701 HAND CASES - BASIC SETUP

includes the following: GANGLION WRIST, GANGLION FINGER, CARPAL TUNNEL RELEASE, TRIGGER FINGER RELEASE, DUPUYTRENS EXCISION, CMC ARTHROPLASTY, FLEXOR OR EXTENSOR TENDON REPAIR - items in black pull for every case, items in grey for some cases


 

OPERATIVE TIME: 30-60 minutes

FREQUENCY: 20-30/year

ASSISTANT: no

USUAL LOCATIONS: Mainly Pres Day, NMO, Pres Main

 

ANESTHESIA NOTES

IV regional, double tourniquet upper arm or single tourniquet forearm, Kefzol 1gm IV before tourniquet goes up

PATIENT POSITION | SETUP

On stretcher, with eye protection, tube gauze under tourniquet, 1000 drape

TABLE POSITION

Rotate stretcher 90°

ROOM SETUP

Arm table, [2] pump-up chairs

 

EQUIPMENT

□Arm table

□tourniquet box set to 250 or 275 mmHg

□tourniquet double or single cuff 18", 24"

□3" stockinette under tourniquet

□Orthoglass splint cart as needed

SPECIALS

Mini OEC, Stryker power and sagittal saw for CMC arthroplasty

PREP

CHG prep set for all hand cases, take off tape, keep IV in

DRAPING

Basic pack, mayo cover, [1] 3/4 sheet, [2] half sheets,

large impervious stockinette

CAUTERY

Mentor or Xomed small bipolar cautery unit set to 60, pedal next to bed, bipolar cord, disposable green bipolar forceps

SUCTION

none

 

SOLUTIONS | IRRIGATION

Kefzol irrigation, water

LOCAL ANESTHETIC

0.5% Marcaine for IV regional or general anesthesia;

for MAC mix 0.5% Marcaine with 2% Lidocaine with epi 50:50

NEEDLES | SYRINGES

1 ½" 25g needle, 10cc syringe

MEDICATIONS

□Kefzol

□Bacitracin ointment 2 oz

 

SETS TO OPEN

Hand set, special plastic

INSTRUMENTS USED (keep on back table) - varies with specific procedure - see below

     FORCEPS

Dissecting Adson, Smooth gold Adson, 03 Adson, 05 Adson, rat tooth

     SCISSORS

curved Stevens, straight Stevens, Metz

     NEEDLE HOLDERS

Webster, Crile Wood, Mayo Hagar

     RETRACTORS

Senn, Ragnell, Weitlaner, finger, large Senn, double skin hooks

     KNIFE | BLADES

[2] No. 15

     OTHER

Lead hand, osteotome, rongeur small and large, [2] small right angle clamps

 

STERILE SUPPLIES

1000 drape, large impervious stockinette, disposable green bipolar forceps and cord, blue bulb syringe, marking pen

SPONGES

Raytec

NON-STERILE SUPPLIES

Orthoglass splint

 

SUTURES

No

Type

SN

status

 

[ ]

4-0 Nylon PC-3

  

 

hold

[ ]

5-0 Nylon PC-3

 

 

hold

[ ]

4-0 Vicryl P3

 

 

hold

[ ]

5-0 Vicryl P3

 

 

hold

[ ]

3-0 Vicryl SH

 

 

hold

[ ]

2-0 Ethibond RB-1

 

 

hold

[ ]

4-0 Ethibond RB-1

 

 

hold

 

DRAINS

none (except Dupuytrens)

DRESSINGS

Bacitacin, small Adaptic 3x3, 4x4 gauze, 2" or 3" Kling, 3" Orthoglass splint cut to length, 3" Ace






 

NOTES ON SPECIFIC CASES

GANGLION WRIST

 ICD9CM - 727.41

CPT - 25111

Double tourniquet upper arm, lead hand,,

smooth adson, Senn, Ragnell,

3" kling, 3" ace, 3" ortholglass splint

5-0 Vicryl P3

GANGLION FINGER

ICD9CM - 727.42

CPT- 26160

Single tourniquet forearm, Lead hand, 3

2" Kling, 1" Coban, no splint

5-0 or 4-0 Nylon PC-

CARPAL TUNNEL RELEASE ICD9CM - 354.0

CPT - 64721

Double tourniquet upper arm, Weitlaner, Metz, Senn

Lead hand,

4-0 Nylon PC-3

TRIGGER FINGER RELEASE ICD9CM - 727.03

CPT - 26055

single tourniquet on forearm, Lead hand,

2" Kling, 1" Coban, no splint

5-0 or 4-0 Nylon PC-3 (ask)

DUPUYTRENS RELEASE

ICD9CM - 728.6

CPT - 26123

Double tourniquet upper arm, Fluid warmer, headlight, Telfa pad, [2] Raytex, 4" Esmarch, Lead hand, blue vessel loop drains (do not open),

[2-4] 4-0 Nylon PC-3

TENDON REPAIR

ICD9CM - 883.2

CPT - 26356

Lead hand, [2] 22g needles

4-0 Nylon PC3, 4-0 Ethibond RB1, 5-0 Prolene RB1

CMC ARTHROPLASTY

ICD9CM - 715.14

CPT - 25447

Mini OEC and drape, Stryker sagittal saw, ½" blade

Rongeurs, osteotomes, right angle clamps, Metz, rat tooth

[3] Kerlix, orthoglass

3-0 Vicryl SH, 2-0 Ethibond RB-1, 5-0 Vicryl P3

 

POSTOPERATIVE

Put arm on pillow, sling in PACU

DATES MODIFIED

March 2006, October 2007