuff to the upper thigh of the patient's surgical leg and places the surgical leg in an arthroscopic leg holder. The circulating nurse places the nonsurgical leg in a well padded low lithotomy stirrup, ensuring that there is no undue pressure on the calf and peroneal nerve. After the circulating nurse pads and secures the patient's nonsurgical leg, he or she assesses the patient's pedal pulses.

While the circulating nurse, surgeon, and assistant are positioning the patient, the scrub person prepares the larger back table for the arthroscopic and reconstruction portions of the procedure and the hamstring tendon harvest and a smaller back table for assembly and preparation of the hamstring tendon. The circulating nurse shaves the patient's surgical leg from 3 inches to 4 inches above the knee to 4 inches below the patella, laterally and medially. The circulating nurse cleanses the patient's leg with povidoneiodine scrub and paint solutions circumferentially from the thigh to the toes. After the surgeon scrubs, gowns, and gloves, he or she and the scrub person drape the patient for a standard knee arthroscopy. The drapes include a plastic U-shaped drape that is placed around the patient's surgical leg and a lower extremity drape. A smaller drape, such as a half sheet, may be placed over the nonsurgical leg.