Ambulatory Anorectal Surgery by Michael Lavan R.N., Judy Swanson R.N., Andrea Ferrara M.D.

By Michael Lavan R.N., Judy Swanson R.N., Andrea Ferrara M.D. (auth.), H. Randolph Bailey M.D., Michael J. Snyder M.D. (eds.)

Ambulatory Anorectal Surgery is a basic reference on all facets of office-based anorectal surgical procedure for practising common surgeons and surgeons in education. Well-illustrated, this sensible handbook exhibits step by step methods for: - Hemorroidectomy - fix of anal fissures - maintenance of Fistula in-ano - Colonoscopy - Pilondial cyst. The textual content comprises ancillary issues of ambulatory surgical procedure with well timed chapters on set-up of the ability, anesthesic concerns, number of sufferers, pre-op and post-op administration, nursing facets, and coding and billing. A needs to for all normal surgeons.

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In the manual cleaning stage, the scope is cleaned by wiping the outside of the scope and brushing all working channels until no visible debris can be identified. It is very important to leak test the coIonoscope before it is immersed in any liquid. Leak testing is done according to the manufacturer's instructions. This step is critical and must be done properly to avoid repairs that are made costlier by exposure of the electrical components of the scope to liquid by immersing a leaking scope. If the scope has passed the leak testing phase, it is then immersed in solution to aid in the cleaning process.

Also, should any fluids need to be given during the procedure, an intravenous line is readily available. The cost of the intravenous catheter plus the bag of intravenous fluid is comparable to the multiple small vials of normal saline used for flushing the medications into the vein. After any premedications, such as intravenous antibiotics, have been given, the patient is transported to the procedure room. A sturdy cloth pad or draw sheet on the stretcher may be useful for repositioning a sleepy patient during the procedure.

One should refer to the accessory manufacturer's literature before autoclaving any endoscope accessory. After exposure to the disinfectant is completed, the scope must be adequately rinsed with water to avoid exposing the patient to any remaining disinfectant. This is accomplished automatically in the automatic processors. All working channels and surfaces are exposed to this rinsing. Sterile water is ideal but not usually practical in the gastroenterology setting. In cases where a soaking pan has been used, another pan with clean water is used to rinse the outside of the scope while an all-channel irrigator rinses the working channels.

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